A 25-yr-old man newly diagnosed with schizophrenia presents to emergency department (ED) after recent discharge from inpatient psychiatry
Case Study: Psych Mental Health NP Students
A 25-yr-old man newly diagnosed with schizophrenia presents to emergency department (ED) after recent discharge from inpatient psychiatry. While inpatient he had an increase in his antipsychotic medication Risperidone from 1mg po daily to 3mg po BID. The family explained in addition to acute psychosis, they noticed disorientation; he was feverish, displayed robot-like movements, mute, made minimal movements (appeared catatonic), appeared diaphoretic, and had generalized muscle rigidity and tremor. His skin was/is warm and wet.
He presents to you flushed, sweating profusely with noted cogwheeling when flexing and extending his extremities.
Vital signs: Oral temperature >38 degrees Celsius (100.4 degrees Fahrenheit)
BP = 160/105
Pulse 118
Respirations = 30
Significant Laboratory Findings:
Creatinine Kinase (CK) = 9,000 (Normal = 38-174 U/L)
Blood Urea Nitrogen (BUN) = 30 (Normal = 7-18 mg/dl)
WBC = 20,000 (Normal 5,000-10,000 cu/mm)
ALT = 120 (Normal = 5 to 55 U/L)
AST = 135 (Normal = 8-48 U/L)
Clues to consider: Recent new diagnosis; rapid titration of new medications during recent hospitalization may be a precipitating factor.
Please answer the following questions related to the case study. Your answers should be brief and to the point for ALL questions. The word count is outlined within each question. Points will be deducted for going over the word limit for each question.
1. Discuss the pathophysiology of Neuroleptic Malignant Syndrome (NMS)/Serotonin Syndrome. (in no more than 150 words)
2. List the tests that should be included to make the diagnosis and briefly describe what the test measures and why each is needed. (in no more than 150 words)
3. Explain the actions of your selected pharmacologic agent(s) and why it (they) was (were) included in the treatment. (in no more than 100 words)
4. When completing the history and physical exam, what questions would you include in the review of the systems? (in no more than 150 words)
5. Write a detailed history and physical examination using the information from the case and findings you might expect from a person with your diagnosis. (in no more than 2 pages)
6. Discuss why ECT may be selected, how it should utilized, any specific scheduled timing and any other considerations you believe are important. What changes, if any, would you make and why? Use current International Association/APA clinical guidelines and other scholarly articles to support your information. (in 150 words or less)
7. How long should this patient remain on medication treatment and the rationale? (in 100 words or less)
8. When considering the information provided, are the current medications appropriate to continue? Why or why not? (in 100 words or less)
9. Discuss a detailed treatment plan for this patient including patient education (in no more than 2 pages)
Clinical Guidelines: Use the link below to access the current clinical guidelines
USA APA Practice Guideline for the Treatment of Patients with Schizophrenia (2004) https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/schizophrenia.pdf pg. 89-90
International Association: Guidelines for Biological Treatment of Schizophrenia, Part 2: Update 2012 on the long-term treatment of schizophrenia and management of antipsychotic-induced side effects (2013) retrieved from https://www.tandfonline.com/doi/full/10.1080/15622970500483177?src=recsys See Management of Relevant Side Effects
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