Schizophrenia Diagnosis and Treatment
Introduction
E.J is a 62-year-old man that was brought to the hospital by his grandchild over 11 months ago. The patient was experiencing psychosis, auditory hallucinations, mood liability, and paranoia. The patient history analysis revealed that he had been treated before coronary artery disease, hypertension, peptic ulcer disease, hyperlipidemia, peripheral artery disease, and chronic obstructive pulmonary disease (DiPiro, 2014). The patient did not have any prior history of mental illness; her mother, however, had schizophrenia, a severe mental illness that affected the thinking of a perception of their surroundings and their ability to function normally.
Diagnosis
The patient was suffering from onset schizophrenia based on the symptoms he exhibited and the physical examinations. From the history, the patient had no prior mental illnesses or any symptoms. However, the symptoms exhibited, such as auditory hallucinations, psychosis, and mood liability, are consistent with schizophrenia-related to it. The other symptoms experienced include paranoia and agitation (DiPiro, 2014). The patient’s mother was diagnosed with schizophrenia, a mental illness that is characterized by hallucinations, psychosis, mood disorders, and distorted thinking that can drastically affect the normal functions of the patient. The onset symptoms include psychosis and hallucinations, all of which are exhibited by the patient in questions (Liu et al., 2017). Schizophrenia is a serious mental illness that affects the patient’s ability to function as it affects their thinking and perceptions of everything around them. Some of the expected symptoms of schizophrenia, apart from hallucinations and psychosis, include delusion and depression. Based on the symptoms, the patients suffer from the onset of schizophrenia and need to be put in medications immediately to manage the conditions. Since schizophrenia is a lifelong condition, the patients will have to take medications for the rest of his life to manage the conditions.
Differentials
The differential diagnosis considers the current symptoms presented by the patient, the medical history, and the physical examination of the patient. In this case, J, who is a 62 years old white man, has symptoms such as auditory hallucinations, psychosis, and mood liability. Although the last two symptoms are thought to be caused by the administration of high doses of Prednisone, they are also consistent with schizophrenia patients (DiPiro, 2014). An analysis of the patient’s medical history reveals that he had different cardiovascular diseases such as coronary artery disease, peripheral artery disease, and chronic obstructive pulmonary disease. Other medical conditions in the medical history include hypertension, peptic ulcer disease, hypertension, and hyperlipidemia. Cardiovascular medical history has nothing to the mental conditions he is currently experiencing. All the prior diagnosis of the physical symptoms is related to cardiovascular diseases. The patient has a higher risk of heart-related disease and complications. However, all these conditions have no relation to the current symptoms he is exhibiting, such as mood liability, psychosis, and auditory hallucination.
ICD Code
The ICD Code for schizophrenia is F20.9, as classified by the World Health Organization.
Treatment
The treatment of schizophrenia-like most other mental illnesses, is the drug therapy that manages the symptoms exhibited by the condition. Since mental illnesses are not treated, drug therapies enable the patient to live a normal life by managing the symptoms (DiPiro, 2014). As mentioned, the treatment of schizophrenia is lifelong, even in cases where the symptoms have drastically reduced. In severe cases, hospitalizations are the better alternative, whoever in normal circumstances a combination of medication and psychotherapy can be used to manage the condition. The guidance of the treatment, in most cases, is the responsibility of an experienced psychiatrist. In other cases, a team of specialists from different departments works with the psychiatrist to manage the condition (Liu et al., 2017). These specialists include a psychologist, psychiatric nurse, social worker, and a case manager responsible for coordinating the care.
Medications
There are diverse medications that can be used to treat schizophrenia by managing the conditions and the symptoms it exhibits in the patient. The primary treatment of schizophrenia is medication. Medical practitioners use various medications and different dosages before determining the patient (Liu et al., 2017). The administration of antipsychotic medications is to reduce the symptoms of the conditions to the lowest levels. Other medications include anti-anxiety and antidepressants. Some of the second-generation antipsychotic medications include
- Brexpiprazole (Rexulti) Quetiapine (Seroquel)
- Risperidone (Risperdal)
- Asenapine
- Aripiprazole
- Ziprasidone (Geodon) (Sadock, 2014)
First-generation antipsychotics medications include
- Fluphenazine
- Perphenazine
- Chlorpromazine
Long-lasting injectable antipsychotics include
- Aripiprazole (Abilify Maintena, Aristada)
- Haloperidol decanoate
- Risperidone (Risperdal Consta, Perseris)
Antidepressants and anti-anxiety medications
The current and most effective antidepressant medications for E.J’s schizophrenia include Sertraline, Fluoxetine, Citalopram, and Paroxetine. The effects of these drugs and are not immediate and takes a week or two to begin working. Anti-anxiety medications or E.J include Aripiprazole (Abilify Maintena, Aristada), decanoate, Fluphenazine decanoate, and Haloperidol. The best options for E.J are decanoate for his schizophrenia (Gaebel et al., 2019).
Side effects of the drugs
The side effects of schizophrenia medications are adverse, an aspect that discourages most of the patients from taking medication. This side effect applies to both antipsychotic and antidepressant medications. Some of these side effects include;
Drowsiness
Nausea
Constipations
Restlessness
Dry mouth
Low blood pressure
Dizziness
Actual adverse drug responses (ADR),
The adverse effects associated with schizophrenia medications particularly antipsychotics and antidepressants including
Adverse metabolic effects including hyperprolactinemia
extrapyramidal side effects (EPSE)
Impaired lipid and glucose metabolism
Dry mouth and sedation
Impaired cognition
Common drug and/or food interactions
Antipsychotic and antidepressant medications do not interact well with certain types of foods and drinks; some of which include;
- Alcohol, caffeine, nicotine, all of which reduce the effectiveness of the schizophrenia medications.
- Grapefruits are dangerous as they raise the blood levels for some antipsychotic medications.
- COPD drugs such as Anticholinergic drugs do not interact well with antipsychotics.
- Ati-infections disease such as tuberculosis and HIV change the blood levels, especially when used with antipsychotic medications.
Key monitoring points
Increased level of side effects on the medications needs to be reported to the medical practitioner immediately. The antidepressant and antipsychotic medications are expected to begin subsiding the condition (Chan, 2017). In cases where the hallucinations, paranoia, and other related symptoms do not subside in a few weeks, the patient should report to the psychiatrist for a change in the medications used.
Electoral convulsive therapy
Electoral convulsive therapy can be adopted in cases E.J does not respond to medications. This type of therapy can also be used in cases of a patient with depression.
Psychosocial Issues
Schizophrenia patients such as E.J suffer from various psychosocial issues, some of which are difficulty retaining employment, which is regarded as occupational problems. 93% of the patients, such as E.J, have difficulty in social functioning, which is faced by 63% of the patients with schizophrenia. Poor personal health maintenance is yet another problem faced by patients such as E.J. Other psychosocial problems include family problems, including divorce and educational problems (Gaebel et al., 2019).
Variables Related to Aging and Mental Health
E.J is a 62 years old man with schizophrenia, an aspect that makes him susceptible to other medical conditions associated with aging. In the medical history, the patient had a history of cardiovascular disease (Chan, 2017). With his current condition, the possibility of aging-related healthcare conditions is somewhat high. Antipsychotic and antidepressant medications’ side effects increase the chances of a cardiovascular condition such as heart failure and heart attack, among others (Sadock, 2014). In such a case, the medications for heart disease may not interact well with the antipsychotic and antidepressant medication.
Recommendations
J.E needs to understand the severity of the schizophrenia conditions to enhance the significance of sticking to their medication. The patient has schizophrenia, and the treatment involves antipsychotics and antidepressants to manage the conditions. Once the medications fail, the patient should seek immediate medical attention to the change in medications. The patient was also treated for several cardiovascular conditions, including peripheral artery disease (with stents), hypertension, chronic obstructive pulmonary disease, hyperlipidemia, and coronary artery disease (Gaebel et al., 2019). These conditions have a tendency to recurrence in cases where the patient does not practice a healthy lifestyle. The patient should, therefore, exercise regularly to prevent any further medical conditions. The diet should also be rid of cholesterol but instead should consume plenty of vitamins ranging from vegetables and fruits.
References
Chan, V. (2017). Schizophrenia and psychosis: Diagnosis, current research trends, and model treatment approaches with implications for transitional age youth. Child and Adolescent Psychiatric Clinics of North America.
DiPiro, J.T. (Ed). (2014). Pharmacotherapy: a pathophysiologic approach (9th ed.). New York, New York: McGraw-Hill/ Medical.Everyday Health, Retrieved from internet June 10th 2015
http://www.everydayhealth.com/alzheimers/non-medical-alzheimers-therapy.aspx
Gaebel, W., Riesbeck, M., Larach, V. W., Falkai, P., & Zielasek, J. (2019). Trends in Schizophrenia diagnosis and treatment. In Advances in Psychiatry (pp. 603-619). Springer, Cham.
Liu, S., Zhang, F., Shugart, Y. Y., Yang, L., Li, X., Liu, Z., … & Wang, L. (2017). The early growth response protein 1-miR-30a-5p-neurogenic differentiation factor 1 axis as a novel biomarker for schizophrenia diagnosis and treatment monitoring. Translational psychiatry, 7(1), e998-e998.
Sadock, B.J. (2014). Kaplan &Sadocks’s synopsis of psychiatry: behavioral sciences/clinical psychiatry (Eleventh edition). Philadelphia: Wolters Kluwer. Retrieved from the internet on June 25, 2015
http://sleepfoundation.org/ask-the-expert/sleep-and-alzheimers-disease/page/0/1