AccessAPN Case of the Month

Psych/Mental Health Case-of-the-Month: First Episode of Psychosis

J.T., a 20 y/o African American male who is a sophomore in college, was brought to the student health center by his roommate, who reported that J.T. had been acting "strangely" for several weeks and recently began talking to himself and expressing paranoid thoughts.

The roommate stated that J.T. claimed someone had implanted a chip in his brain and that he was being watched through the television. J.T. has stopped attending classes and isolates in his room. Symptoms began approximately 4 weeks ago with sleep disturbances, decreased appetite, and social withdrawal. J.T. began to speak less frequently, and when he did, his speech became increasingly disorganized. He now reports hearing voices and believes that unknown people are spying on him. J.T. stated,  “They’re watching me. I can hear them talk about me through the walls.”

No previous psychiatric diagnoses or treatment. No history of substance use, including alcohol, cannabis, or illicit drugs per self-report and roommate confirmation. No remarkable physical history. mother has a history of depression and a Maternal uncle with Schizophrenia

Questions:

1. Which of the following is a hallmark symptom of psychosis?
A. Elevated mood
B. Hallucinations
C. Obsessions
D. Amnesia

2. Which risk factor in J.T.'s history increases the likelihood of developing psychosis?
A. College stress
B. Family history of schizophrenia
C. Living in a dormitory
D. Being a sophomore

3. What is a key benefit of early intervention in first-episode psychosis?
A. Reduced medication needs permanently
B. Shorter hospital stay
C. Improved long-term functional outcomes
D. Prevents future depressive episodes

Answers:

1. B Hallucinations
Rationale: Hallucinations, especially auditory, are core features of psychosis.

2. B Family history of schizophrenia
Rationale: A genetic predisposition, especially a first-degree relative, significantly increases risk.

3. C Improved long-term functional outcomes
Rationale: Early and consistent treatment in first-episode psychosis improves prognosis.