schizophrenia case presentation

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SPECIALITY DEPARTMENT-IIDEPARTMENT OF
OBSTETRICS/GYNAECOLOGY
Under the Guidance of
Dr. P.ANJANI DEVI M.B.B.S, Dr. ANURADHA
M.B.B.S,DGO Kalyani hospital, Hanmakonda.

• Presented by
• K.PRATHYUSHA
• 12352D.1009
• Pharm.D VI yr.

Academic year 2016-2017
Department of Pharmacy Practice CARE COLLEGE OF
PHARMACY OGLAPUR, ATMAKUR, Warangal 506311,
(T.G) India.
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case presentation

• A 23 year old female came to the clinic with the
  chief complains of headache, hallucinations,
  delusions, irritated, angriness since 15 days.
  Precipitating factors fear towards marriage.
  Aggravating factors thoughts about marriage,
  PMH typhoid-1month back.
• FH/SH Nothing relevant. Menstrual history
  irregular LMP 15/10/2016, Childhood behavior
  similar symptoms during degree 1st year 5yrs
  back.

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SUBJECTIVE

• Name NA05 Age/Sex 23Y/FEMALE
  OP 1411/16
• Ward PSYCHIATRY OP DOA 06-12-2016
• Reasons For Admission headache, hallucinations,
  delusions, irritated, angriness
• History Of Present Illness Since 15 days
• Past Medical History typhoid
• Personal History And Habits Mixed diet.
• Family History Insignificant.
• Precipitating factors fear towards marriage.
• Aggravating factors thoughts about marriage.
• Menstrual history irregularLMP-15/10/16
• Childhood behavior similar symptoms 5years back.

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OBJECTIVE

• PREMORBID CONDITION
• Social relations good Attitude
  towards work good
• Hobbies watching TV Energy not
  active
• Intellectual activities good

General examination
Physical Examination Physical Examination
Blood Pressure 100/60mmHg Weight35kgs
Temperature 360 CNS
PULSE 98bpm P/A Soft

Radiological examination - Laboratory data-

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SCHIZOPHRENIA

• The schizophrenic disorders are characterized in
  general by fundamental and characteristic
  distortions of thinking and perception, and
  affects that are inappropriate or blunted. Clear
  consciousness and intellectual capacity are
  usually maintained although certain cognitive
  deficits may evolve in the course of time.
• The most important psychopathological phenomena
  include
• thought echo
• thought insertion or withdrawal
• thought broadcasting
• delusional perception and delusions of control
• influence or passivity
• hallucinatory voices commenting or discussing the
  patient in the third person
• thought disorders and negative symptoms.

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• Schizophrenia occurs with regular frequency
  nearly everywhere in the world in 1 of
  population and begins mainly in young age (mostly
  around 16 to 25 years).
• Schizophrenia is defined by
• a group of characteristic positive and negative
  symptoms
• deterioration in social, occupational, or
  interpersonal relationships
• continuous signs of the disturbance for at least
  6 months

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Course of illness

• Course of schizophrenia
• continuous without temporary improvement
• episodic with progressive or stable deficit
• episodic with complete or incomplete remission
• Typical stages of schizophrenia
• prodromal phase
• active phase
• residual phase

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Positive and Negative Symptoms
Negative Positive
Alogia Hallucinations
Affective flattening Delusions
Avolition-apathy Bizarre behaviour
Anhedonia-asociality Positive formal thought disorder
Attentional impairment
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Etiology of Schizophrenia

• The etiology and pathogenesis of schizophrenia is
  not known
• It is accepted, that schizophrenia is the group
  of schizophrenias which origin is
  multifactorial
• internal factors genetic, inborn, biochemical
• external factors trauma, infection of CNS,
  stress

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Etiology of Schizophrenia - Dopamine Hypothesis

• The most influential and plausible are the
  hypotheses, based on the supposed disorder of
  neurotransmission in the brain, derived mainly
  from
• the effects of antipsychotic drugs that have in
  common the ability to inhibit the dopaminergic
  system by blocking action of dopamine in the
  brain
• dopamine-releasing drugs (amphetamine, mescaline,
  diethyl amide of lysergic acid - LSD) that can
  induce state closely resembling paranoid
  schizophrenia
• Classical dopamine hypothesis of schizophrenia
  Psychotic symptoms are related to dopaminergic
  hyperactivity in the brain. Hyperactivity of
  dopaminergic systems during schizophrenia is
  result of increased sensitivity and density of
  dopamine D2 receptors in the different parts of
  the brain.

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Etiology of Schizophrenia - Contemporary Models

• Dopamine hypothesis revisited various
  neurotransmitter systems probably takes place in
  the etiology of schizophrenia (norepinephric,
  serotonergic, glutamatergic, some peptidergic
  systems) based on effects of atypical
  antipsychotics especially.
• Contemporary models of schizophrenia
  conceptualize it as a neurocognitive disorder,
  with the various signs and symptoms reflecting
  the downstream effects of a more fundamental
  cognitive deficit
• the symptoms of schizophrenia arise from
  cognitive dysmetria (Nancy C. Andreasen)
• concept of schizophrenia as a neurodevelopmental
  disorder (Daniel R. Weinberger)

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Etiology of Schizophrenia - Neurodevelopmental
Model

• Neurodevelopmental model supposes in
  schizophrenia the presence of silent lesion in
  the brain, mostly in the parts, important for the
  development of integration (frontal, parietal and
  temporal), which is caused by different factors
  (genetic, inborn, infection, trauma...) during
  very early development of the brain in prenatal
  or early postnatal period of life.
• It does not interfere too much with the basic
  brain functioning in early years, but expresses
  itself in the time, when the subject is stressed
  by demands of growing needs for integration,
  during formative years in adolescence and young
  adulthood.

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diagnosis

• For the diagnosis of schizophrenia is necessary
• presence of one very clear symptom - from point
  a) to d)
• or the presence of the symptoms from at least
  two groups - from point e) to h)
• for one month or more
• the hearing of own thoughts, the feelings of
  thought withdrawal, thought insertion, or thought
  broadcasting
• the delusions of control, outside manipulation
  and influence, or the feelings of passivity,
  which are connected with the movements of the
  body or extremities, specific thoughts, acting or
  feelings, delusional perception
• hallucinated voices, which are commenting
  permanently the behavior of the patient or they
  talk about him between themselves, or the other
  types of hallucinatory voices, coming from
  different parts of body
• permanent delusions of different kind, which are
  inappropriate and unacceptable in given culture

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Treatment of Schizophrenia

• The acute psychotic schizophrenic patients will
  respond usually to antipsychotic medication.
• According to current consensus we use in the
  first line therapy the newer atypical
  antipsychotics, because their use is not
  complicated by appearance of extrapyramidal
  side-effects, or these are much lower than with
  classical antipsychotics.

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self-deprecating A self-deprecating person knows
her own weaknesses and shortcomings and isn't
afraid to point them out, often in a humorous
way.Some people are egotistical, always talking
about how great they are. The opposite type of
person is self-deprecating, dwelling on his own
faults and even joking about how he's short,
unsuccessful, or not that smart. Being
self-deprecating is usually considered a good
trait, a quality of someone with a wry sense of
humor. When being self-deprecating goes too far,
it can become self-loathing and self-sabotaging,
which are less amusing forms of putting yourself
down
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Self-talk can have a great impact on your
confidence. It can be positive or negative, and
have different effects on how you feel. There are
a few ways you can develop better self-talk,
which can be as simple as listening to what
youre saying to yourself each day. It's a good
idea to practice how to you talk to yourself,
because feeling good is always worth the effort
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assessment

• Diagnosis of the patient was done based on
  patients complaints, Physical examination and the
  patient was assessed to be suffering from
  Schizophrenia with acute psychotic episode.

Guidelines for the treatment and management are according to DSM-IV
PLAN Based on the diagnosis patients treatment
plan is as follows
S. DRUGS DOSE mg ROA FREQ
1 Amisulpride 50 PO HS
2 Clonazepam 0.25 PO BD
3 Thiothixene 5 PO BD
4 Diphenylhydramine 50 PO BD
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PRESCRIPTION DRUGS
Drug Category Use Monitoring parameters R
Amisulpride Antipsychotic, dopamine antagonist Schizophrenia Constipation, weight gain Y
Clonazepam Benzodiazepine Panic disorder, seizure, social phobia Liver function tests Y
Thiothixene Anti-psychotropic Schizophrenia Leukopenia, neutropenia, pigmentary retinopathy, lenticular pigmentation Y
Diphenylhydramine Anti histamine Insomnia Gait distrubances Y
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PHARMACIST INTERVENTIONS

• Checked for drug interactions, medication errors.
• Monitored signs and symptoms.
• Obtained patient history, including drug history
  and any known allergies, and allergy to any of
  the drugs given.
• Monitored Blood pressure, incidence of seizures
  carefully during treatment.

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Patient counselling

• Many people living with schizophrenia continue to
  live regular, fulfilling lives even if they
  continue to experience symptoms. With the right
  support and treatment, many people can learn to
  manage the disorder.
• Spotting the signs - An effective way to manage
  the disorder is learning to recognise the signs
  that you are becoming unwell. This can include
  feelings of anxiety, stress or loss of appetite.
  There may also be less obvious symptoms
  developing. Feeling fearful, suspicious or
  worrying about peoples motives is common.
• Look after physical health - When living with
  schizophrenia, it is important to ensure you get
  plenty of sleep. If you are struggling to sleep,
  it will become more difficult to cope with
  symptoms and manage your feelings of worry.
  Eating a balanced diet can help you to feel
  healthier. Eating regular meals and healthy
  snacks can also help to avoid changes in blood
  sugar levels, related to psychosis.

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• Be involved - If you are suffering with
  schizophrenia, being involved in your treatment
  can be effective. Try to ask your doctor and
  therapist about your diagnosis and the treatments
  available to you. Asking questions about a
  professionals opinion and make sure you
  understand what is happening.
• Minimise stress - Being in a stressful situation
  can increase the chances of illness and can often
  make symptoms of schizophrenia worse. Try to be
  aware when you are feeling overwhelmed or need to
  ask for help.

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• THANK YOU