NOTE: The Dx of Paranoid Schizophrenia is still referred to by those who have been in psych for years. It is not in the DSM 5, but refers to someone who has a preoccupation with one or more delusions or frequent auditory hallucinations. (Disorganized speech, disorganized or catatonic behavior, flat or inappropriate affect are not present.) In this assignment, look at Paranoid Schizophrenia as someone with the above description. Look at Schizophrenia as someone who meets the criteria for Schizophrenia without the paranoia piece. You can reference the DSM IV if you would like more understanding. Patient is married 38yearold man working as a computer analyst for 15 years. His psychiatrist has moved away, and he needs a prescriber. His chief complaint is that “the government is out to get me and there is a grand conspiracy against me” Uneventful childhood, but became “suspicious” with some strange thoughts and sexual ideas diagnosed as OCD and for which he retained insight that they were excessive and not true. He would look at people in the face and develop disturbing sexual thoughts, so began to avoid eye contact. Given SSRIs with equivocal improvement. Some affective instability variably diagnosed as bipolar disorder or schizoaffective disorder. Main treatment was psychotherapy between ages 19 and 27 which the patient believes helped him greatly “hold things together.” After college, got a job as a computer analyst for the government, but quit precipitously a few months ago after he began to think that the government was against him and they would “do him in” by which he thought he would be choked to death. Is currently preoccupied by police cars, thinking they are after him. He now regrets resigning from his job but has no doubt that the government is actually after him, even though he admits no one else, including his wife, believes this. Affect somewhat flat but not overtly depressed. No other delusions or hallucinations. Family Hx: Sister and paternal aunt dx with schizophrenia. Current medication: Topiramate (Topamax) 300 mg/ day Buproprion SR (Wellbutrin SR) 300 mg/ day Buspirone (Buspar) 60 mg/ day Paroxetine (Paxil) 60 mg/ day Aripiprazole (Abilify) 40 mg/ day Risperidone (Risperdal) 8 mg/ day Give a rationale for each of the medications (taking into consideration the dosage of each) related to this particular case. (6 points – 1 point for each medication) What do you think is his diagnosis? Explain your choice, and why/how you would rule out each of the other diagnoses. (8 points – 1 point for each of the diagnoses) Paranoid schizophrenia Schizoaffective disorder Delusional disorder Simple schizophrenia Schizophreniform disorder Schizotypal personality disorder OCD vs Obsessive compulsive personality disorder (address both) Schizoid personality disorder
How would you treat him? Explain your choice, and why/how you would decide on each of the options below. (7 points – 1 point for each of the choices) Try another SSRI Try another atypical antipsychotic Raise the dose further of his current SSRI Raise the doses further of his current antipsychotics Reduce the doses of his antipsychotics Discontinue one of his antipsychotics Refer for psychotherapy Explain how the diagnosis may or may not influence your choice of medication. (5 points) APA formatting – references, spelling, grammar, etc. (4 points)