Patient History The patient ("K.R.") is a 27-year-old man who was diagnosed with schizophrenia at age 23, following an acute psychotic episode while in graduate school. During the initial stages of illness, the patient's most prominent symptoms were the acute positive psychotic symptoms of auditory and visual hallucinations, persecutory delusions, and sleep and behavioral disturbances. K.R. required hospitalization during this episode. As an undergraduate, the patient had been a successful student and athlete; however, he had been having difficulty with his graduate studies and felt that he had little in common with the other students. Treatment was started with risperidone during the hospitalization. K.R. returned to graduate school shortly thereafter, but decided to leave to pursue other interests. K.R. was stabilized on risperidone for almost 4 years. During this time, he was able to maintain a job and enjoy some outdoor activities, and he continued to live with his brother as he did when he was in school. However, during that time, K.R. gained about 20 lbs and was experiencing erectile dysfunction, which caused him to feel depressed. In addition, he required anticholinergic cotreatment for moderate muscle stiffness, as a lower dose of the risperidone insufficiently stabilized his psychotic symptoms. He used to go out for a beer with friends every once in a while but lately has been drinking more often by himself. He has also started smoking. K.R. lost 5 lbs recently, which he attributes to taking his medication "every once in a while," but some psychotic symptoms have reemerged. Progressive worsening of symptoms led to his most recent hospitalization. Schizophrenia and Relapse