Case Study Presentation: Schizophrenia Diagnosis and Treatment

This case study presents a detailed analysis of a 24-year-old woman recently diagnosed with schizophrenia. The report encompasses her medical history, clinical examination findings, differential diagnosis, and a comprehensive plan of care, including therapies, medications, and counseling. It explores the pathophysiology of schizophrenia, focusing on neurotransmitter abnormalities and their impact on the disease's progression. The study also delves into the etiology, epidemiology, prevalence, potential complications, and prognosis of the disease. Ethical dilemmas in treating schizophrenic patients are discussed, along with the importance of patient support and the need for additional investigations to address potential lifestyle disorders. The case highlights the significance of both pharmacological and non-pharmacological treatments in managing the disease and improving patient outcomes, even though the prognosis can last a lifetime.

Running Head: CASE STUDY PRESENTATION
CASE STUDY PRESENTATION OF SCHIZOPHRENIA
Name of the Student
Name of the University
Author’s Note

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Abstract
The following report is a case study presentation of a 24 year old who is recently diagnosed with
schizophrenia. It is a detailed explanation and analysis of her health conditions including medical
history, analysis of her clinical examination, an appropriate plan of care, differential diagnosis,
the support she needs due to her mental state, exploration of other medical investigations, the
pathophysiology of the disease, treatment and patient management. It also includes the etiology,
epidemiology, prevalence, complications, prognosis and ethical dilemmas concerning
schizophrenic patients and schizophrenia as a disease.

2CASE STUDY PRESENTATION
Introduction
This case study is on a 24 year old woman who is recently diagnosed with Schizophrenia.
She is unmarried, has a bachelor’s degree in psychology, is unemployed and has to attend a
diploma thesis for a master’s degree. She went to Belgium in September 2016, and she started
taking ecstasy and marijuana with her friends. Her mother started noticing changes in her when
she returned to Bulgaria with reduced weight and consistent strange behaviour of not interacting
with anyone, refusing to go out and sitting in a dark place to avoid any communication. Her
medical history was taken with the help of available medical records, and this is the second time
she came to a mental institution clinic. She only had a tonsillectomy when she was an infant.
According to the tests and analysis of the patient, it is seen that there is no evidence of
disorders in the internal organs or negative neurological symptoms. The psychomotor evaluation
showed tensed conditions with reduced signomy and masked facies, her communication is
unclear, clear consciousness, also psychically oriented, has a rigid posture, parabolic behavioural
acts and had tendencies of poor sleep. Her clinical examination indicated that her blood
parameters were normal and the brain X-ray also showed that her corticol sulcuses were normal
in the cerebellum1. After being consulted with a psychologist, a questionnaire MMPI-2 was
given to her, and the results showed that her profile was similar to a person who feels distressed,
has chronic anxiety, feelings of inadequacy, insecurity and inferiority including mental
retardation and concentration problems. The appropriate plan for such complications will be
therapies, medications and counselling sessions with a psychiatrist. She needs to get the required
help to come out of her mental distress and understand her psychological problem, which is
1 Ward, Simon E., Lewis E. Pennicott, and Paul Beswick. "AMPA receptor-positive allosteric modulators for the
treatment of schizophrenia: an overview of recent patent applications." Future medicinal chemistry 7, no. 4 (2015):
473-491.

3CASE STUDY PRESENTATION
leading to such mental disorders2. The medication she was prescribed included Periridan
(antipsychotic) and Clonarex, which improved her speech, contact, behaviour and her reasoning.
Her suicidal ideas decreased, and her catatonic manifestations deactivated. The differential
diagnosis found here is that the symptoms can have several implications of diseases, she is
diagnosed with schizophrenia, but she could be vulnerable to other diseases.
Schizophrenic patients need to be supported because they are not aware of their mental
state; the common symptoms are hallucinations, delusions and poor concentration with the lack
of motivation. They should be considered and given support even when they are showing all the
abnormal symptoms, their family and friends should look after them irrespective of their
behaviour and make them involved in their social circle3. Additional investigations can be
advised because she complained of increased appetite and weight gain, which could have several
implications or symptoms of other lifestyle disorders.
The pathophysiology of schizophrenia is related to the abnormalities in the
neurotransmitter, to be more specific, it occurs due to deficiency of neurotransmitters such as
serotonin, glutamate and dopamine. The neurochemical imbalance of glycine, aspartate, and
gamma-aminobutyric (GABA) is also the pathophysiology of schizophrenia. The symptoms
occur due to abnormal activities in the dopamine receptor sites (specifically D2), and 4
dopaminergic pathways have been associated with this disease4. Treating schizophrenia includes
prevention of relapse and increasing adaptive function of the patients so that they can be a
respected member of the society. Both pharmacological and non-pharmacological treatment
2 Sanatinia, Rahil, Violet Cowan, Kirsten Barnicot, Krysia Zalewska, David Shiers, Stephen J. Cooper, and Mike J.
Crawford. "Loss of relational continuity of care in schizophrenia: associations with patient satisfaction and quality
of care." BJPsych open 2, no. 5 (2016): 318-322.
3 Chien, Wai Tong, Andrew V. Clifton, Sai Zhao, and Steve Lui. "Peer support for people with schizophrenia or
other serious mental illness." Cochrane Database of Systematic Reviews 4 (2019).
4 Grace, Anthony A. "Dysregulation of the dopamine system in the pathophysiology of schizophrenia and
depression." Nature Reviews Neuroscience 17, no. 8 (2016): 524.

4CASE STUDY PRESENTATION
methods are used for the treatment such as prescribing antipsychotic drugs, amphetamines and
other central nervous system stimulants, psychotherapeutic approaches can be used that includes
counselling sessions and schizophrenia management5.
Discussion
The etiology of schizophrenia has been identified after a century of research, and it is
found that various phenotypes of the disease are caused due to environmental influences as well
as genetic susceptibility. One of the major reason for the development of schizophrenia starts
from the time an individual is a foetus, obstetric complications, emergency caesarean sections,
gestational diabetes, low birth weight or asphyxia. These health complications can lead to
schizophrenia in later life.
The prevalence of schizophrenia is 1% all around the world, the number of new cases
annually is 1.5% in every 10,000 people, and the age of onset is usually between 16-30 years of
age, suffering from schizophrenia during late life is rare6.
The complications of this disease are suicidal thoughts, self-harm, obsessive-compulsive
disorders and anxiety, depression, substance abuse such as alcohol and drugs, inability to
perform daily life activities, can come across legal and financial problems, social isolation,
medical complications, being victimised and behaving aggressively with others7.
No cure for this disease has been identified, which means that the prognosis of this
disease can last a lifetime. Only 50% of the patients can get back to their normal life after they
5 Lally, John, and James H. MacCabe. "Antipsychotic medication in schizophrenia: a review." British medical
bulletin 114, no. 1 (2015): 169-179.
6 Brown, Alan S., and Florence S. Lau. "A review of the epidemiology of schizophrenia." In Handbook of
Behavioral Neuroscience, vol. 23, pp. 17-30. Elsevier, 2016.
7 Yogaratnam, Jegan, Neetesh Biswas, Ramyadarshni Vadivel, and Rajesh Jacob. "Metabolic complications of
schizophrenia and antipsychotic medications--an updated review." (2017).

5CASE STUDY PRESENTATION
are diagnosed of this disease, 25% need the required support and help network from others, 15%
are in the hospitals and do not have any chances of recovering and 10% find no other way, so
they end up giving their life8.
Certain ethical dilemmas come in question during the treatment of this disease because
the concerned patient is mostly paranoid or not in their senses, which makes it difficult for the
health providers to reveal the complications of the disease. Telling them the truth or not becomes
an obstruction during the treatment because a psychiatrist should not withhold information from
a patient regarding their treatment or diagnosis as it affects a patient’s autonomy, and if they
reveal the information, then they can risk the mental state of the patient.
Conclusion
Schizophrenia is a disorder that is complex and requires immediate treatment when the
person is showing the symptoms of psychotic episodes. When the treatment plan is being
decided, then the medical professional should consider the potential for non-adherence and
adverse effects of treatment. Although, several treatment methods have been found under
pharmacological and non-pharmacological methods that can support and decrease the intensity
of the disease even if the prognosis can last a lifetime. The patient in the case study showed
symptoms of schizophrenia, and she was diagnosed for the same, she had health complications
when she was an infant, and this can be a reason for the development of schizophrenia in her
later life.
8 Yamanaka, Hiroshi, Nobuhisa Kanahara, Tomotaka Suzuki, Masayuki Takase, Toshihiro Moriyama, Hiroyuki
Watanabe, Toyoaki Hirata, Makoto Asano, and Masaomi Iyo. "Impact of dopamine supersensitivity psychosis in
treatment-resistant schizophrenia: an analysis of multi-factors predicting long-term prognosis." Schizophrenia
research 170, no. 2-3 (2016): 252-258.

6CASE STUDY PRESENTATION
Bibliography
Ward, Simon E., Lewis E. Pennicott, and Paul Beswick. "AMPA receptor-positive allosteric
modulators for the treatment of schizophrenia: an overview of recent patent
applications." Future medicinal chemistry 7, no. 4 (2015): 473-491.
2 Sanatinia, Rahil, Violet Cowan, Kirsten Barnicot, Krysia Zalewska, David Shiers, Stephen J.
Cooper, and Mike J. Crawford. "Loss of relational continuity of care in schizophrenia:
associations with patient satisfaction and quality of care." BJPsych open 2, no. 5 (2016): 318-
322.
3 Chien, Wai Tong, Andrew V. Clifton, Sai Zhao, and Steve Lui. "Peer support for people with
schizophrenia or other serious mental illness." Cochrane Database of Systematic Reviews 4
(2019).
4 Grace, Anthony A. "Dysregulation of the dopamine system in the pathophysiology of
schizophrenia and depression." Nature Reviews Neuroscience 17, no. 8 (2016): 524.
5 Lally, John, and James H. MacCabe. "Antipsychotic medication in schizophrenia: a
review." British medical bulletin 114, no. 1 (2015): 169-179.
6 Brown, Alan S., and Florence S. Lau. "A review of the epidemiology of schizophrenia."
In Handbook of Behavioral Neuroscience, vol. 23, pp. 17-30. Elsevier, 2016.
7 Yogaratnam, Jegan, Neetesh Biswas, Ramyadarshni Vadivel, and Rajesh Jacob. "Metabolic
complications of schizophrenia and antipsychotic medications--an updated review." (2017).
8 Yamanaka, Hiroshi, Nobuhisa Kanahara, Tomotaka Suzuki, Masayuki Takase, Toshihiro
Moriyama, Hiroyuki Watanabe, Toyoaki Hirata, Makoto Asano, and Masaomi Iyo. "Impact of

7CASE STUDY PRESENTATION
dopamine supersensitivity psychosis in treatment-resistant schizophrenia: an analysis of multi-
factors predicting long-term prognosis." Schizophrenia research 170, no. 2-3 (2016): 252-258.