hardfirst-episode psychosisrisperidonePANSScritical perioddose optimizationtreatment response
A 21-year-old male was diagnosed with first-episode psychosis eight weeks ago and started on risperidone 2 mg daily. At initial presentation, he exhibited persecutory delusions, auditory hallucinations, and disorganized speech with a PANSS total score of 92. At his current follow-up, his PANSS total score is 64, representing a 30% reduction. He reports the voices are quieter and less commanding but still present intermittently. His persecutory beliefs have diminished in intensity but he remains guarded and occasionally references neighbors monitoring him. He is attending a first-episode psychosis early intervention program and has returned to part-time work. His mother reports he is sleeping and eating better but still isolates in his room most evenings. Metabolic labs and ECG are within normal limits. The PMHNP is evaluating the adequacy of this treatment response. Which of the following best represents the appropriate evaluation of this patient's trajectory?