Schizophrenia is a cognitive disorder affecting an individual’s ability to think, feel, and behave normally. About 25% of patients with Schizophrenia present with depressive disorder (Harrigan, 2015). This a scenario of a male adult patient complaining of loss of appetite and hearing voices for the past ten months. The patient also complained of often being abusive to his sister and mother and spent most of his time roaming around town. Besides, the patient reported always being restless, thinking that people want to harm him. The patient also never returned home after taking a leave from work and asking someone to replace him. A month after the commencement of his leave, he received his salary. However, he was not paid for subsequent months, and hence he opted to go from one bank to another to make withdrawals. After a few attempts, he was arrested and jailed for four days, even though he was not given a reason; he also reports receiving death threats from a private number via call. The person did not talk. However, he perceived that as a death threat.
History of Present Illness
The patient had no family history of physical or mental illness. However, he had a medical history of paranoid delusion. He also had a premorbid personality of being introvert. Upon hospital admission, his mental state examination revealed that the patient exhibited apprehensive behavior and that the patient was emaciated. Besides, the patient had a constricted affect and a depressed mood and paced to and fro in the ward. Besides, he experienced auditory hallucinations.
Delegate your assignment to our experts and they will do the rest.
Treatment and Management of Schizophrenia
The treatment and management of schizophrenia involve the integration of psychosocial, psychological, and medical inputs. The bulk of this care takes place by a combination of a case manager, social worker, sociopharmacologist, a therapist or counselor, and a vocational counselor since it takes place in an outpatient setting. Antipsychotic medications prevent relapse in people with schizophrenia by diminishing positive symptoms. These medications are also known as major tranquilizers or neuroleptic medications. Suppose antipsychotic drugs are stopped, approximately 80% of patients with schizophrenia relapse. However, if treated, only 20% relapse.
Psychopharmacologic Treatment
Psychosocial interventions include cognitive behavioral therapy, social cognition training, social skills training, and cognitive remediation. Psychosocial treatments are carried out based on the recovery model. This model's goals for the person with schizophrenia are to avoid hospitalization, manage his or her medication and funds, have stable or few symptoms, and be working at least half time. In this treatment approach, choice, hope, and community integration are given emphasis. Schizophrenia affects the whole family of the person, and the family's responses can affect the trajectory of the illness. Besides, intrusiveness, hostile over-involvement, and other familial, "high-expressed emotions" can lead to more frequent relapses. According to research, family interventions or family therapy can improve medication compliance, reduce hospital admissions, and prevent relapse.
Pharmacotherapy
Upon initiation of treatment with olanzapine therapy, the patient complained of fine tremors, which were considered untreated. Besides, this was documented in his medical records. Intervention with trihexyphenidyl 5mg is for this situation since anti-muscarinic agents are recommended for the management of acute extrapyramidal effects that are side effects of antipsychotic medications. According to the British National Formulary, olanzapine 5mg tablets are recommended when there is no prior liver function test and renal function test. Besides, flupentixol 1M should be initiated at a dose of 20mg.
Antipsychotic pharmacotherapy is usually slow in response and are and have adverse effects. As a result, clinicians should warn their patients and their families before the commencement of treatment. Alleviation of psychosis usually takes several weeks. However, the patient may be less agitated or calmer almost immediately. Electrocardiography is sometimes performed routinely before beginning antipsychotic treatment (Sadock et al., 2014). This is also done as frequently as necessary when agents are changed, or doses are increased. The first antipsychotic agents were dopamine D2 antagonists, and they include haloperidol and chlorpromazine. They are conventional, typical, and first-generation antipsychotics.
Second-generation antipsychotics to be used in the treatment of schizophrenia include clozapine. They are known as novel antipsychotics and are atypical. Risperidone, which is also a second-generation antipsychotic agent, is available as a long-acting injection. It uses biodegradable. Aripiprazole, paliperidone, and olanzapine are also available as a long-term corporation. Asenapine is also available for transdermal use. Both the first and second-generation agents have their side effects (Gabbard, 2007). For instance, the second-generation cause elevated prolactin levels and extrapyramidal adverse effects. On the other hand, the second generations cause abnormalities in lipid and glucose control and are also more likely to cause weight gain. However, first-generation drugs are more expensive than the first generations and are more preferred by the patients.
Anticholinergic agents such as diphenhydramine, trihexyphenidyl, benztropine, and amantadine are used to treat extrapyramidal symptoms and to prevent dystonic movements. This is done by using these agents in conjunction with conventional antipsychotic agents. In addition to antipsychotic agents, psychotropic medications treat many patients with schizophrenia: anxiolytic agents, mood stabilizers, and anti-depressants (Stahl, 2017). However, clozapine and carbamazepine cannot be used together. Besides, a little rigorous evidence supports polypharmacy in schizophrenia (Gabbard, 2007). Benzodiazepines are perceived to be relatively safe and hence are often used. However, they are addictive and often lead to falls in patients using them and especially convalescents, and as a result, they may increase mortality in patients that use them.
Community Resources and Support Groups
Having schizophrenia does affect not only the patient but also the family and friends. As a result, there are a lot of support groups, including National Mental Health offices, that can help concerning mental health issues. For instance, there is a National Alliance for the Mentally Ill (NAMI). There is a list of local chapter affiliates, including California NAMI and Ney York Metro NAMI, people can visit that with schizophrenia for help. In Canada, there is a schizophrenia society of Canada with provincial chapters.
Follow-Up Plan
The patient should do a 30-day follow-up with the clinical practitioner after partial hospitalization, intensive outpatient encounter, and an outpatient visit (Lee et al., 2015). Follow-up involves a visit in a non-behavioral healthcare setting with a diagnosis of mental illness. Besides, it involves a visit with a mental health practitioner and with a behavioral mental health practitioner. This is to ensure the effectiveness of treatment and to avoid relapse.
References
Gabbard, G. O. (2007). Gabbard's treatments of psychiatric disorders . American Psychiatric Pub.
Harrigan, J. (2015). Depressive disorders [Video]. San Luis Obispo, CA: Micro training Associates.
Lee, S. Y., Kim, K. H., Kim, T., Kim, S. M., Kim, J. W., Han, C., ... & Paik, J. W. (2015). Outpatient follow-up visit after hospital discharge lowers risk of rehospitalization in patients with schizophrenia: a nationwide population-based study. Psychiatry investigation , 12 (4), 425.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
Stahl, S. M. (2017). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (6th ed.). New York, NY: Cambridge University Press.
