For this patient and his current health status, it is necessary to examine the different
factors associated with his current medications, Seroquel and Melatonin. Specifically, 400 mg BID is no longer an option for this patient and his stoppage of the medication without a doctor’s approval is also problematic. However, Seroquel also has numerous side effects which can be problematic for a patient that include suicidal thoughts, increased anxiety or depression, panic attacks, difficulty sleeping, and other mood changes; therefore, this medication may not be the best option and other alternatives should be considered to ensure that the patient’s symptoms are under control and he experiences some degree of regularity that will promote calm and alleviate some of his symptoms (FDA.gov, 2018).

An alternative medication to Seroquel to consider is Risperdal, a traditional antipsychotic
which is known as a common treatment for schizophrenia; this medication should be prescribed because the patient is experiencing agitation, hallucinations, and other symptoms, 4 mg orally once daily is recommended to begin with and the dosage will be adjusted as necessary for the patient so that control over his condition can improve (RxList, 2009). However, some of the most common side effects should be considered and include neuromuscular responses that include motor restlessness as well as insomnia, neck spasms, and other complications in some patients (RxList, 2009). The patient should be monitored very closely with any type of medication adjustment to ensure that he does not have additional symptoms which could be problematic and cause harm over time.

For this patient, it is not recommended that he should be prescribed an additional medication
to treat his schizophrenia condition because the side effects and counterindications of antipsychotic medications are too high and may pose additional risk for the patient beyond what he is already experiencing. Therefore, it is only recommended that he take one antipsychotic to determine how he responds to this medication and only after a period of monitoring, determine if a different medication may be required. Careful monitoring of the patient once he begins taking risperidone is necessary because this medication involves numerous potential side effects for which the patient must be evaluated routinely. If the patient was prescribed two antipsychotic medications at once, it could exacerbate his current symptoms and cause additional harm and he is already in a highly vulnerable position.

Based upon the patient’s current health profile and the side effects associated with Seroquel,
Risperdal is a recommended alternative which has been proven effective in prior research studies. Specifically, Subotnik et al. (2015) noted that a longer-acting version of risperidone (Risperdal) can have a greater impact on patients with schizophrenia because they are not required to address medication adherence daily with an already complicated mental health profile. In addition, patients with a history of medication non-adherence may benefit from injectable administration and are likely to have greater control over their symptoms with this option (Subotnik et al., 2015). Due to the general difficulties associated with schizophrenia, medications are necessary to alleviate symptoms; furthermore, Nemeth et al. (2017) recognized that risperidone can have a positive impact on patients with the disease despite its side effects and requires routine monitoring to improve symptom management. One of the advantages of using risperidone is to improve health-related quality of life (HRQoL) in patients with schizophrenia and enable them to experience improvements in their daily living (Isitt, Nadipelli, Kouassi, Fava, & Heidbreder, 2016). A study by Niolu et al. (2015) offers similar insight to demonstrate that quality of life can improve with the use of risperidone as directed.

To ensure that Saul understands that it is very important to take his medications as directed,
providing an explanation regarding his symptoms and how they might be alleviated with this medication is a positive step forward. At the same time, the patient should also be aware of the different side effects that may occur with this medication as well as the level of patience that is necessary because the patient may not notice an immediate improvement. Education for this patient should be provided as necessary but it may be difficult for the patient to understand the challenges of the situation and how he can improve his health. For example, he may be fearful of taking a new medication that may or may not aid his condition and instead cause additional harm; therefore, understanding the symptoms and possible side effects due to a change in medication is necessary so that Saul can prepare himself for any changes that he might experience with the new medication.

For this patient, it is not standard practice to conduct blood testing as a diagnostic tool for
schizophrenia; however, other mechanisms are appropriate such as a health history and psychiatric evaluation which will determine if the patient is responding to the prescribed medication and if there are any other complications that may arise with the patient that could further compromise his health.

This patient would benefit from a visit to a primary care physician to evaluate other issues
which affect his health that include his weight and A1C level, both of which are elevated. It is possible that with clinical guidance, the patient can address health-related concerns which affect his physical health and most likely impact his mental health status. These tools require physicians with knowledge of the disorder and some of the most common complications that are present.