Case Study: Schizophrenia and Drug-Induced Psychosis

This case study explores the symptoms, diagnosis, and treatment of schizophrenia and drug-induced psychosis. It discusses the interventions, including medication and psychosocial therapy, that can be implemented to manage the condition.

Running head: WRITTEN ASSIGNMENT
Case study
Name of the Student
Name of the University
Author Note

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Introduction
The chief purpose for Andy’s medical appointment can be accredited to the
apprehensions of his GP. Individuals diagnosed with schizophrenia manifest auditory
hallucinations, persecutory delusions, social isolation, repeated statements, distorted
thoughts, suicidal ideation, and lack of control on self (Jauhar et al.2014). The DSM-IV
published by the American Psychiatric Association, gives a detailed account of the signs and
symptoms that are characteristics of Schizophrenia. The psychosis teaching video offers
awareness into the procedure of diagnosis formulated in DSM-IV-TR that helps in
determining presence of schizophrenia.
Part A
The case scenario involves Andy, a 21-year-old male who is seeking consultation
from the psychiatrist owing to apprehensions that had been raised by the GP. His condition
had been reported by his classmates to the family members. Previous instances encompass
complaints made by Andy of his roommates inserting an MI5 in his head, in order to control
him, as evidenced by statements "They are putting stuff in my brain" (3:50). Patient history
suggests the presence of delusions, where the client Andy remained worried an anxious about
the insertion ofMI5 by the roommates. One of his statements like, "It is MI5" (4:15)
demonstrates his obsession and anxiety over MI5. Another common symptom of
schizophrenia included the manifestation of passive suicidal thoughts and feelings.
Andy self-confessed to consuming drugs for a prolonged duration and stated that "I
thought of taking some pills" (7:00). He also admitted of not being involved in any kind of
quarrel or squabble with any person. This was supported by statements like "I am not that
kind of person….” (7:25), which in turn provided an indication for the fact that the presence
of schizophrenia failed to induce any kind of visible and apparent violent behaviour in the

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client towards his family members or roommates, regardless of the fact that schizophrenia is
associated with violent actions. Andy also reported a history of consuming Bhang and several
drugs. This points towards the possibility of the person of suffering from drug-induced
psychosis, which has been closely correlated with schizophrenia. Following conducting a
comprehensive patient risk assessment and taking note of the patient history, it was
understood by psychoanalyst that the presenting complaints of hallucinations was a major
problem in Andy, which in turn could be allied with the overconsumption of bhang
(marijuana). The repeated symptoms of hallucination made his family members seek
appointment from the family clinician who was also concerned about Andy’s health and
referred him to the psychiatrist.
For the last four years, Andy has been a university student, without being involved in
any other occupation. Andy has never been involved in any kind of violent conduct, neither
has engaged in any form of illegal or unlawful action, prior to attending the interview.
Nonetheless, he has of late self-proclaimed of contemplating suicide by taking an overdose of
medications. However, he has not being subjected to any treatment modality, in order to cure
the complaint. Analysis of the risk assessment also suggests that his surrounding
circumstances also forced Andy to resort to drug abuse. He also manifested other signs and
symptoms that have been associated with the presence of schizophrenia.
Part B: Mental State Examination
Appearance- Andy is a young lad, aged 22 years, who appeared in casual attire and
was well groomed.
Behaviour-Andy was able to quickly settle down and involve himself in the
assessment. He did not maintain adequate eye contact, and also developed good relationship,
during the course of the assessment.

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Affect and Mood-He demonstrated the presence of a persistent low mood and also
appeared apprehensive, indifferent, nervous and disheartened. On analysing his speech, it was
found to be consistent and coherent, he could maintain a normal tone during the conversation.
Thought form-Andy manifested the presence of reasonable thought form
Thought Content- He exhibited though content that was associated with unhappiness,
hopelessness, reasoning, terrors, delusions, and suicidal feelings.
Perception- His awareness and insight was associated with the perception of things
that were not congruent with actuality, and were manifested in the form of misapprehensions
about the surroundings.
Cognition-Andy has correct orientation to place, time and being.
Insight and judgment- Andy has poor thought and impaired opinion.
Risk Assessment-Andy has a danger of poor nutrition, suicidal thoughts, and social
isolation.
Formulation- Andy, the client is aged 22 years and has presenting complaints that
comprise of anxiety, apprehensions, worry, and depression. He also feels uncomfortable
while establishing eye contact for prolonged duration with the physician. Some noteworthy
signs and symptoms that are manifested by the client include auditory hallucinations and
illusions that alter his perception and make him remain preoccupied with illogical
information that impedes intellectual functioning. This in turn deteriorates his awareness and
insight, and also affects his capability of judgment. On conducting the risk assessment it was
found that he suffers from suicidal ideations, is socially isolated, and has nutritional
deficiency.
Provisional diagnosis

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The primary diagnosis of the client Andy comprised of drug induced psychosis that is
a major symptom of schizophrenia.
Need for referral
Taking into consideration the aforementioned facts, there is a need for referring him
to a psychiatrist, who will provide the necessary assistance to overcome life stresses, since
the symptoms manifested are commonly found in schizophrenia (Gold et al.2013).
Part C care plan
Interventions based on clinical evidences that can be implemented in the present
scenario include psychosocial treatment modalities, medication practices, and nursing
intervention. The primary intervention that can be implemented in this case involves disease
management system and utilisation of chronic care model that is imperative for ensuring
quality treatment to the client.
Application of medication
The primary goal of medication administration would be to eliminate and manage the
presenting complaints of hallucination and delusion. However, medication administration
would also involve demonstration of several adverse effects. Common antipsychotic drugs
that can be implemented are aripiprazole, cariprazine, clozapine, and asenapine (Hasan et al.,
2012). These drugs belong to the category of second generation and/or first generation
antipsychotics (Hasan et al., 2012). Administration of second generation antipsychotics
would be most beneficial in this case as the side effects would be less (Demjaha et al., 2012).
Elimination of symptoms can be easily accomplished, while subjecting Andy to treatment
modality that includes medicines as well as other psychosocial intervention.
Psychosocial intervention

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The major purpose of this intervention would be to assist Andy to engage in social
interaction with others, and help him leader meaningful and purposeful life (Bustillo & Weil.,
2016). Such interventions will be applied in combination with the drugs even after
elimination of the psychotic symptoms (Razali et al., 2000). It will help in effective
management of persecutory delusions. Providing social skills training will also prove
imperative in enhancing communication skills and speech capabilities (Bustillo & Weil.,
2016). Andy might also be shifted to another location in order to restore his social life. The
intervention would also involve family therapy that will facilitate his integration into the
community (Bustillo & Weil., 2016). Implementation of psychosocial intervention will also
help in preventing him from remaining preoccupied with unreal thoughts and would reduce
severity of his hallucinations (Vizzote et al., 2015).
Nursing intervention
The primary goal of this intervention would be to eliminate delusions by providing a
therapeutic and safe environment. Taking into consideration his delusional thoughts, the
nurse is expected to show acceptance towards his values and beliefs, even though they are
unreal. Efforts will be taken not to compromise his trust or deny his belief, while ensuring
that no false promises are given. Andy will be made to confront reality by engaging in
discussions that talk about individuals or things that are currently existing (Pinho, Pereira, &
Chaves, 2017). At the time of medication administration and feeding, special care will be
provided to prevent Andy from developing the false belief that he is being poisoned. This can
be achieved by confirming the medications and the food that is intended to be fed (Schultz &
Videbeck, 2009).
His signs of hallucination will also be addressed by promoting the presence of a
comfortable and safe environment that will help in increasing his orientation to reality.

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Demonstrating acceptance towards the client will make him feel comfortable that will enable
him to talk about his auditory hallucinations and prevent any episodes of self-inflicting harm
(Pinho, Pereira, & Chaves, 2017). Care will be taken to help him understand that perception
regarding MI5 and the voices that he hears are not real. He will also not be subjected to any
kind of discrimination of stereotyping attitude.
Development of a therapeutic association will enhance his recovery, and prevent
further deterioration of the mental condition. Development of remedial association with Andy
will help him realise the impact of the treatment, and reduce severity of schizophrenia. Social
interaction can also be enhanced by introducing him to other patients, and preventing his pre-
occupation with distorted thoughts (Schultz & Videbeck, 2009).
Conclusion
To conclude, the signs and symptoms manifested by the client are due to drug
induced psychosis that often brings about an impairment in speech and cognition, cause
anxiety, depression and impairment of intellectual disability. On analysing patient history it
can be suggested that overdose of drugs played an important role in his present condition.
Thus, appropriate interventions that are based on medication administration, psychosocial
modalities, and nursing treatment should be implemented to cure the condition.

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References
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