The client is a 34-year-old Pakistani female who moved to the United States in her late teens/early 20s. She is currently in an â€œarrangedâ€ marriage (her husband was selected for her when she was 9 years old). She presents following a 21-day hospitalization for what was diagnosed as â€œbrief psychotic disorder.â€ She was given this diagnosis as her symptoms have persisted for less than 1 month.
Prior to admission, she was reporting visions of Allah, and over the course of a week, she believed that she was the prophet Mohammad. She believed that she would deliver the world from sin. Her husband became concerned about her behavior to the point that he was afraid of leaving their 4 children with her. One evening, she was â€œout of control,â€ which resulted in his calling the police and her subsequent admission to an inpatient psych unit.
During todayâ€™s assessment, she appears quite calm and insists that the entire incident was â€œblown out of proportion.â€ She denies that she believed herself to be the prophet Mohammad and states that her husband was just out to get her because he never loved her and wanted an â€œAmerican wifeâ€ instead of her. She says she knows this because the television is telling her so.
She currently weighs 140 lbs., and she is 5â€™ 5.
Client reports that her mood is â€œgood.â€ She denies auditory/visual hallucinations but believes that the television talks to her. She believes that Allah sends her messages through the TV. At times throughout the clinical interview, she becomes hostile towards you but then calms down.
A review of her hospital records shows that she received a medical workup from a physician, who reported her to be in overall good health. Lab studies were all within normal limits.
Client admits that she was tolerating her Risperdal well but stopped taking about a week after she got out of the hospital because she thinks her husband is going to poison her so that he can marry an American woman.
MENTAL STATUS EXAM
The client is alert and oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Her speech is slow and, at times, interrupted by periods of silence. Self-reported mood is euthymic. Affect is constricted. Although the client denies visual or auditory hallucinations, she appears to be â€œlisteningâ€ to something. Delusional and paranoid thought processes as described above. Insight and judgment are impaired. She is currently denying suicidal or homicidal ideation.
You administer the PANSS which reveals the following scores:
-40 for the positive symptoms scale
-20 for the negative symptom scale
-60 for general psychopathology scale
Diagnosis: Schizophrenia, paranoid type
PANSS Scale. Available at: http://egret.psychol.cam.ac.uk/medicine/scales/PANSS
Â§ Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261â€“276. doi:10.1093/schbul/13.2.261
Â§ Clozapine REMS Program. (n.d.). Clozapine REMS: A guide for healthcare providers. Retrieved September 7, 2016, from https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf
Â§ Paz, Z., Nalls, M., and Ziv, E. (2011). The genetics of benign neutropenia. Israel Medical Association Journal, 13(10), 625â€“629. Retrieved from http://www.ima.org.il/FilesUpload/IMAJ/0/40/20149.pdf
Decision Point One
Select what you should do:
Start Zyprexa (olanzapine) 10 mg orally at BEDTIME
Start Invega Sustenna 234 mg IM X1 followed by 156 mg IM on day 4 and monthly thereafter
Start Abilify (aripiprazole) 10 mg orally at BEDTIME