The patient is a 27-year-old Filipina single woman accompanied by an aunt and an uncle with whom she lives.

Norwich University Schizophrenia Case Study

The patient is a 27-year-old Filipina single woman accompanied by an aunt and an uncle with whom she lives. 

Chief Complaint: “I have schizophrenia and I need my medications ordered.” 

History of chief complaint: The psychiatrist who has been treating the patient does not take her insurance any longer, so she needs a new provider.  She has been taking olanzapine 15 mg daily.

Past Psychiatric History: The patient started hearing voices as a freshman in college.  Initially, the voices were just chattering but then started saying they were going to hurt her.  She said, “I thought people were stalking me.”  She was treated by a psychiatrist with olanzapine that helped.  She thought she was fine and stopped the olanzapine.  She relapsed and was hospitalized and was prescribed risperidone before being discharged, but she could not sleep.  She was prescribed a variety of antipsychotic medication (ziprasidone, aripiprazole, quetiapine).  They did not control the paranoid thinking and the voices were loud and threatening.  Eventually, she was prescribed olanzapine again, which she described as the most effective.  She has been taking olanzapine consistently.

Medical history: No acute or chronic medical conditions. 

Appetite: good

Sleep: 7-8 hours at night.

Menstrual pattern: Regular menses, not sexually active.

Height: 5’0”

Weight: 114 lbs.

Drug or Alcohol Abuse: Denied

Family History: Lived with her mother until 5 years old when her mother died in a motor vehicle accident.  Then she lived with her aunt and uncle.  Patient considers her cousins her siblings. Her aunt and uncle are very supportive.  The patient worries about her aunt because she has diabetes.

PERSONAL HISTORY

NO KNOWN ALCOHOL OR DRUG USE BY MOTHER DURING PREGNANCY.  NORMAL VAGINAL BIRTH.  NO DISABILITIES OR SOCIAL IMPAIRMENT DURING CHILDHOOD.  GIFTED ACADEMICALLY DURING HIGH SCHOOL.  IDENTIFIES AS GAY BUT NEVER SEXUALLY ACTIVE.   STARTED HAVING TROUBLE CONCENTRATING AND BEING MOTIVATED WHEN SHE WENT TO COLLEGE.  REPORTED MEMORY AND DECISION-MAKING DEFICITS.  LOST A LOT OF HER FRIENDS IN COLLEGE.  SHE THOUGHT THEY WERE STALKING HER, AND SHE WAS SENDING THEM BIZARRE AND EXCESSIVE TEXT MESSAGES.

Trauma/Abuse History: Denies

MENTAL STATUS EXAMINATION 

APPEARANCE: CASUAL DRESS.   APPEARS YOUNGER THAN STATED AGE.  IS VERY THIN AND PETITE.

Behavior and Psychomotor activity: Good eye contact.  Cooperative.

Consciousness: Alert 

Orientation: Oriented to person, place, time 

Memory: Had difficulty providing a clear history.  Could not accurately identify dates she attended college.  Could not remember details of her medication history or menstrual history.

Concentration and Attention: Generally attentive.

Intellectual Functioning: Average or above. 

Speech and Language: Normal rate and volume. 

Perception: Reports she still hears voices most of the time but knows not to trust them and tries to ignore them.  She thinks they interfere with her ability to concentrate and attend college. 

Thought Process: Clear and logical

Thought Content: No unusual content identified

Suicidality and Homicidality: Denied 

Mood: Good

Affect: Congruent to mood. 

Impulse Control: good 

Judgement/Insight/Reliability: Good 

Write a paper of 2-3 pages describing possible solutions to help your patient with their condition. Include therapy, drugs, alternative therapies that you would recommend for this patient. Consider the following in your response:

What diagnosis should be considered?

What is the rationale for the diagnosis?

What test or tools should be considered to help identify the correct diagnosis?

What differential diagnoses should be considered?

What treatment would you prescribe and what is the rationale? Please consider both pharmacologic treatment and other modalities if appropriate.

What psycho-education should be offered with your pharmacologic treatment?