Undifferentiated schizophrenia case presentation

1. CASE PRESENTATION
PRESENTED BY
OVIYA.J.P
PHARM D

2. CASE SUMMARY
A 34 year old female was admitted in xxx hospital . Patient came with C/O poor self care and reduced
sleep with auditory hallucinations for 3years which is continuous, rest illness and irritability , N/K//CO –
DM, HTN, Asthma, epilepsy . Past medical history:H/O similar illness in past not on medications lab
investigation: Abnormal in Haemoglobin , Lymphocytes ,Platelet count , RBC Count , Absolute
Lymphocyte count. The patient was diagnosed with UNDIFFERENTIATED SCHIZOPHRENIA and
treated with
• T.OLANZAPINE
• T.CLONAZEPAM
• T.TRIHEXYPHENIDYL
• T.RISPERIDONE
• T.PROPRANOLOL
• T.MULTI VITAMINE
• T.LACTULOSE
• Inj . OLANZAPINE

3. PATIENT DETAILS
NAME Mr.X
AGE 34 YEARS
SEX FEMALE
IP. NO yyyy
HOSPITAL xxx HOSPITAL
DATE OF
ADMISSION
03/1/20
DATE OF
DISCHARGE
30/1/20
DEPARTMENT PSYCHIATRY

4. SOAPANALYSIS
S - SUBJECTIVE
O- OBJECTIVE
A - ASSESSMENT
P - PLAN

5. SUBJECTIVE

6. REASON FOR ADMISSION:
C/O Presented with an insidious onset continuous course illness for the last 3years more since the
last 6months not on medications characterised by auditory hallucination , hallucinatory behaviour,
anger outburst , poor self care , increased sleep , hypergraphia, restlessness and irritability in the
absence of organicity.
PAST MEDICAL HISTORY
H/O similar illness in past not on medications
PAST MEDICATION HISTORY :
not on medications.
SOCIAL HISTORY:
Known allergies : Nil
Marital status : Married
Family: Nil

7. OBJECTIVE

8. GENERAL EXAMINATION O/E : Conscious / oriented / afebrile
Sl. No vitals 3/1/20
1. Blood Pressure (mm/Hg)
120/60
110/70
2. Pulse Rate 60-100
(beats/min)
86
3. Respiratory Rate
(breaths/min) 12-22
22
4. Temperature 97 Fº
(Fº)
N

9. LABORATORY INVESTIGATIONS
Sl.No Parameters Reference
value
Normal
1. Haemoglobin 12.1 12-15 g/dl
2. Lymphocytes 45.5% 20-40
3. Platelet count 226000 150000-450000
4. RBC Count 3.33 4.50-5.50million/cumm
5. Absolute Lymphocyte count 3.50 1.03-3.00 10*3 /µl
6. Renal function test:
Sodium
134 136-145mEq/l

10. ASSESSMENT

11. DIAGNOSIS
UNDIFFERENTIATED
SCHIZOPHRENIA
SPECIFIC TESTS : urine examination
blood test.
PANSS RATING
GENDERAL PSYCHOPATHOLOGY SCALE

12. PLAN

13. BRAND NAME GENERIC NAME DOSE FREQ DATE
3/1-
13/1
14/1-
18/1
19/1 20/1-
28/1
29/1-
30/1
T.OLEANZ OLANZAPINE 5mg 1-0-2    - -
10mg 1-0-1 - - -  
T.LINOTRIL CLONAZEPAM 1mg 0-0-1   - - -
0.5mg 0-0-1 - -   
T.PACITANE TRIHEXYPHENIDYL 2mg 1-0-1     
T.SIZODON RISPERIDONE 2mg 1-0-1   - - -
4mg 1-0-1 - -   
T.PRONATE PROPRANOLOL 20mg 1-0-0     
T.MVT MULTI VITAMINE 1-0-0     
Syp .
LACTULOSE
LACTULOSE SOS     
Inj. TOLAZLA OLANZAPINE 40mg OD     

14. DRUGS MECHANISM ADR USES
OLANZAPINE Act through combination of
dopamine and serotonin type 2
receptor site antagonism
Weight gain ,
dizziness, constipation
hypotension
Antipsychotic
CLONAZEPAM It increases the GABA activity, that
send chemical signals to nervous
system
Somnolence ,
depression, dizziness,
memory impairment
Anticonvulsant
TRIHEXYPHENIDYL Inhibits the parasympathetic
nervous system and has a relaxing
effect on smooth muscle .
Anticholinergic side,
rash,
stiffness, tremors,
spasms, and poor
muscle control
of Parkinson's disease
RISPERIDONE It blocks D2 receptor and 5H2
receptor
Insomnia ,
somnolence,
headache,
parkinsonism
mental/mood
disorders,
schizophrenia

15. PROPRANOLOL It reduces the heart
beat slowly with less
force which lower
blood pressure
Hypotension ,
aggravated congestive
heart failure
hypertension
MULTI VITAMINS It supports metabolic
functions such as DNA
and RNA.
Dark colored stools,
constipation , diarrhea
vitamin deficiencies
LACTULOSE Increases stool water
content , soften stools
that promotes
peristalsis decreased
blood ammonium
concentration
Dehydration,
abdominal cramping,
constipation

16. DISCHARGE MEDICATION
S.NO N.AME OF THE DRUG DOSAGE FREQUENCY DURATION AFTERFOOD
1. T.SIZODON/RISPERIDONE 4 mg 1-0-1 15days After food
2. T.PRONATE/PROPRANDLOL 20 mg 1-0-0 15days After food
3. T.LINOTRIL/CLONAZEPAM 0.5mg 0-0-1 15days After food
4. T.PACITANE/TRIHEXTPHENIDYL 2mg 0-0-1 15days After food
5. T.MVT 1-0-0 15days After food

17. PHARMACIST INTERVENSION
Drug – Drug Interaction
CLONAZEPAM +RISPERIDONE :- Both drugs increase sedation.
RISPERIDONE,OLANZAPINE +TRIHEXYPHENIDYL:- increases the effect of trihexyphenidyl by
pharmacodynamic system.
OLANZAPINE + RISPERIDONE :- Both increases the effect of anti dopaminergic effect and sedation.
RISPERIDONE + CLONAZEPAM+ ETHANOL:- Both increases sedation.

18. General counselling
PATIENT COUNSELLING :
Don’t take any medications including OTC medications without physician advice.
 Reduce stress , anxiety.
Avoid isolation from other persons.
Counselling to reduce the suicidal taught .
Engaged about other works like exercisng and watching tv.
Life style modification or non medical treatment
 Group therapy .
 Family therapy.
 Community support group.

19. Drug Based
OLANZAPINE :-Do not drive a car or operate machinery until you know how this medication affects you
CLONAZEPAM:-Body aches and pains, palpitations, memory disturbance, headache, and tiredness and
several other side effects have also been reported.
TRIHEXYPHENIDYL:-May be taken before or after meals; tolerated best if given with food.
RISPERIDONE:-You should avoid the use of alcohol while being treated with risperidone . Alcohol
can increase the nervous system side effects of risperidone such as dizziness, drowsiness, and difficulty
concentrating.
PROPRANOLOL:- People taking propranolol should also avoid nonsteroidal anti-
inflammatory drugs (NSAIDs) such as ibuprofen. These drugs may reduce the effects of propranolol.

20. “If you talk to God
you are praying ;
if God talks to you,
you have SCHIZOPHRENIA”
THANK YOU