Management of the Psychotic Substance Using Patient

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Chris is a 21-year-old male who lives at home with his parents and is in his 3rd year of Engineering. He is currently on academic probation for poor attendance and failure to complete assignments. He is brought to see you in your office by his parents, due to complaints from neighbours that Chris has been leaving threatening messages in their mailboxes. Chris complains that he can hear his neighbours talking about him and believes that they have planted a video-camera in his home, as they comment on his every action. He has been hearing their voices for the past 3 weeks, but has had trouble organizing his thoughts for at least 3 months, leading to his declining academic performance. Over the past year he has been spending progressively more time alone at home, playing video games and writing about life and its meaning. He quit playing pickup hockey, and hasn't seen his friends for months. Chris started smoking cannabis at the age of 17, initially about once per month at parties, but in university his use increased to weekly. Six months ago he lost a part-time job in landscaping, and his use increased again to 1 gram daily. His last use was 2 weeks ago, when he stopped because he wondered if it was making him paranoid. Despite this, his beliefs about his neighbours have only intensified. He has no prior psychiatric history or family history of psychiatric illness. On mental status exam he is guarded with poor hygiene and blunted affect. He appears to be responding to voices and his thought form is tangential.

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