Saul Kahneman is a 42-year-old, single white male with a diagnosis of schizophrenia. His current symptoms include auditory hallucinations, disorganized speech, and diminished emotional expression. His father, David, brings Saul to the inpatient psychiatric unit for treatment. This is his third psychiatric admission two years. David explains, “Saul stopped taking his Seroquel and melatonin a week ago because he told us it just isn’t working anymore. Which his mom and I vehemently disagree with. But what can we do? He’s been responding to internal stimuli and talks to himself a lot. He says that he’s a celebrity spy and that the government has bugged our home. Saul thinks it’s his responsibility to debug our house and therefore stays awake for most parts of the night to design a rescue plan. I don’t understand half the things he tells me. It seems like a…a word salad I heard it called…and doesn’t make much sense.” When you, the psychiatric nurse practitioner, talk to Saul, he simply says, “The medication isn’t working anymore.” Vital signs: BP 148/72, HR 88, R 18, pulse ox 98% HT: 6’ 1” WT: 230 pounds Appearance: Unkempt, poor hygiene, dressed in several layers of clothing (current season is late spring, average temperature outside is 70 degrees) Blood work: A1C 6.2, total cholesterol 188 mg/dl, HDL 22 mg/dl, LDL 176 mg/dl Triglycerides: 148 mg All other lab results are within normal limits. Medications: Seroquel 400 mg BID for psychosis and melatonin 6 mg for sleep You know you will change Saul’s antipsychotic medication. Would you add any other medication or recommend the addition of another medication to address other symptoms Saul is having or any physical problems you are concerned about? Why or why not? Would you refer Saul to any other providers (such as primary care, psychotherapy, social worker, dietician, and so on)? Who would you refer Saul to and how or in what way would you expect this provider to assist in Saul’s treatment plan?