1) A 52-year-old female patient was admitted to the hospital complaining of talking to herself, suspiciousness, increased anger, irritability, reduced sleep, and reduced food intake over the past week. 2) She has a history of schizophrenia for over 22 years and has been admitted 6 times previously. She is currently on medications for schizophrenia, hypertension, and Parkinson's disease. 3) She was assessed as having paranoid schizophrenia based on delusions of persecution and a restricted affect. She was started on a treatment plan including olanzapine, lorazepam, haloperidol, clonazepam, and clozapine.

1. Case study on Paranoid Schizophrenia
SRI RAMACHANDRA FACULTY OF PHARMACY
DEPARTMENT OF PHARMACY PRACTICE
1
REG NO: P1520004
NAME: JEEVA P
P.B.PHARM D II YEAR

2. SUBJECTIVE EVIDENCE
A 52 years female patient was admitted in the hospital.
C/O:
Talking to self ,suspiciousness
Increased anger and irritability 1week
Reduced sleep,reduced food in take
Insidious onset;continuous course
2

3. SUBJECTIVE EVIDENCE
History of present illness:
• k/c/o psychatric disorder on treatment on more 22 years.1 week she expressing increased
anger towards verbally and physically then.
• she was found to be reduced sleep and talking self to be presented.
• The patient claim that her daughter was planning kill her by mixing unwanted tablets in
the food.
• The patient brought into srmc opd for admission.
• No H/O of mood symptoms.
• No H/O fever,head injury,seizures.
3

4. SUBJECTIVE EVIDENCE
She was admitted 6 times in SRMC and diagnosed as a schizophrenia.
ECT given in 2016 (5 session).
K/C/O HTN on RX approximately greater than 20 years.
K/C/O drug induced Parkinson on T.SYNDOPA PLUS 125 mg since 7/12/2020.
Past medication: nil
4

5. OBJECTIVE EVIDENCE
Physical examination:
Temp-98
Pulse-80 beats/min
BP-120/80mmHg
RR-20breaths/min
NO PICCLE
Systemic examination:
CVS-S1S2+ no murmurus
RS-NVBS +;no added sound
CNS-NFND
P/A-Soft; no organomegaly
5

6. OBJECTIVE EVIDENCE
Mental State Examination:
Rapport:difficult
ETEC:+/+
PMA:Average
Talk:Relevant
Mood: nalla iruku
Affect:Restricted
Thought: delusion on persecution
Perception: no abnormality
6

7. LABORATORY INVESTIGATION
7
parameter Observed value Normal range
COMPLETE BLOOD COUNT:
HB 8.2↓ 12-17g/dl
PCV 29.3↓ 41-59*/*
TC 2048↑ 4000-1100cumm
MCV 72.7↓ 76-96fl
MCH 19.6↓ 27-32pg
MCHC 27.0↓ 31-35
LIVER PROFILE:
SGOT 21↑ 15-17U/L
SGPT 17↓ 30-65U/L

8. ASSESSMENT
8
 Paranoid schizophrenia

9. PLAN - Drug chart
DRUGS PRESCRIBED
DOSE ROUTE FREQUENCY DURATION
GENERIC NAME
T.AMLODIPINE 5mg P/O 0-0-1 8/11 TO 2/12
T.ENALAPRIL 5mg
P/O
0-0-1 8/11 TO 2/12
T.TRHEXAPHENYDL 2mg P/O 0-0-1 10 days
T.LITHIUM 300mg P/O 0-0-1 7 Day
T.CHLOROPROMAZINE 100mg P/O 0-0-2 15 days
T.DIAZEPAM 5mg P/O 0-0-1 18 days
T.LEVODOPA&CARBIDOPA 125mg P/O 1-1-1 8/11 TO 2/12
INJ.HALOPERIDOL 5mg IM SOS 6 days
INJ.PROMETHAZINE 25 mg IM SOS 5 days
T.HALOPERIDOL 5mg P/O 1-0-1 2 days
9

10. GENERIC NAME DOSE ROUTE FREQUEN
CY
DURATON
INJ.LORAZEPAM 4mg IM HS 15 days
T.HALOPERIDOL 5mg P/O 1-0-1 2 days
T.OLANZAPINE 10mg P/O 0-0-1 20 days
T.RANTIDINE 150mg P/O 1-0-1 8 days
T.CLONAZEPAM 1mg P/O 1-0-1 8days
T.CLOZAPINE 12.5mg P/O HS 6days
INJ.IRON SUCROSE 200mg IV 1-0-0 3 days
T.CHLORPROMAZINE 50mg P/O BD 4 days
T.MIRTAPINE 7.5mg P/O HS 7 days
10

11. Drug related problems
1.Untreated indications: NIL
The given drugs are comes the Indian pschyatric
society.
2.mproper drug selection:NIL
The given drugs are proper drug selection of indan pschyatrc
society guideline.
3.Sub therapeutic dose: NIL
The given drugs are reaches drug acton appropriate doses.
4.Medication failure to receive: NIL
5.Medication overdose: NIL
11

12. 6.Adverse drug reaction:. NIL
7.Medication use without indication: NIL
8.Drug interaction: YES (Practically)
T.OLANZAPINE+T.CHLORPROMAZINE
The given drugs to the patient cause a (QT –PROLONGING AGENT).
Adviced to physician to be change the drugs orders.
These drug caused tachycardia and fever with chillness.
Reference : uptodate
9.Antibiotic Resistance : NIL
10.Intervention: YES
12

13. Critical Analysis Of Prescription
Guidelines used INDIAN PSCHYATRIC SOCIETY
Clinical condition Paranoid schizophrenia
Contraindication NIL
Drugs prescribed as per guideline YES
The drugs are prescribed under
INDAN PSCHYATRC SOCIETY.
T.CHLORPROMAZINE,
T.HALOPERIDOL,
T.CLONAZEPAM
13

14. PATIENT COUNSELING
Regarding the drugs:
Schizopherina is a serious mental disorder n
which people interpart reality abnormally.It may result in some
combinaton of hallucinatons,delusions and behaviour.
Paranoid Schizopherina is characterized by
feeling of persecution,grandiose delusionand auditory
hallucinations.
14

15. PATIENT COUNSELING
Regarding the drugs:
• T.OLANZAPINE is an atypical antypical antipschyatric used to treat Schizopherina
and bipolar disorder.
• T.LORAZEPAM is used to treat anxiety disorder, trouble sleeping and alcohol
withdrawal.
• INJ.HALOPERIDOL is used to treat mental disorder/mood disorder.it help to think
more clearly and feel less nervous.
• INJ.PROMETHAZINE is used to treat allergies,trouble in sleeping and nausea.
15

16. PATIENT COUNSELING
Regarding life style modification:
• Psychotherapy or talk therapy is an imoortant part of treatment for bipolar disorder
• During the therapy the patient can discussion feelings,through and behavior,that cause
you problems.
• It can help you maintain a positive self image
• Congnitive behavioural therapy.it teach individuals have to manage stress and side effect
of medication.it can also help to treat anxiety and depression.
• Interpersonal therapy
• Ensure to get plenty of sleep upto symptoms
• Be involued in your treatment
• Minimize stress.
16

17. 17