Question

Carter Louis, a 25-year-old male, the eldest of three siblings in a middle class family, was diagnosed with paranoid schizophrenia. He is currently in an inpatient unit.

His parents and a close relative reported he has been reserved and shy since childhood, rarely initiating a conversation or any activity and hesitant to talk to others. Behavioral changes were noticed by members of the family as he entered adolescence but were taken in a lighter vein and ignored. His irritable nature and antisocial behavior worsened over the years, and recently, he had a violent bust out on a minor financial issue with a neighbor.

There was no history of any complicated trauma, no alcohol or drug dependence, nor physical or psychiatric illness of the mother during pregnancy. His was in school from age four through 19. There are no reports of school phobias or any kind of learning difficulty. He quit his studies in accordance with his parents’ advice. He prefers indoor and solo games, such as video games, rarely indulges in group activities, and does not have very healthy relationships with his younger siblings. His activities are mostly sedentary. He at times regrets not being sent to a more established and well reputed high school.

The mental status examination revealed that his eye contact was not continuous and he moved his eyes suspiciously and furtively. He tried a little hard to change the body postures and lethargic movements of the limbs (particularly) were also noticed. Quantity of speech was reduced, and he became hesitant on expression of some of his views and beliefs. During conversation, there were blank intervals and tangentiality in his train of thoughts, with changes in pitch. Generalizations based on inappropriate or limited information were also present. He was not able to understand and use the concepts easily. His attention and concentration were intact to an extent. Reaction time was normal, and no compulsive acts or habits were present. Orientation to time, place, and person were intact. His insight into the illness was minimal, as he completely attributed it to others around him.

Carter’s dad reported suspicious behavior, and delusions of reference, persecution (such as a relative inflicting him with some mantras), auditory (sounds of people talking about him), and olfactory (poisoning of the air). Hallucinations were also present but were rare. On investigation, it was learned that, in the prodromal state Carter presents nonspecific symptoms like loss of interest, irritability, oversensitivity, lack of appetite, and insomnia. The parents reflected on his non-compliant behavior makes administration of medication difficult for them (who then resort to tricks, such as saying, “These drugs are for your psycho-sexual disorder,” as he once had a hallucination that his genital nerve was being cut).

In addition to the presence of the atypical clinical features, a history of head injury was reported when Carter was 10 years old, when a metal rod pierced his fore brain. Deterioration of psycho-social functioning was observed and reported by the parents.

Questions"

What diagnosis would you give Carter? Please match Carter’s symptoms with the DSM-5 criteria.

What recommendations relative to medications would you make? Name the type of typical or atypical antipsychotic you would prescribe and identify the dosing and administration

Answer 1

Anxiety peronality disoder or genralized personality disorder is a group of condition that connect the people with various pshyciatrc disorder.
DSM- 5 critieria:
Anxiety disorder: reserved, shy since chideren and hesitate to other to talk.
dperessive disorder: behavioral changes, antisoausl and psychosocial behavior, avoiding social relationships, and sedentary lifestyle.
Bipolar disorder: poor eye contact, lethargic, the speech was reduced, hesitant on expression, and easy distraction.
Schizophrenia disorder: hallucination, abnormal limb movement
post-traumatic stress disorder: a history of head injury.
Medications: antidepressants, antianxiety, atypical antipsychotic drugs, and selective serotonin reuptake inhibitors will be helpful for the patient to change the disorder.
atypical antipsychotic drugs act on dopaminergic system by blocking dopamine type 2 receptors by reducing anxiety and depression symptoms, negative and positive signs of schizophrenia. quetiapine(50-300mg/d) per oral as a safe dose can be prescribed.