This case presentation discusses a 20-year-old female diagnosed with paranoid schizophrenia, characterized by symptoms including irritability, hallucinations, and social withdrawal. The patient was treated with various medications, including haloperidol and risperidone, with a notable decrease in her symptoms as assessed by the Positive and Negative Syndrome Scale (PANSS). The treatment outcomes indicated significant improvement in her condition, with a reduction in hallucinations and better social interaction by discharge.

1. CASE PRESENTATION ON
PARANOID SCHIZOPHRENIA
Student Name: MOHAMED JAFRAN J
Date:05.02.2025
Preceptor Name: Dr. MOHAN KUMAR
Ward: PSYCHIATRIC WARD

2. Introduction
• Schizophrenia is a mental disorder characterized by disruptions in thought
processes, perceptions,irritability, and social interactions. Risk factors include
family history, stress and other environmental factors.
• Paranoid schizophrenia is a type of schizophrenia characterized by
paranoia,which is distrust and suspicion towards others.
• Schizophrenia has two main types of symptoms that are positive & negative.
• The positive symptoms are hallucination, delusions, thought disorders ,
movement disorders.
• The negative symptoms are social withdrawal, isolation, apathy and reduced
speech.[1]
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3. Epidemiology
Schizophrenia is a significant mental health concern in India, with prevalence rates
reported between 1.5 to 2.5 per 1,000 individuals. Among the various subtypes,
paranoid schizophrenia is notably prevalent. For instance, a study conducted in
Central India found that 79.59% of schizophrenia diagnoses were of the paranoid
type.Similarly, research from an Indian hospital reported that 63.3% of schizophrenia
cases were classified as paranoid schizophrenia.[2]

4. Subjective Evidence
PATIENT
DEMOGRAPHICS:
• Patient ID: 19165
• Age: 20 Years
• Sex: Female
• Date of admission :22/01/25
• Date of discharge :31/01/25
• Height:150cm
• Weight: 70Kg
• BMI:31kg/m2
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CHIEF COMPLAINTS:
• C/O Irritability,
• Isolation,
• Delusion,
• reduced food intake,
• reduced sleep,
• suspicion,
• Auditory hallucination,
• Visual hallucination x past 1months

5. • Past medical history : Nil.
• Past medication history: Nil.
• Social history – Social withdrawal.
• Family history – History of mental illness to her father.

6. Objective Evidence
GENERAL EXAMINATION:
• BP: 120/80 mmHg
• Pulse rate: 78/min
• Temp: 98.6°F
• RR: 22/min
• SPO2: 98%
SYSTEMIC EXAMINATION:
• CVS: S1S2+
• RS: B/L AE+
• CNS: NFND
• PS: Soft.

7. Other Investigations:
Mental State EXAMINATION(MSE):
• Mood: Hostile
• Perception: Auditory hallucination,Visual hallucination.
• Thought:Suspicion.
• Speech: Relevant(RT-↓).

8. Laboratory Investigations
PARAMETERS OBSERVED VALUE NORMAL VALUE
Hemoglobin 12.8 13 to 17 g/dl
Total RBC count 4.78 3.8-4.8 millions/mm³
WBC count 7500cells/mm³ 4,000-10,000cells/mm³
Differential Count
N-40%
L-38%
M-03%
N-40-80%
L-20-40%
M-2-10%
Platelet count 3.8 lakhs 2.0-4.0 lakhs/mm3

9. Assessment
• Through my assessment patient’s father had mental illness and the patient’s risk
factor associated with social withdrawal, isolation, reduced sleep with the DSM-5
criteria the patient is assessed to have PARANOID SCHIZOPHRENIA.
• The severity of the present condition was assessed using PANSS(Positive and
negative syndrome scale) scale and on the time of admission the score is 116
(Moderate severe)
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10. Therapeutic Goals
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• To reduce the symptoms of delusion, suspicion, auditory hallucination and visual
hallucination.
• To prevent the progression of disease
• To monitor undesirable effect of following drugs:
Haloperidol- Tardive dyskinesia,hypotension,bradykinesia
Trihexyphenidyl- Blurred vision,tacycardia,constipation.
Risperidone- Tremor,orthostatic hypotension,Weight gain.
clonazepam- slurred speech,drowsiness,sedation.

11. Treatment Plan
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DRUG NAME BRAND
NAME
Dose ROA Frequency D1 D2 D3 D4 D5 D6 D7 D8 D9 D10
T.Haloperidol Haldol 5mg P/O 0-0-1   
T.THP Trihex 2mg P/O 1-0-0          
T.Clonazepam Clonax 0.5mg P/O 0-0-2          
T.Risperidone Risper 2mg P/O 0-0-1       

12. Dose Calculation[3]
Risperidone dose calculation ,
• Given data
• Weight:70 Kg
• Standard dose: 0.03mg/kg
Required dose for my patient:
Dose = Standard Dose(mg) x weight(kg)
= 0.03 x 70
Dose = 2.1mg.

13. Drug - Drug Interactions
• No significant drug – drug interaction found.

14. Discharge Medications
Drug name Dose Frequency
Tab. Risperidone 2mg 0-0-1
Tab. Trihexyphenidyl 2mg 1-0-0
Tab. Clonazepam 0.5mg 0-0-2
Review after 2 weeks

15. Pharmacist Interventions
• On the day of admission, the patient was treated
with haloperidol for psychosis. However the patient
develops tardive dyskinesia, and treatment was
switched to risperidone
• After two days,tardive dyskinesia resolved,and
risperidone treatment continued.
• The severity of the present condition was assessed
using PANSS (Positive and negative syndrome
scale) scale on the time of admission and also
evaluated the efficacy of therapy by applying
PANSS scale at the time of discharge.

16. Treatment Outcome
• Patient visual hallucination condition was reduced.
• Patient auditory hallucination and delusion condition was reduced.
• Patient having a good interaction with others.
• Patient sleeping pattern has been improved.
• On applying the PANSS scale at the day of admission, the patient scored 116 (Moderate severe) and
on the day discharge the patient scored 68 (Mild) which shows the therapeutic outcome of the
patient. (3)
ON ADMISSION
POSITIVE SCALE SCORE : 29
NEGATIVE SCALE SCORE : 28
GENERAL PSYCHOPATHOLOGY SCALE SCORE : 59
TOTAL SCORE : 116
DISCHARGE
POSITIVE SCALE SCORE : 12
NEGATIVE SCALE SCORE : 15
GENERAL PSYCHOPATHOLOGY SCALE SCORE : 41
TOTAL SCORE : 68

17. Patient Counselling
The patient caretaker was advised to follow the instructions for patient care
• Don’t skip any prescribed medications.
• Advice the patient to get adequate sleep.
• Encourage the patient to partipation in simple household activities like house
keeping, arranging household things.
• Seek medical attention if side effects such as tardive dyskinesia or bradykinesia
occur.
• Regular follow-up is mandatory.

18. Clinical Pearls
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Learn about how to apply PANSS scale.
Scoring and Interpretation
• 58-75: Mild
• 75-95:Moderate
• 95-116:Moderate severe
• >116 : Severe
Clinical Use
• Helps quantify positive,negative and
general symptoms in schizophrenia.
• Assess the severity of schizophrenia.
• Evaluate medication efficacy.

19. Reference
[1] National Institute of Mental Health. Schizophrenia [Internet]. www.nimh.nih.gov.
NationalInstitute of Mental Health;2024.Available from:
https://www.nimh.nih.gov/health/statistics/schizophrenia
[2] https://www.msjonline.org/index.php/ijrms/index
[3] Findling R, Drury S, Jensen P, Rapoport J, Bukstein O, Walter H, et al. American Academy of
Child and Adolescent Psychiatry .Available
from:https://www.aacap.org/App_Themes/AACAP/docs/practice_parameters/
Atypical_Antipsychotic_Medications_Web.pdf
[4] POSITIVE AND NEGATIVE SYNDROME SCALE (PANSS) POSITIVE AND NEGATIVE
SYNDROME SCALE (PANSS) [Internet]. Available from:
https://sitotapsy.com/wp-content/uploads/2016/07/panss.pdf
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