First-episode psychosis, schizophrenia spectrum, and knowing what real psychosis looks like.
3 cases
A 32-year-old man with schizophrenia has failed multiple adequate antipsychotic trials and continues to experience debilitating psychosis. This case explores the rationale, logistics, and clinical considerations involved in initiating clozapine for treatment-resistant schizophrenia.
A 20-year-old computer science major is brought to your clinic by his terrified parents. Over 4-5 months he's withdrawn, stopped showering, and failed his classes. Now he believes the WiFi is monitoring his thoughts and a stranger's voice is narrating his actions. This is what real psychosis looks like — the companion case to the PTSD veteran whose trauma re-experiencing was mistaken for psychosis.
A 24-year-old woman referred from a domestic violence shelter reports hearing a male voice telling her she's worthless. Sometimes it sounds like her childhood abuser — clearly trauma-linked. But sometimes it's a stranger narrating her actions in the third person — which doesn't fit trauma at all. She's paranoid about being followed, but she's also fleeing a violent partner. This case doesn't fit neatly into one box, and the correct clinical position is to sit with that uncertainty rather than force a premature diagnosis.
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