MX, a 13-year old girl, was admitted to the psychiatry ward after displaying signs of aggression, hallucinations, and delusions in school. She reported seeing and hearing strange things and feeling that her classmates were invoking her. Upon examination, she exhibited irrational and repetitive speech, auditory and visual hallucinations, and was diagnosed with an acute psychotic illness. Her medication regimen was adjusted to increase the dose of an anticholinergic drug to address extrapyramidal side effects from her antipsychotic medication.

2. GENERAL PATIENT INFORMATION AND
CHIEF COMPLAIN
MX, a 13 year old girl from Enugu State who
was presently living at Elele was well till
about nine hours when she was admitted to
the psychiatry ward on account of her
hearing and seeing strange things and been
invoked by her classmates in school

3. HISTORY OF PRESENT ILLNESS
MX was apparently well in the morning until 9
hours in School where she began displaying signs
of aggressiveness. She complained of seeing
strange things and hearing strange voices; she
also complained of being invoked by her
classmates in school. After that, she was rushed
to the Psychiatry ward where she displayed signs
of aggression, hallucination, inappropriate
laughter and delusion. She felt people are against
her.

4. PAST MEDICATION HISTORY
MX had no record of any medication before admission
PHYSICAL EXAMINATION
MX is a well nourished young girl who is overweight. Her weight shows 113 Kg
No record of vital signs taken for MX.
Mental Status Examination:
A young girl, well dressed, calm and cooperative.
Speech: Irrelevant, irrational and repetitive.
Mood: Does respond appropriately.
Affect: Constraint
Thought: Parliament
Perception: Auditory and Visual hallucination
Cognition: conscious and oriented TPP (Time, Place Person)

5. DIAGNOSIS
Differential diagnosis: Schizophrenia and
Mania form of Bipolar Disorder
R/O: Mania form of Bipolar Disorder
Definitive Diagnosis: Acute Psychotic
illness

6. MEDICATION HISTORY
Inj Diazepam 10 mg STAT
On Admission:
Tab Haloperidol 5 mg b.d × 2/52
Tab Benzhexol (Trihexyphenidyl) 2.5 mg b.d × 2/52
Tab Nitrazepam 5 mg b.d × 2/52
On review on 3rd day of admission
Inj Biperiden (Akineton) 5 mg STAT
Tab Benzhexol (Trihexyphenidyl) 5mg b.d × 2/52
Paracetamol 1g t.d.s × 2/7

7. PHARMACEUTICAL CARE PLAN
To stabilize the patient
To improve patient mental status
To prevent potential and actual side
effects
To improve patient adherence
To improve patients quality of life.

8. DRUG THERAPY RECONCILIATION
DOSAGE/DOSES FUNCTION EVALUATION
i) Inj Diazepam 5
mg (IV) STAT
Anxiolytic/Hypnotic Satisfactory
ii) Tab Haloperidol
5 mg b.d × 2/52
Typical
Antipsychotic agent
Satisfactory
iii) Tab Benzhexol
(Trihexyphenidyl)
2.5 mg b.d × 2/52
Anti-Parkinsonian
agent;
Anticholinergic
Not satisfactory
iv) Tab Nitrazepam
5 mg b.d × 2/52
Anxiolytic/Hypnotic Satisfactory
v) Inj Biperiden
(Akineton) 5 mg
STAT
Anti-Parkinsonian
agent;
Anticholinergic
Satisfactory
vi) Tab Benzhexol
(Trihexyphenidyl) 5
mg b.d × 2/52
Anti-Parkinsonian
agent;
Anticholinergic
Satisfactory

9. Drug Therapy Problem
The typical Antipsychotic drugs have
extrapyramidal side effect. This is usually
countered with an Anticholinergic. The dose of
Benzhexol was too low to counter the effect of
haloperidol on this patient which resulted in
stiffness of neck. There was turning of neck
days later

10. PHARMACEUTICAL CARE INTERVENTION
Due to the development of extrapyramidal side effect
expressed as stiffness and turning of neck, the attention
of the physician was drawn to it and the dose increased
to 5 mg for the remaining time she spent in the hospital.
Also, she was giving Biperiden (Akineton) 5 mg STAT
to reduce the cholinergic effect
 since the patient has been discharged, no further
intervension was made on the case
The a suggestion was made to the attending Physician,
to seek out for the