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“The voices were telling me to run.”
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History of Present Illness
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Alan Moore is a 32-year-old male presenting to the Emergency Department after jumping from a moving car and receiving only superficial injuries (scrapes and bruises). He states that while riding with his parents on a trip to the grocery store, the voices "in his head" told him that "something bad was going to happen" and that he needed to escape. He is in apparent distress, disheveled, and frequently responds to internal stimuli.
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What signs and symptoms of schizophrenia does the patient have?
Hint: See Clinical Presentation and Diagnosis and Course and Prognosis in PPP
What types of information would you want to have in order to make decisions about pharmacologic treatment options?
Hint: See Course and Prognosis, Treatment in PPP
What pharmacologic options are available for the treatment of Alan's symptoms of psychosis? What changes, if any, would you consider making to his medication regimen?
Hint: See Treatment and Tables 38-2, 38-4, 38-5 in PPP
Which of the options from above would you recommend for Alan, including titration schedule and monitoring plan, and why?
Hint: See Tables 38-2, 38-3, 38-4, 38-5, and Treatment, Outcome Evaluation in PPP
What risks and adverse effects of therapy would you discuss with the patient?
Hint: See Treatment, Outcome Evaluation and Tables 38-3, 38-6 in PPP
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Given Alan’s history of symptoms, side effects, and past treatment options, what pharmacotherapy changes would you recommend, if any?
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Hint: See Treatment and Table 37-3 in PPP
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Schizophrenia is present worldwide. However, when assessing for the signs and symptoms of schizophrenia (delusions, hallucinations, etc.), it is important to take cultural and religious beliefs into consideration as what is considered within the norm for a certain ethnic group may not be considered within normal limits for another. Differences in response to antipsychotic treatment may exist due to differences in genetic makeup of persons with schizophrenia, from both an efficacy and adverse effect standpoint, although information is limited. Antipsychotic medications are the treatment of choice for schizophrenia; however, the agents available in various countries may differ. In addition, the treatment algorithms may differ widely depending on the location of treatment.