Schizophrenia case study

SCHIZOPHRENIA CASE STUDY 8

Schizophreniacase study

Institutions:

Schizophreniacase study

Demographics

A47 year old African American with a history of schizophrenia and HIVperson admitted for his disorderly and confrontational behavior. Hehas not been on medication for seven months. He does not have a joband depends on his wife. He is a Muslim and is fluent in English andArabic.

ChiefComplaint

“Idon’t know who brought me here while I should be in my home”. Thepatient is in this asylum facility after being brought by hisrelative due to his assaultive and temperamental behavior.

Historyof the present illness:

Thepatient is not aware of what happened before his admission to thisfacility. He argues that he had previously been diagnosed withSchizophrenia and that he has been in a good state of mind for closeto a year after he was treated for the condition. Before he wasadmitted to this facility, the patient was forced in by his relativesafter he tried to sexually assault a minor in broad day light. Hisrelatives took him and brought him here for treatment. During theinterview, the patient appears much confused than before. Heconsiders this facility a prison and sees no reason for being here.He argues that he had been admitted before but nothing much came outof it. He therefore believes that his stay is unnecessary as it willno impact on his health.

Acall to his wife reveals that the patient has been quite paranoid forthe better part of the year. She admits that she has known thepatient for the last 14 years and that his condition is worse thanever. She reports that patient has avoided his medication statingthat he is not a “mad man” to take medicine.

Psychiatrichistory:

Thepatient’s partner states that he was diagnosed with the conditionduring his late teenage period and that he had been in hospital threetimes. The wife also reports that he been to a psychiatric facilityafterwards but cannot recall the exact date. He was also enrolled inan outpatient care in 2010 but later pulled out after eightcontinuous months. He was mostly given Seroquel during the treatmentperiod but would report no benefit for such scheme. The patient alsoreports that he has previously used Lithium and Haldol, both of whichwere not very effective.

Medicalhistory:

Itwas in 1996 when the patient learnt about his HIV status. He admitsthat he had previously engaged in unsafe sex before his diagnosis.Currently, the patient is under a clinic program forantic-retroviral. However, the patient has not been consistent in theuptake. The patient does not however have a clear history his ofmedical condition. He manages to identify the following symptom: lunginfections, lesions on the skin, and thrush. He does provide anyother detail about his HIV status.

Developmentalhistory

Informationconcerning the patient was obtained from his parent and the birth andschool history. No problem was encountered during her mother’spregnancy. The patient developmental stage was normal just like otherchildren of his age. His parents reported that the patient was quitehyperactive and restless during his childhood. His performance inschool was just average but he experienced a lot of challenges duringhis 12thgrade where he had difficulty in mathematics and sciences. Theparents also reported that the patient was quite a social personuntil he was 18 years of age before a problemsetin.

Substanceuse history

Thepatient has a history of drug abuse whereby he has been takingalcohol and marihuana. He admitted to having being taking marihuanafor the last two months prior to his admission. However, he onlytakes alcohol in moderation and has since stopped using marihuana.

Substance

1st

use/amount

Period of

heaviest use/amount

Method of use

Last/current

use/amount

Amphetamines

N/A

Bath salts

N/A

Benzodiazepines

N/A

Caffeine

300 ml

Morning

Drinking

300ml

Crystal Meth

Ectasy

Energy drinks

Heroin

Marijuana

Smoking

One stick per day

Methadone

Narcotics(specify)

Nicotine

Four sticks per da day

PCP/Acid

Spice

Other(specify)

Personalhistory

Thepatient resides with his wife. He is currently not in any form ofemployment. Other details about his education and work history arenot known. The wife also reports that the patient has been consumingalcohol but in little amount. In addition, the patient reportedhaving smoked bhang sometimes back. He however does not give anyinformation any other drug abuse.

Familyhistory

Thepatient’s problem can be traced back to his family history wherebyhis grandfather also experienced the problem. His father alsoexperienced schizophrenia problem in his early 20’s but was latercured of the problem.

Mentalstatus exam:

Thepatient has a problem cooperating during the interview and has to beredirected back to the same questions. Poor grooming is acharacteristic which comes out quite clearly. The patient’s speechis normal and does not show any sign of distress. At the beginning ofthe interview, the tone of the patient was quite low but improvedwith time.

Thought:thepatient demonstrates a clear lack of attention during the interviewand has to be guided in order to answer the questions accordingly.This shows that he can still go back to normal after a period ofmedication(World Psychiatric Association, 2010).Article Grade: FA

Suicidaltendency: Thepatient denies any previous attempt.

Physicalexam:

Thepatient has a height of 5 Ft 6” and weighs 58 Kgs. He has astraight gait and walks normal.

Differentialdiagnosis

-Schizoaffectivedisorder

-Alcohol-relateddisorder

-Cannabispsychosis – this has been shown to be quite prevalent in people whoconsume marihuana (Stone,Raffin, Morrison, &amp McGuire, 2010). Article Grade: GA

-Schizophrenia

-AIDS

Plan

Iwill try to find out much information about the patient psychiatrichistory from the mental facilities that he visited last. I willcooperate with the medical service team to assist the patient withhis medical issue especially on HIV. With the consent from thepatient, I will prescribe quetiapine which should be taken before hesleeps (National Collaborating Centre for Mental Health, 2009). Thisis informed by the patient’s previous partial use of the drug whichproved effective. I will observe its effect on the patient anddevelop another strategy if no improvement is made(Kristensen &amp Myatt, 2011).ArticleGrade: FA

Culturalaccommodations

Iwill advise the patient to refrain from using marihuana and any otherdrug which may increase the psychotic symptoms but will only allowhim to smoke cigarette. Cannabis is a very dangerous drug especiallyon a person with psychotic history(D’Souza, Sewell, &amp Ranganathan, 2009).Article Grade: FA

Medications

Quetiapine100mgs per day (Tandon,Belmaker, &amp Gattaz, 2009). This has been shown to be quiteeffective in the reduction of alcohol related psychosis. ArticleGrade: FA

Dischargeplanning/ follow up

Iwill prescribe antipsychotic and mood depressors including Geodon tobe taken once per day(Stone, Raffin, Morrison &amp McGuire, 2010).Article grade: GA

References

D’Souza,D. C., Sewell, R. A., &amp Ranganathan, M. (2009). Cannabis andpsychosis/schizophrenia: human studies. Europeanarchives of psychiatry and clinical neuroscience,259(7),413-431.

Kristensen,D., &amp Myatt, M. W. (2011). Treatment of schizophrenia. DrugDiscovery Today: Therapeutic Strategies,8(1),1-2.

NationalCollaborating Centre for Mental Health (UK. (2009). Schizophrenia:core interventions in the treatment and management of schizophreniain primary and secondary care (update). British PsychologicalSociety.

Martinotti, Andreoli,, Di Nicola, Di Giannantonio, M., Sarchiapone, &ampJaniri (2009). Quetiapine decreases alcohol consumption, craving, andpsychiatric symptoms in dually diagnosed alcoholics. HumanPsychopharmacology: Clinical and Experimental,23(5),417-424.

Shajahan,P., Keith, S., Majjiga, C., Murphy, J., MacRae, A., Bashir, M., &ampTaylor, M. (2009). Comparing the effectiveness of aripiprazole andquetiapine in schizophrenia and related psychoses: a naturalistic,retrospective chart review study. TheJournal of clinical psychiatry,70(5),692-698.

Stone,J. M., Raffin, M., Morrison, P., &amp McGuire, P. K. (2010). Review:the biological basis of antipsychotic response in schizophrenia.Journalof Psychopharmacology,24(7),953-964.

.World Psychiatric Association Pharmacopsychiatry Section statement oncomparative effectiveness of antipsychotics in the treatment ofschizophrenia. Schizophreniaresearch,100(1),20-38.