The nurse practitioner said she's not ruling out a psych referral/inpatient treatment at some point, but the first thing she wants to try is a higher dosage of the antipsychotic meds. She did tell him in no uncertain terms that he cannot have any kind of firearms.
The weird thing is that he really is oriented to person, time, and place and doesn't have marked memory issues. It's like he has a foot in 2 worlds -- he's totally aware of and rooted in the real world, but then he is *also* 100% sure the hallucinations are real and he interacts with them and wants to shoot them. My brother said (to me, not the NP) that if Dad were his patient, he'd diagnose him with schizoaffective disorder.
Dad insulted me during the appointment, calling me "interfering mother," and I almost lost my shit at him for that, because (1) he didn't throw a gendered insult at my brother for doing the same thing I was doing (ie, wrangling his health care); and (2) okay, fuck me for trying to help you, you enormous asshole.
Unsurprisingly, I got a migraine in the middle of the appointment. But CVS sorted out whatever weirdness was going on with my refills, so I have migraine meds and I'm going to go lay down with an ice pack on my head after I finish one short thing for work.