Case D: A 43 year old African American Male S.O, is a father of two. He came to

Question

Case D: A 43 year old African American Male S.O, is a father of two. He came to the clinic with depression. He had stopped going to work stating “my boss hates me and he always like to get me in trouble.” Patient came in with wife who is very supportive. History shows patient had being treated for psychosis schizophrenia, has had two inpatient and many outpatient hospitalization. Two months ago, patient mildly agitated. Wife reported that he was pulling furniture behind the doors of the living room saying “they are trying to break into ou5r house.” Patient has become isolative, eating less and often don’t want to go out of the house. Stopped taking medication 2-4 weeks ago, stating it is a poison.

Clinical Impressions: (Rationale for diagnosis and recommendations for services) DSM-5 Diagnosis with list of diagnostic creterials: Recommendations: Labs: Psychiatric Medications: Drug: Dose/Schedule: Number/Refill: Fact Sheet Given Other Rationale for each recommendation Teaching What would you include in a biopsychosocial treatment plan for the patient in addition to pharmacotherapy?

Explanation / Answer

Psychosis Schizophrenia:
clinical impression:
Clinical global impression-schizophrenia(CGI-SCH) scale,designed to assess positive,negative,depressive and cognitive symptoms in schizophrenia..CGI-SCH adopted from CGI scale..concurrent validity and sensitivity to change were assessed by comparison with the positive and negative symptoms severity(PANSS) and global assessment of functioning scale(GAF)..To evaluate inter-rater reliability,all patients were assessed by two clinicians..correlation coefficient between the CGI-SCH and the GAF and PANSS scores were high,with positive and negative symptoms..CGI-SCH scale is a valid,reliable instrument to evaluate severity and treatment response in schizophrenia..
Recommendation:
-Work in partnership with people with schizophrenia and their carers..provide help,treatment and care..provide supportive and emphathic relationship as an essential part of care..
   -collect full history and physical examination to identify physical illness..
   -Assess their weight,smoking,nutrition,physical activity and sexual health..
   -Assess neurodevelopmental conditions..
-Provide recreation to the patient and establish occupational and educational therapy will be helpful..
   -Monitor their coexisting conditions,including depression and anxiety..
   -Assess their antopshchiatric medication followup..
   -Mental health services should work with local stakeholders to enable people with mental health problems..
Lab:
   -complete blood count
   -Comprehensive metabolic panel(electrolyte,glucose,liver,renal test)
   -serum B12 level
   -Urine Toxicologic screen
    -Blood alcohol
   -Thyroid stimulating Hormone
Medication:
Thioridazine: initial dose 50 to 100mg oral 3times a day
   Maintenance dose:200 to 800mg/day
      Maximum dose 800mg/day
Biopsychosocial treatment:
Social skills training:
    -Make social interactions with patient for teaching..
Family psychoeducation:
    -Acollaborative,respectful relationship with the family,the provision of information about schizophrenia and its treatment is important..
coginitive therapy: Antipsychotic medication are effective for reducing positive symptoms..cognitive behavior therapy technique used to reduce distress associated with both hallucination and delusions..
cognitive rehabilitation: provide cognitive rehabilitation programs to increase memory capacity,attention,and high level problem -solving skills..

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