This is for research purposes for a fiction novel. The patient is an 18 year old boy, physically healthy but with signs of personal neglect. He admits that he doesn’t always remember to eat and that he bathes infrequently. He wears gloves that he refuses to remove, and he fidgets anxiously with his hands. He claims to hear voices all around him almost constantly, talking to each other and talking to him, demanding his attention. He sees people who aren’t there, sometimes clearly and sometimes faintly or out of focus. He says that the gloves are to keep him from touching things, because when he touches things, he can feel their history and emotions and it overwhelms him. He claims to have had these symptoms his whole life, but says that they’ve become steadily worse over the last two or three years. He has not sought treatment until now because his mother refused to send him to therapy, claiming that there was nothing wrong with him.
During the session, he would frequently stop talking suddenly and seem to address someone not present, usually with anger. He can answer questions accurately—where he was born, what year it is, who the President is—but he has a lot of difficulty focusing. Overall, he seems tired. He says that he doesn’t think therapy will work and seems anxious to be prescribed something that will help him, but there is no indication that he has a history of drug abuse.
How would a patient like this be treated? Would therapy be attempted first to try to lessen his symptoms, or would he actually be prescribed something fairly quickly? What would be prescribed?
As he gets older, the medications won’t be very effective, and he will probably be eager to up his dosage of whatever his doctor felt was best, and he would be unlikely to report any bad side effects he experienced if he felt the medication was helping. What sort of side effects might he have, depending on which medication(s) he was on?