CASE LEARNING OBJECTIVES
Recognize the signs and symptoms of schizophrenia and be able to distinguish among positive, negative, and cognitive symptoms of the illness
Identify the treatment goals for a patient with schizophrenia
Recommend appropriate antipsychotic medications using patient-specific data
Develop an appropriate treatment and monitoring plan for the treatment of symptoms of schizophrenia
Educate a patient about antipsychotic medications and the importance of adherence to the treatment
"I'm being poisoned because I'm going to be a TV star."
History of Present Illness
Carla Lee is a 24-year-old woman who presents to the clinic after being brought in by a family member. Her family has noted that she has become more withdrawn within the past 8 months, and she rarely comes out of her room at the family home. CL has been seen muttering to herself for the past 6 weeks and when questioned, has been telling family members that her "TV agent" has been talking to her all day and all night. By her own report, she is not sleeping as much as usual so that she can get through these important conferences with her agent. CL's family has become worried since she has been refusing to eat food in the family home. She has been suspicious of all the food that her mother cooks, and complains that her mother and others in the house may be trying to poison her food due to their jealousy over her upcoming celebrity status. She now refuses to eat any food that is not prepackaged or shrink-wrapped, and has started complaining that even that is not a guarantee that her food has not been altered. CL recently lost her job as a clerk at a convenience store because she missed too many shifts. Other employees saw her as disruptive since she would carry on conversations, apparently with herself, while ringing up customers. CL stated that she used to like to work at the store, but lately she has noticed people staring at her and talking about her. She attributes this to their jealousy about her role in the TV show The Carla Show which is all about her life. CL presents as unkempt and malodorous, wearing several different layers of clothes and a large hat, which she refuses to take off since it is keeping her fans from recognizing her. She has not showered for several days and has not brought along the correct medical paperwork, although she has brought along her journal, which she uses to track her thoughts for script ideas. Although she complains of being thirsty, she refuses a drink of water as the paper cup may have been tampered with.
CL has a history of acne in adolescence, which was treated with oral antibiotics from age 17 to ...