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About a year ago, Julio, a 22-year old Hispanic male was referred to a Community Mental Health Center from his primary physician after his parents mentioned to the physician that Julio had been acting “weird”. Julio kept on accusing his mother that she was putting something in his beverages that would make him want to reveal personal secrets to her. Julio stated that his mother could not deal with the fact that he had a private life. He went on to say that his mother was installing cameras and microphones in his bedroom. Julio said that he also hears voices telling him to “clear the place of bugs and other spying equipment” before he going to bed. Julio was admitted to the psychiatric unit once in the past year for severe symptoms. At that time, he was prescribed risperidone 4mg by mouth at bedtime. Julio lives with his mother and father in a 3-bedroom apartment. Since his hospital discharge, Julio has continued to experience psychotic symptoms. He does not take the risperidone as prescribed because he hates not having any erections. He spends most of the day watching television, playing video games, and smoking cigarettes. He does not engage in any social activity with friends. He thinks that anyone who wants to give him medications is conspiring to enter his room to install listening devices. Based on the information you have, please discuss the following questions. How does risperidone control psychotic symptoms relating to receptor binding and dopamine? How does risperidone cause erectile dysfunction? How would you manage Julio’s side effects? Would or could you consider a medication change? What would you suggest and why? How would you intervene with his smoking? What significance impact would smoking cessation have on medication treatment?

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