Mr. C is a 39-year-old male with a history of schizoaffective disorder, traumatic brain injury (TBI), and borderline intellectual functioning, who presented to the ER complaining that he felt unsafe at home. Patient C was historically prescribed oral aripiprazole 2 mg daily. On arrival, he was afebrile, with HR 68, RR 18, and BP 127/83. CBC, CMP, and UA were unremarkable. UDS was positive for only THC. On psychiatric evaluation, the patient reported paranoid and bizarre delusions that someone was dissolving puppies in his bathtub at home with various chemicals. He had tried to involve the local and federal authorities and was encouraged by his minister to come to the hospital. The patient was perseverative on delusions and exhibited disorganization in speech, and was endorsing low mood and energy, poor sleep, and feelings of emptiness. He was disheveled with limited hygiene. The patient reported smoking Delta8-THC daily for 8 months, and self-discontinuation of his aripiprazole 4 months prior.
Per the family reports, though the patient has a TBI, he is the primary caretaker for his mother who has chronic medical issues. The family reports that the patient behaves appropriately when on his medications and does not mention delusions or display confusion throughout the day.
On the second day of admission, patient C was started on oral aripiprazole 2 mg, after he initially refused medication. He began to gain some insight that some of his delusions might not be true. After he was increased to aripiprazole 5 mg daily on the 3rd day of admission, he showed less perseveration on the delusions and was more future-oriented thinking about the need to help his mother around the house. On the 4th day of admission, he was discharged with instructions to increase his aripiprazole to 10 mg daily at home and follow up closely with his outpatient psychiatric provider, as well as to abstain from Delta8-THC products.
Patient C did not show up for his 3-week outpatient follow-up appointment but has left messages at the nurses' line stating similar delusions from his presentation to the hospital. He has not presented to the hospital again in the 3 months following discharge.