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Diagnosis and Management

Non-medical treatment:

• Cognitive behavioural therapy

• Counselling and psychotherapy

Community Mental Health Team - A mental health worker from local team (your care coordinator)

Community psychiatric nurses can give you time to talk and can help sort out problems with medication.

• Social help

Subjective

Signs and symptoms of condition:

  • eye contact, self-care and behaviour abnormal

  • speech was fast, spontaneous, flight of ideas

  • mood, she was flat, anxious, blunted, depressed, angry calm and had some suicidal ideaton/intent.

  • Thought disorder apparent withdrawn, block, delusions

Patient was teary and sad in mood - felt nothing was wrong with her.

Staff say patient maintained that she was a little girl, reported to have seen ghosts and that staff rape her.

Stages of the condition and diagnosis

Three stages of the condition:

• Prodromal phase - memory and concentration problems, social withdrawal, unusual and uncharacteristic behaviour

• Acute phase - when patient will experience the positive symptoms of the disease such as hallucinations, delusions, and behavioural disturbances

• Relapse - Some patients experience disturbing symptoms briefly whilst others may last months – years

European study of six countries found that 80% of patients Dx: Schizophrenia suffered long term effects, and 80% remained unemployed [1].

Diagnosis involves Mental Health Assessments and Physical State assessments.

Case study

One of the top 10 medical disorders causing disability (WHO 1990) and 50% higher rate of mortality than general population [1].

Patient:

  • Mrs ZS

  • 31 yr old

  • Psychotic symptoms in 2005 - receiving derogatory mesages from the tv etc.

Use of alcohol & drugs e.g. cannabis

  • Allergy status: penicillin,morphine

Introduction

Schizophrenia is a major psychiatric disorder which affects a patient's thoughts, perception and behaviour [1]. There are two categories of symptoms which include:

1. Positive symptoms - hallucinations, thought disorder, delusions.

2. Negative symptoms - Apathy, social withdrawal.

Though patients may suffer from this condition lifelong, aims of therapy are to improve cognitive and social functioning and to alleviate suffering - of both the patient and their carers [2].

Anti-psychotics are used to manage the positive symptoms but are less effective in managing negative symptomse.

FBC

  • WBC - 8.2
  • Neutrophils - 4.4
  • Platelets - 323
  • Eosinophils - 0.1

Objective

Schizophrenia with manic episodes

Borderline personality disorder

Hx: Admitted under section 2 of the mental health act in 2000, then under section 3.

  • BP sitting: 126/84
  • BP standing: 118/92
  • Temperature: 36.3^c

Contents

1. Introduction to Schizophrenia

2. Case study of patient

3. Subjective view of condition

4. Objective results

5. Assessment

6. Plan for therapy

7. References

Schizophrenia

Hamida B. Abdul-Malik

  • Psychotic symtpoms in 2005 - receiving derogatory mesages from the tv

  • Drug and alcohol abuse

  • Vulnerable to sexual exploitation

  • Non-compliance with medicines

  • History of self-harm, suicidal ideations, self-neglect.

  • Sectioned - level 3 (Treatment stage)

1. Clozapine Titration variable BD. Starting at 12.5mg ON.

2. Lithium Carbonate (Priadel) 1.2g ON M/R

3. Clonazepam variable BD (0.5mg then 1mg)

4. Aripiprazole 30mg OM

Monitor FBC, Temp. Pulse, BP. especially due to risk of agranulocytosis with clozapine, and due to NTW nature of Lithium.

Assessment

Thank you

Plan

1. Schizophrenia; The NICE guideline on core interventions in the treatment and management of schizophrenia in adults in primary and secondary care [2010]. Accessed online at: http://www.nice.org.uk/nicemedia/live/11786/43607/43607.pdf

2. Antipsychotic drugs; Drugs used in psychoses and related disorders. Central Nervous System, BNF edition 64.

3. Lithium Information booklet

References

Patient will be titrated up to appropriate dose of Clozapine; regular monitoring for both Clozapine and Lithium.

Therapy will be lifelong; sectioning will include varying degrees of freedom to leave the hospital and visit family.

Currently patient will remain in hospital, with regular visits from family.

Counselling and other non-medical therapy to continue.

Conclusion

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