This patient was admitted to a psychiatric inpatient unit in the middle of a second paranoid psychotic schizophrenia episode

Symptoms consisted mainly of paranoid- and guilt-based delusions, thought blocking, and mild negative symptoms

During his first psychotic break, he was released after successful inpatient treatment with haloperidol (Haldol) 10 mg/d

Despite this treatment, the symptoms increased to the point of requiring a second inpatient stay where an increase in haloperidol (20 mg/d) was ineffective

At this time, risperidone (Risperdal) was the only atypical antipsychotic available and he was switched and titrated to 6 mg/d with relief of psychosis, and discharged from the hospital

Over the next year while followed in an outpatient setting, he was noted to be very compliant with his medication and appointments

Family was supportive and involved in his care, and he wished to return to college to obtain an advanced degree

Things were going well clinically and psychosocially; discussions were begun about long-term treatment, the risk of TD, and what his wishes were if he began a third psychotic break

Unfortunately, the psychosis returned, and while an inpatient again