Posted: September 14th, 2015

paranoid schizophrenia and depression

1. OL is a 43 yo woman with past medical history of paranoid schizophrenia and depression (per previous admission reports). The police had received reports of her trying to contact the FBI and she was subsequently brought to the hospital due to paranoid and aggressive behavior. She is extremely agitated and is swinging at both staff and police. You are unable to get a current medication history.

Select/recommend the most appropriate treatment for acute agitation.

2. OL has been admitted to the acute psychiatric inpatient unit and is has calmed down since admission but is still very disorganized. She reports that the FBI has micro chipped her and she has been mailing letters and calling FBI headquarters to demand that it be taken out. Her most recent admission was three months ago in relation to similar delusions. Discharge summary from the last admission list discharge medications were olanzapine 20mg daily and sertraline 200mg daily. She reports she stopped taking these medications three weeks ago because she was sleeping all day. Previous antipsychotic trials include: haloperidol (akathisia). Pertinent info from last admission include: weight 200lbs, BP 135/80, HR 76, BMP and CBC WNL, TC 170, LDL 80, TG 140, HDL 40. She has agreed to vitals and lab work, which provides you with the following information: weight 240lbs, BP 145/80, HR 80, urine drug screen, BMP, and CBC WNL, TC 240, LDL 130, TG 250, HDL 40.

Select/recommend the most appropriate therapy.

3. RI is a 35 yo man with history of schizophrenia, anxiety, and substance abuse (cocaine; has maintained abstinence for 1 year). He presents to clinic today for follow up. He has been stable on risperidone 3mg twice daily and fluoxetine 40mg daily for the past year, but does admit to missing several doses a week; stating “It’s hard to stick to the twice a day schedule”. He can tell when he misses a few doses in a row because his hallucinations start returning. He is worried that he will miss so many doses that he will completely decompensate which he fears will lead him to start abusing substances again. He denies any adverse effects, urine drug screen negative, and all pertinent labs WNL.

Select/recommend the most appropriate therapy.

If you select a different treatment, how will you transition RI from current risperidone dose to his new treatment?

4. PA is a 21 yo male college student brought in by police after being found running on the highway. He is extremely paranoid and reports that the mafia is coming for him so he ran away. When asked, he does admit to auditory hallucinations, mostly a commanding male voice telling him to hurt himself and his family. All pertinent labs are WNL. He is admitted to acute inpatient psychiatric unit for psychotic episode. He still lives with his parents and his father reports that over the past several months he has secluded himself to his room and can hear him talking “with someone” every once in a while. His father denies any previous medical or psychiatric history for PA and he is not currently taking any medications. He does report the following family history: DM, dyslipidemia (father, paternal grandfather), schizophrenia (maternal aunt).

Select/recommend the most appropriate therapy.

5. CL is a 30 yo woman with a history of schizophrenia and depression. She has been admitted to your hospital 10 times in the past two years with disturbing visual and auditory hallucinations with subsequent depression and suicidal thoughts. She has trialed risperidone, olanzapine, and haloperidol at maximum doses with little benefit; she denies any side major side effects from these trials. She has become increasingly depressed and is starting to lose hope; during this hospital admission she is voicing suicidal ideations with a plan to cut her wrists.

Select/recommend the most appropriate therapy.

6. TR. is a 50 yo woman with history of schizophrenia, depression, and DM2. She was started on clozapine 1 month ago, titrated up to 300mg daily. She presents to clinic today for monitoring. WBC and ANC trends are as follows:

What interventions (if any) need to be made to her clozapine therapy and/or monitoring schedule?

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