The parents of an 18-year-old high school student noticed their son becoming distracted, withdrawn, and increasingly worried about small and insignificant things. The young man was concerned about a car parked outside their home or the doorbell ringing. Interaction with his high school classmates was becoming strained, and his teachers noticed he was having difficulty concentrating on his schoolwork. His parents brought him to see René S. Kahn, MD, PhD, Chair of Psychiatry, an internationally renowned authority on the neurobiology of schizophrenia.
“When I first saw the patient, he didn’t show outward signs of psychosis. But there was some distracted behavior and he did not communicate well and sometimes smiled in a strange fashion. In short, he wasn’t behaving like a normal 18-year-old. Moreover, it was clear he had been paranoid at some point in time, at the very least overly suspicious,” said Dr. Kahn. “Although the symptoms were very mild, I still had to consider whether this young man could be developing schizophrenia.”
Dr. Kahn asked the young man and his parents to come back in several weeks. When the condition failed to improve over that period and after additional sessions with the patient and parents, Dr. Kahn determined the patient most likely had a mild form of psychosis, and he prescribed a very low dose of risperidone.
A return visit a few weeks later revealed the patient was becoming more relaxed, but still showed some suspiciousness, including unfounded worries about the safety of his parents. Dr. Kahn increased the dosage of the antipsychotic slightly to 1 mg at night and .5 mg in the morning. That regimen opened the door to a gradual improvement and, after three months, an elimination of the troubling symptoms. The patient’s turnaround was also apparent at school, where he began reconnecting with friends. He has remained stable over the past year, allowing Dr. Kahn to lower the medication.
“Even though the symptoms in this case were fairly minimal, it’s not hard to imagine how they could have progressed to much more advanced paranoia and delusional behavior or even full-blown schizophrenia if something concrete wasn’t done,” said Dr. Kahn. “As physicians, we can take only so much credit for turnarounds like these. The reality is that it’s up to the parents to pick up on early warning signs instead of ignoring them or sweeping them under the carpet—which so often happens—and seek the help of an experienced professional.”
René S. Kahn, MD, PhD
Esther and Joseph Klingenstein Professor and Chair of the Department of Psychiatry