Case Study on Schizophrenia and Asymptomatic Antipsychotics

This essay discusses a case study on schizophrenia, its impact on patients and caregivers, and the features of the disease. It also covers the management measures and the use of asymptomatic antipsychotics. Course code, name, and university are not mentioned.

Running head: SCHIZOPHRENIA AND ASYMPTOMATIC ANTIPSYCHOTICS
Case Study on Schizophrenia
Name of the Student
Name of the University
Author Note

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Introduction
Around the world, schizophrenia is one of the most painful mental health disorders,
and it affects the thinking, feeling, and behaviors of the individuals. However, it is also true
that this disease is not common, like other mental health problems. While defining
schizophrenia disease, it can be stated that it is a complex chronic condition that affects the
neuronal functions of the individuals. In this context, it can be mentioned that the disease is
mainly associated with the alteration of the thinking behaviors of the individuals and this
emotion of the individual is also altered due to this disease condition (Mental Health
Foundation 2020).
Moreover, in some cases, this disease also affects the perception of the individual. In
the case of Schizophrenia in UK, it is stated that the rate of this mental health disorder is very
high in the country and it is observed that almost one out of six people in UK need the
treatment for the issue of mental health disorder in their overall lifetime. Therefore, it can be
stated that the impact of the mental health disorder in the country is quite high (Hayes et
al.2017). In this regard, it should be mentioned that among all the mental health disorders in
UK, schizophrenia is a significant contributor to the overall disease condition and the data of
the NHS stated that almost 220,000 people are treated for this disease condition in the
country. Moreover, it is also noted that the patients who are suffering from this condition,
have a chance of dying by 5 per cent to 10 per cent cases that is almost 5 to 10 per cent
patients of schizophrenia may face mortality due to their disease condition (Mental Health
Foundation 2020). According to the study of Falkenburg and Tracy (2014), it is stated that
the effect of schizophrenia is not at all gender-biased that is the disease affects the individuals
equally irrespective of their gender. The mortality rate of the patients showed that the chances
of dying among the schizophrenic patients are two and half times higher than that of the
normal population of the country and thus this disease condition must be treated seriously.

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While discussing the most risky ages of the patients to have the disease, it can be stated that
most of the patients have this disease in their late teens and early twenties. However, it is also
reported that among the women the disease strikes later than that of the men population of the
country and it is said that in case of late onset of the disease, the condition can attack the
person in the late 70s as well (Mental Health Foundation 2020).
In this essay, the case study of a patient suffering from the disease is discussed. Along
with this, the management measures of the disease, the impact of the disease on the patients
and family members, features of the disease, supportive actions taken by the caregivers are
also discussed in the latter part of the essay.
Description of the Patient
In this essay, the case study of a patient suffering from the mental health problem that
is schizophrenia is discussed. The patient is a 21-year-old male white British and he is
referred to as Adrian as per his pseudonym. Adrian was diagnosed with this disease at the
age of 19 and it was reported that his mental and behavioral problems were mainly due to the
practice of cannabinoid consumption and along with this, it was also reported that a trait of
emotionally unstable personality disorder along with the problem of Asperser’s syndrome
was also detected in Adrian. Initially, the patient was not ready to accept his disease
condition; however later, Adrian agreed to his condition. Due to his disease condition, the
patient was very sad and that was the reason he was not at all ready to accept his condition.
He has a long-standing recurrent history of not compliant with his medication and this has
caused various hospital admission cases since his last 2 years. His medical history also stated
that he was accused under section 2 of the Mental Health Act when he became erratic in
nature and that time caseworker and support worker called the police. Then the patient was
transferred to another hospital from the current hospital due to aggression, self-harm

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behaviour and paranoia behaviour. As a part of his disease, he complained about hearing
voices and issue of hallucination was also reported by the patients. Adrian stated that he
listened to a specific sound that provides him instructions and commands him about what to
do to the people. Not only this, but the patient also reported that the particular voice also
instructed to do self-harm, attack people and this voice also tells him to kill himself.
Moreover Adrian also stated that the he believed that this voice had complete control over his
speech and body language. As a part of the management, it is reported that the voice also
instructed him to perform various activities and a case of self-harm by using blade on his arm
was also reported by the health care professionals in the hospital. Therefore, the issue of
aggression was reported when he pulled the hair of a female staff in the hospital and later he
admitted that it was the voice that instructed him to do so. As a part of his medication the
hospital authority provided him a few pharmacological and non-pharmacological
interventions.
Features of the Mental Health Problem
While discussing about the features of the disease that is schizophrenia, it can be
stated that there are a few standard features of this mental health problem and they are mainly
negative symptoms, delusions, hallucinations, disorganized thinking.
The first characteristic of this disease is negative symptoms that is a severe and
debilitating condition of the mental health condition of the individual and in this regard, it can
be stated that this mental health problem can alter the thinking and emotional behaviors of the
individuals and it is reported that these negative symptoms among the patients suffering from
this particular disease (Imak 2014). As a part of the negative traits, it can be stated that the
patient showed the avoidance behavior when making eye contact with the health café
professionals or other caregivers of the family. Along with this, social withdrawal behaviors

4SCHIZOPHRENIA AND ASYMPTOMATIC ANTIPSYCHOTICS
and lack of interest in the activity of daily living are also reported as a part of the negative
reactions of the people. In this context, it can be stated that this type of behavior is not
observed in the case of Adrian.
Another feature of schizophrenia is abnormal motor behavior and as a part of this, the
patients may show unusual behaviors related to the motor functions of the individuals. As a
part of the abnormal motor behaviour may include abnormal posture, pronounced agitation,
unnecessary movements, and resistance to training given by the health care professionals can
be reported (Walther et al. 2017). In this context, it can be stated that part from the agitate
behaviour, no other abnormal motor behaviour is not present in this case. As a part of the
agitation, the patient became violent to a health care professional and pulled her hair.
Another feature of the schizophrenia is reported to be delusion that is characterized by
the presence of false beliefs in the mind of the patients. Such incidents are not at all present
in the reality and they show paranoia behaviour (Irmak 2014). Moreover, in some cases, due
to the delusions, the patient may feel superiors than other people and they think themselves as
most powerful and in the case of Adrian such type of behaviour is also not present.
Another essential feature of the schizophrenia is the presence of hallucinating
behaviour among the patients. In this context, it can be stated the hallucination is the
characterized by hearing of voices, instructions, presence of figures who are exist in reality
(Song et al. 2015). In this case, the issue of hallucination is the main issue for Adrian. As per
the case study, it was reported that the patient has complained about hearing voices and the
issue of hallucination was also reported by Adrian. Adrian stated that he heard a specific
sound that provides him instructions and also commands him about what to do to the people.
Not only this, but the patient also reported that the particular voice also instructed to do self-
harm, attack people and this voice also tells him to kill himself. Moreover, Adrian also stated

5SCHIZOPHRENIA AND ASYMPTOMATIC ANTIPSYCHOTICS
that he believed that this voice had complete control over his speech and body language. Such
kind of hallucinating behaviours is prevalent among patients with schizophrenia. According
to the study of McCarthy-Jones and Longden (2015), it is stated that auditory hallucinations
or hearing of different types of voice is one of the most common symptoms of schizophrenia
and it is reported among more than 75 per cent cases of schizophrenia. In this context, it
should be mentioned that in most of the cases the auditory hallucination occurs due to the
history of previous traumatic life events and in this case of Adrian it was observed that the
patient had the trait of emotionally unstable personality disorder and it may be possible that
the cases of hallucination may be due to this previous unstable emotional condition of the
patient. The study of Jones and Longden (2015) also reported the presence of auditory verbal
hallucination (AVH) among the patients who have schizophrenia. Moreover, along with the
presence of AVH, this present study also reported the fact that in cases of hallucination, the
patients may have previous traumatic incidents in their life and as a consequence of those
traumatic incidents, the individual is experiencing the hallucinating episodes in their life. The
study of Sheffield et al. (2014) reported that due to previous traumatic events there are
changes in the neuronal cells of the body and as a result case of hallucination is informed by
the patients suffering from schizophrenia.
Impact of the Problem
While discussing the impact of the mental health disorder on the family members and
other caregivers of the patients suffering from the problem of schizophrenia it can be stated
that this disease has a seriously bad impact on the caregivers and the family members of the
patients who are suffering from the problem of schizophrenia. According to the study of
Caqueo-Urízar et al. (2017), it is stated that the presence of schizophrenia in a specific family
can alter the dynamics of the family and the roles of each member of the family are altered by
caring for the patients who have schizophrenia. Moreover, due to the process of care giving

6SCHIZOPHRENIA AND ASYMPTOMATIC ANTIPSYCHOTICS
to the patients suffering from schizophrenia the family members may lose their social life and
friends as they are unable to go outside of the house. Moreover, the study also reported that
caregivers indicated that the patients are not at all, fulfilling their expectations. Moreover due
to the caring process of schizophrenic patients, the caregivers and the family members are
facing a huge amount of stress due to their care process. Moreover, in these studies, the
researchers also reported that during the caring process, the family members face a huge
amounts of stress as they are not able to communicate with their family members suffering
from schizophrenia. The issue of financial burden due to the problem of schizophrenia the
caregivers also face trauma and stress-related conditions in their life. Another study by Hayes
et al. (2016) reported about the poor quality of life is reported among the family members of
the patients suffering from the disorder that is schizophrenia. The study reported that the
negative impact of caregiving process on the family members of patients having
schizophrenia was identified since the mid-1950s. The present study reported that as a part of
difficulties among the caregivers, issue of mental burden, distressing behaviors and reduced
quality of life were reported. The main aim of the present study is associated with the
measurement of altered quality of life and enhanced social isolation and another aim of the
study is to assess the experiences of the care givers while delivering care to the patients who
have schizophrenia. In this study almost 60 participants were recruited as study sample and
each of the participants was family members of the patients suffering from schizophrenia. In
order to assess the quality of life of among the family members a few assessment scales were
used and they are mainly The experience of caregiving inventory (ECI) scale, The friendship
scale (FS) scale, The general health questionnaire-28 (GHQ) scale, The World Health
Organisation Quality of Life Questionnaire, brief form (WHOQoL-Bre`f). In this study, the
rate of participation was almost 48 per cent (Hayes et al. 2016). The study result showed that
the family members of the patients suffering from schizophrenia have ten times more socially

7SCHIZOPHRENIA AND ASYMPTOMATIC ANTIPSYCHOTICS
isolated than that of the family members of the normal people. Along with this, the study also
stated that the quality of life is also degraded among the family members of schizophrenia
patients. Moreover, the present study also reported that the caregivers or the family members
of the patients suffering from dementia met almost 40 per cent criteria of developing mental
illness among themselves as well. The researchers reported that the main reason for
developing mental health problems is associated with the fact that the need of the carers are
not met and thus, they may feel distressed due to their social isolation (Hayes et al. 2016).
Therefore, it can be stated that the lack of meeting the requirements among the family
members of schizophrenic patients is associated with the development of mental health
disorders among the caregivers of the patients suffering from schizophrenia. However the
study also deduced that the lack of proper knowledge regarding schizophrenia also could
cause mental distress among caregivers. This study also supported that due to schizophrenia,
the carers also faced economic and social burden due to social isolation (Hayes et al. 2016).
The study of Shamsaei et al. (2015) also reported the onset of stress among the family
members of the patients who have schizophrenia. The main of this study is to find the
prevalence of the burden on the family members of the patients suffering from the disease
condition. In this cross sectional study face to face interview was conducted by the
researchers with the family members who are responsible for providing care to the patients
with schizophrenia. The study reported that it is very stressful to live with a relative who has
the problem of schizophrenia. In this context, it can be stated that the family members face a
high level of stress condition and a lot of burden due to this mental health disorder and as a
consequence of this stress condition, it is reported that the patient may face adverse health
condition, disruptions in the social life of themselves, reduction of the household income and
thereby also contributes to the economic burden on the family as well. In this study, it was
mentioned that the taking care process is identified differently in different countries

8SCHIZOPHRENIA AND ASYMPTOMATIC ANTIPSYCHOTICS
(Shamsaei et al. 2015). In this context, the example of Thailand can be given. In Thailand, the
family members generally like to take care of their mentally ill family members in their own
house, but they perceive it as suffering for them and this type of experience was marked as
negative experience by them and this example of Thailand also stated that due to this mental
health disorder the family members also experienced the emotional distress, physical burden,
economic burden and social stigma as well. In this context, it can be stated that the family
members also had a lack of knowledge regarding mental health disorders. This present study
also revealed that the different culture poses different perspective to the process of care
giving to the mentally ill patients and health and social care system of different countries may
influence the caregiving process of mentally ill patients. The study of Shamsaei et al. (2015)
was conducted from July to September 2012 and the study samples were selected by using a
convenience sampling method. In this study almost 225 relatives of patients having
schizophrenia were selected as study population. In order to collect the data from the
patients’ relative face-to-face interviews were conducted by a team of researchers. The Socio-
Demographics Questionnaire and one scale were used by the authors to collect the data from
the study samples. While measuring the burden symptoms of the participants, Zarit Burden
Interview (ZBI) was used by the researchers and it was reported that the instrument has a
possible score of 0-88 as per the responses of the care givers of the family. The study result
showed that 94 family members out of 225 care givers had reported about moderate burden
due to the condition and 61 family members reported about severe burden in their life due to
the caring process of schizophrenia patients. Therefore, the study concluded that the burden
experienced by the family members of the patients with problem of schizophrenia is
multifaceted and large. The study also reported that due to the burden on the family members
of patients with schizophrenia, the stress coping capability of the family members is reduced
and as a result they face more stress due to the caring process of the schizophrenic members

9SCHIZOPHRENIA AND ASYMPTOMATIC ANTIPSYCHOTICS
of the family. Moreover, the study also reported that the duration of the disease condition
could also enhance the burden of stress among the family members that are spending more
hours with the mentally ill patients can enhance the burden of stress among them. Thus it can
be stated that the stress of the family members can be contributed by the enhanced hour of
care process (Shamsaei et al. 2015).
Assessment of Disease
While discussing the evaluation of the disease condition, it can be stated that the
diagnosis process of the disease condition is executed by mental health practitioners and it is
very crucial to identify the disease as it is a chronic mental health condition. As a part of the
diagnosis of schizophrenia, the physician firstly should start a physical condition of the
patient in order to mitigate other complications related to the health of the patients. As a part
of the next stage screening process various diagnostic tests can be performed by the doctors
and for example it can be stated that for diagnosing the condition MRI scan, CT scan can be
used. In the study of Dazzan et al. (2015) the effectiveness of MRI scanning is examined and
the study tried to predict the first episode of schizophrenia by using this imaging technique.
By using this modern imaging technique, the researchers can detect the changes in frontal and
temporal grey matter, enlargement of the ventricles and volumes reductions that are related to
outcome of schizophrenia among the patients. In this present study, 11 studies were used for
the systematic literature study and all of the articles are dealing with the problems of
alteration in the brain structure such as medial temporal and prefrontal cortical areas, and in
the neural networks which connect them with subcortical organizations in the brain of the
individuals suffering from the mental health disorder condition. The study concluded that by
using the neuroimaging techniques the researchers are able to predict the first episode of
schizophrenia. However, it is also reported that in some cases, the researchers may have to
use the combination of neuroimaging techniques and other biomarkers for detecting the

10SCHIZOPHRENIA AND ASYMPTOMATIC ANTIPSYCHOTICS
structural disorientation in the brain of the individuals. Another study by Pasternak, Kubicki
and Shenton (2016) also supported the findings of Dazzan et al. (2015) and it was reported
that neuro-inflammation due to mental health problems such as schizophrenia could be
detected by the help of neuro-imaging technique. This study also states that apart from the
MRI technique there are various other imaging techniques such as positron emission
tomography, anatomical MRI and diffusion MRI and MRS can also be used for the detection
of schizophrenia among the patients. However, the study also reported that during the PET
scan the subject may expose to ionization and in case of MRS no such ionizing radiation is
reported by the researchers along with this, it is also identified that the MRS technique has
higher level of specificity in terms of targeting the metabolites which present in the glia cells
in the brain cells. However, in this method poor spatial resolution and limited coverage of the
brain are also reported by the researchers. Moreover the accuracy of the anatomical MRI and
diffusion MRI are more sensitive in terms of detecting neuroanatomical changes in the brain
cells; however, the specificity is less than that of PET scan technique and MRS technique
(Pasternak, Kubicki and Shenton 2016).
Support to the Patient
While discussing the care process given to Adrian in the hospital care setting, it can
be stated that the nurse first treated the cut of Adrian when he self-harmed himself as a part of
his aggressive behaviours. From the case study of the patient, it can be reported that the
patient preferred a one to one session with the health care professionals. Along with this, it
was also reported that Adrian also requested lorazpam for sleeping at night as he had
disrupted sleeping patterns. In this context, it can be stated that the nursing personnel used a
person centred care for treating Adrian as all the care process revolves around Adrian. As a
part of the care process the nurses attended a one to one session with Adrian and Adrian
reported that one of the voices tells him to stop his medications. Along with this, the health

11SCHIZOPHRENIA AND ASYMPTOMATIC ANTIPSYCHOTICS
care professionals also started to engage Adrian in various activities with other staff and
patients so that he cannot pursue any type of aggressive behaviour. As a part of the
pharmacological therapy Adrian is currently receiving drugs like clonazepam, Quetiapine,
Depakote and Lorazpam. According to the study of Mohapatra (2016), it is reported that the
use of clonazepam, Quetiapine is quite effective in treating the conditions of schizophrenia.
In another study by Rode et al. (2014), the use of Quetiapine in the treatment of
schizophrenia was reported by the researchers. In this study the researchers identified that the
use of this drug is quite common among the patients of schizophrenia and among the 196
cases of schizophrenia, approximately 7.96 per cent of patients were prescribed this drug for
their condition. In another study by Grover et al. (2017) it is reported that the use of
Lorazpam is useful in the management of schizophrenia patients. In this case study, it was
observed that Adrian was given those drugs which were proven to be effective for managing
schizophrenia in previous studies by multiple authors.
Conclusion
Therefore, it can be concluded that schizophrenia is a global problem and it has
enormous impact on the family members of the patients suffering from the disease condition.
In this essay, the case study of a patient named Adrian is described who is diagnosed with the
problem of schizophrenia since his age of 19. Schizophrenia is a complex chronic condition
that affects the neuronal functions of the individuals. In this context, it can be mentioned that
the disease is mainly associated with the alteration of thinking behaviours of the individuals
and along with this emotion of the individual is also altered due to this disease condition. He
complained about hearing voices and issue of hallucination was also reported by the patients.
Adrian stated that he heard a specific voice that provides him instructions and commands him
about what to do to the people. Not only this, but the patient also reported that the particular
voice also instructed to do self-harm, attack people and this voice also tells him to kill

12SCHIZOPHRENIA AND ASYMPTOMATIC ANTIPSYCHOTICS
himself. Moreover, Adrian also stated that he believed that this voice had complete control
over his speech and body language. A few common features of this mental health problem
and they are mainly negative symptoms, delusions, hallucinations, disorganized thinking. The
presence of schizophrenia in a specific family can alter the dynamics of the family and the
roles of each member of the family are changed by caring for the patients suffering from
schizophrenia. Moreover, due to the process of care giving to the patients suffering from
schizophrenia the family members may lose their social life and friends as they are unable to
go outside of the house. For assessing the condition the physician may use MRI, PET scan as
these are proven to be effective in detecting schizophrenia. As a part of the pharmacological
therapy Adrian is currently receiving drugs like clonazepam, Quetiapine, Depakote and
Lorazpam.

13SCHIZOPHRENIA AND ASYMPTOMATIC ANTIPSYCHOTICS
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