Undifferentiated schizophrenia

Undifferentiated schizophrenia case presentation

1. CASE PRESENTATION PRESENTED BY OVIYA.J.P PHARM D

2. CASE SUMMARY A 34 year old female was admitted in xxx hospital . Patient came with C/O poor self care and reduced sleep with auditory hallucinations for 3years which is continuous, rest illness and irritability , N/K//CO – DM, HTN, Asthma, epilepsy . Past medical history: H /O similar illness in past not on medications lab investigation: Abnormal in Haemoglobin , Lymphocytes ,Platelet count , RBC Count , Absolute Lymphocyte count. The patient was diagnosed with UNDIFFERENTIATED SCHIZOPHRENIA and treated with T.OLANZAPINE T.CLONAZEPAM T.TRIHEXYPHENIDYL T.RISPERIDONE T.PROPRANOLOL T.MULTI VITAMINE T.LACTULOSE Inj . OLANZAPINE

3. PATIENT DETAILS NAME Mr.X AGE 34 YEARS SEX FEMALE IP. NO yyyy HOSPITAL xxx HOSPITAL DATE OF ADMISSION 03/1/20 DATE OF DISCHARGE 30/1/20 DEPARTMENT PSYCHIATRY

4. SOAP ANALYSIS S - SUBJECTIVE O- OBJECTIVE A - ASSESSMENT P - PLAN

5. SUBJECTIVE

6. REASON FOR ADMISSION : C/O Presented with an insidious onset continuous course illness for the last 3years more since the last 6months not on medications characterised by auditory hallucination , hallucinatory behaviour, anger outburst , poor self care , increased sleep , hypergraphia, restlessness and irritability in the absence of organicity. PAST MEDICAL HISTORY H/O similar illness in past not on medications PAST MEDICATION HISTORY : not on medications. SOCIAL HISTORY : Known allergies : Nil Marital status : Married Family: Nil

7. OBJECTIVE

8. GENERAL EXAMINATION O/E : Conscious / oriented / afebrile Sl. No vitals 3/1/20 1. Blood Pressure (mm/Hg) 120/60 110/70 2. Pulse Rate 60-100 (beats/min) 86 3. Respiratory Rate (breaths/min) 12-22 22 4. Temperature 97 Fº (Fº) N

9. LABORATORY INVESTIGATIONS Sl.No Parameters Reference value Normal 1. Haemoglobin 12.1 12-15 g/dl 2. Lymphocytes 45.5% 20-40 3. Platelet count 226000 150000-450000 4. RBC Count 3.33 4.50-5.50million/ cumm 5. Absolute Lymphocyte count 3.50 1.03-3.00 10*3 /µl 6. Renal function test: Sodium 134 136-145mEq/l

10. ASSESSMENT

11. DIAGNOSIS UNDIFFERENTIATED SCHIZOPHRENIA SPECIFIC TESTS : urine examination blood test. PANSS RATING GENDERAL PSYCHOPATHOLOGY SCALE

12. PLAN

13. BRAND NAME GENERIC NAME DOSE FREQ DATE 3/1-13/1 14/1-18/1 19/1 20/1-28/1 29/1-30/1 T.OLEANZ OLANZAPINE 5mg 1-0-2 - - 10mg 1-0-1 - - - T.LINOTRIL CLONAZEPAM 1mg 0-0-1 - - - 0.5mg 0-0-1 - - T.PACITANE TRIHEXYPHENIDYL 2mg 1-0-1 T.SIZODON RISPERIDONE 2mg 1-0-1 - - - 4mg 1-0-1 - - T.PRONATE PROPRANOLOL 20mg 1-0-0 T.MVT MULTI VITAMINE 1-0-0 Syp . LACTULOSE LACTULOSE SOS Inj. TOLAZLA OLANZAPINE 40mg OD

14. DRUGS MECHANISM ADR USES OLANZAPINE Act through combination of dopamine and serotonin type 2 receptor site antagonism Weight gain , dizziness, constipation hypotension Antipsychotic CLONAZEPAM It increases the GABA activity, that send chemical signals to nervous system Somnolence , depression, dizziness, memory impairment Anticonvulsant TRIHEXYPHENIDYL Inhibits the parasympathetic nervous system and has a relaxing effect on smooth muscle . Anticholinergic side, rash, stiffness, tremors, spasms, and poor muscle control of Parkinson's disease RISPERIDONE It blocks D2 receptor and 5H2 receptor Insomnia , somnolence, headache, parkinsonism mental/mood disorders, schizophrenia

15. PROPRANOLOL It reduces the heart beat slowly with less force which lower blood pressure Hypotension , aggravated congestive heart failure hypertension  MULTI VITAMINS It supports metabolic functions such as DNA and RNA. Dark colored stools, constipation , diarrhea vitamin deficiencies LACTULOSE Increases stool water content , soften stools that promotes peristalsis decreased blood ammonium concentration Dehydration, abdominal cramping, constipation

16. DISCHARGE MEDICATION S.NO N.AME OF THE DRUG DOSAGE FREQUENCY DURATION AFTERFOOD 1. T.SIZODON/RISPERIDONE 4 mg 1-0-1 15days After food 2. T.PRONATE/PROPRANDLOL 20 mg 1-0-0 15days After food 3. T.LINOTRIL/CLONAZEPAM 0.5mg 0-0-1 15days After food 4. T.PACITANE/TRIHEXTPHENIDYL 2mg 0-0-1 15days After food 5. T.MVT 1-0-0 15days After food

17. PHARMACIST INTERVENSION Drug – Drug Interaction CLONAZEPAM +RISPERIDONE :- Both drugs increase sedation. RISPERIDONE,OLANZAPINE +TRIHEXYPHENIDYL:- increases the effect of trihexyphenidyl by pharmacodynamic system. OLANZAPINE + RISPERIDONE :- Both increases the effect of anti dopaminergic effect and sedation. RISPERIDONE + CLONAZEPAM+ ETHANOL:- Both increases sedation.

18. General counselling PATIENT COUNSELLING : Don’t take any medications including OTC medications without physician advice. Reduce stress , anxiety. Avoid isolation from other persons. Counselling to reduce the suicidal taught . Engaged about other works like exercisng and watching tv. Life style modification or non medical treatment Group therapy . Family therapy. Community support group.

19. Drug Based OLANZAPINE :- Do not drive a car or operate machinery until you know how this medication affects you CLONAZEPAM :- Body aches and pains, palpitations, memory disturbance, headache, and tiredness and several other side effects have also been reported. TRIHEXYPHENIDYL :- May be taken before or after meals; tolerated best if given with food. RISPERIDONE:- You should avoid the use of alcohol while being treated with risperidone . Alcohol can increase the nervous system side effects of risperidone  such as dizziness, drowsiness, and difficulty concentrating. PROPRANOLOL:- People taking propranolol should also avoid nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. These drugs may reduce the effects of propranolol.

20. “ If you talk to God you are praying ; if God talks to you, you have SCHIZOPHRENIA” THANK YOU