Posted: July 1st, 2022

C.Z. Case Discussion

Discussion 1 Segura Herrera, Rafael E

C.Z. Case Discussion
C.Z. presents with delusion, hallucination, trouble focusing, thought disorders, and speech difficulties. These symptoms suggest C.Z. has schizophrenia, as defined by the American Psychological Association (APA; 2020). Also, DSM-V include 2 or more criteria present for a significant portion of time during 1 month period, C.Z. has delusion, hallucination This paper describes schizophrenia’s etiology, course, associated abnormalities, and management.
Etiology
Schizophrenia’s etiology includes several possible causes. Potential causes include heredity, stressful events, alcohol, and substances use, especially amphetamine and cannabis, and perinatal, neuroanatomic, and neurodevelopmental factors (Rosenthal & Burchum, 2021; Hany et al., 2022). Social isolation, childhood trauma, family history, and urbanization also heighten risk (Hany et al., 2022). However, the specific cause is unknown.
Course
The course of schizophrenia is varied. Some patients may show subtle, gradual changes before schizophrenia symptoms manifest (Rosenthal & Burchum, 2021). Once the illness develops, acute episodes feature delusions and hallucinations symptoms (Rosenthal & Burchum, 2021). Patients may have less vivid residual symptoms after the acute episode, including suspiciousness, diminished judgment, reduced self-care capacity, and poor anxiety management (Rosenthal & Burchum, 2021). The condition’s long-term course features episodic acute exacerbations with partial remission intervals with progressive decline in social functioning and mental status becoming evident with time (Rosenthal & Burchum, 2021). Others may have continuous symptoms. Appropriate treatment can prevent long-term deterioration and reduce acute relapse risk.
Structural/Functional Abnormalities
Notably, schizophrenia is linked to structural and functional abnormalities. Imaging tests have shown structural abnormalities, including disrupted white matter integrity and reduced gray matter volume in parietal and temporal regions (Zhao et al., 2018). Functional abnormalities are present since schizophrenia is linked to a dysregulation of dopaminergic signaling and increased striatal activity (Zhao et al., 2018). Other functional abnormalities include abnormal neural activity and emotional and cognitive dysfunction (Zhao et al., 2018). Notably, the abnormalities occur over the disease’s course, with Zhao et al. (2018) observing abnormalities before symptoms emerge and becoming more evident with the onset of the illness.
Treatment
Pharmacotherapy is recommended for schizophrenia for symptom management to enhance and maintain recovery. APA (2020) guidelines recommend antipsychotics for patients with schizophrenia (Keepers et al., 2020). Medications for this disorder could be classified typical and atypicals, the first one also by binding affinity with D2 receptor: low, medium, and high.
High potency we have by PO/IM/IV routes, Haloperidol 2,5-30 mg mg/d orally, half-life 12-38 hours.IM immediate release injection 2.5 mg each dose. LAI every 4 weeks 10-20 daily dose of oral. Overlap PO x 2-3 weeks. 100 mg limit for first dose.
Fluphenazine PO/IM 1-20 mg daily; half-life 15 hours. IM immediate release 1.25 mg initial doses. 2.5-10 mg/d q 6-8 hours. LAI 12.5-25 mg q 3 weeks.
Mid Potency: Perphenazine 4-8 mg TID or 8-16 mg BID, max 64 mg; IM release injection 5 mg. Loxapine: 10 mg BID, titrate over 1 week, 60-100 mg/d in divided doses.
Low Potency: Chlorpromazine PO/IM/IV dose 50-600 mg/day. IM formulation 50 mg/IM often used for agitation.
Second Generation Antipsychotics:”Atypicals”
*Serotonin antagonism more than dopamine antagonism, improve cognition, negative sx, and mood
Aripiprazole: 10-30 mg single dose (half-life 75 hours) LAI: 400 mg IM, q4 weeks.
Asenapine: 10-20 mg BID dosing
Clozapine: 25 mg daily, increase 25-50 mg daily, target dose 300-450 mg
LLoperidone: 8-32 mg daily, half-life 12-15 hours
Lurasidone: 40-160 mg daily
Olanzapine: 5-20 mg daily
Quetiepine: 25-50-400-800 mg daily
Risperidone: 1-2 mg/day, final 4-6 mg/d. half-life 3 hours. LAI 25-50 mg q2weeks, increase dose in 12.5 mg interval
The initial goal of acute treatment should be reduce acute symptoms, trying to return the patient to his baseline level. The choice of medication depends on many factors: patient treatment preferences and previous patient treatment response, presence of other cognitive impairment. Because a first episode of psychosis may respond more rapid and require less dose, the recommended dose is one-quarter to one-half of the usual dose.
Clinical experience suggests many patients are cooperative with Clozapine. The potential benefit of this recommendation outweigh the potential harms.
Patients must be monitored closely for response and side effects since this can influence treatment (APA, 2020). Notably, pharmacotherapy should be person-centered to enhance effectiveness, and that treatment should continue even when improvement is observed. Second generation antipsychotics have lower risk of EPS/TD but greater metabolic effect. Consider long-acting injectables right away.
Notably, pharmacotherapy is coupled with nonpharmacological interventions to enhance schizophrenia treatment. Address stress, family needs, supportive employment, social skills training, assertive community treatment. Family involvement and education, increase community connection, and minimize exposure to MJ, stimulants.
Cognitive-behavioral therapy for psychosis (CBT) is linked to benefits, including improved QoL and social, occupational, and global functioning while reducing illness-related symptoms (APA, 2020; Keepers et al., 2020). This intervention involves establishing a nonjudgmental, collaborative therapeutic relationship helping the patient learn how to monitor the link between their feelings, thoughts, behaviors, and symptoms while evaluating their beliefs, thought processes, and perceptions leading to those symptoms (APA, 2020). Notably, CBT can help patient’s alternative, realistic, and healthier explanations for their maladaptive cognitive assumptions helping stop the perpetuation of hallucinatory experiences and delusional beliefs (APA, 2020). Psychoeducation is also a helpful intervention (APA, 2020). The combined pharmacotherapy and non-pharmacotherapy interventions could cumulatively help C.Z. reach the treatment goal.

References
American Psychiatric Association. (2020). The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia (3rd ed.). American Psychiatric Pub.
Discussion 2

Schizophrenia is a progressive mental illness that typically presents itself in early adulthood and does not go into remission. It is a neurological disorder that affects the brain, and it causes sufferers to have an erroneous interpretation of the world around them. It is yet unknown what causes schizophrenia in its sufferers. According to the findings of recent studies, an individual’s susceptibility to developing the disorder is likely determined by a confluence of a number of factors, including those that are genetic, environmental, psychological, and physical. (Muller et al., 2018) Some people may be genetically predisposed to developing schizophrenia, and a stressful or emotionally upsetting incident in their lives may set off an episode of psychosis in them. It is predicted that 0.7% of the population may experience schizophrenia at some point in their lifetimes, making it one of the top 20 causes of disability across the globe.
C.Z. exhibits characteristics that are consistent with schizophrenia in this context. This illness is characterized by hallucinations as well as delusions. He feels that the increased campus security and local police surveillance are to blame for the slowdown in his internet speed. A person who suffers from schizophrenia will have larger ventricles in their brain that are filled with fluid, and their brain will appear to be smaller overall. A person who suffers from schizophrenia has abnormalities in the parts of their brain that control movement, speech, and language. This is a persistent condition. Both males and females can be affected by this serious mental disorder in equal measure. In spite of the fact that schizophrenia can manifest at any age, the typical age range during which symptoms first appear is between the late teens and the early 20s for men and between the late 20s and the early 30s for women. It is unusual for someone to be diagnosed with schizophrenia if they are younger than 12 or if they are older than 40. It is not impossible to lead a fulfilling life despite having schizophrenia. Some persons experience bouts of disease that persist for weeks or months and are followed by complete remission of symptoms; others have a fluctuating course in which symptoms are ongoing; and still others have extremely minute shifts in the manifestations of their illness over the course of years. (Stepnicki et al., 2018)
People who have schizophrenia can receive treatment in the form of cognitive behavioral therapy, cognitive remediation, psychoeducation, social and coping skills training, intervention with families, and assertive community treatment. It is imperative that healthcare providers employ trust-building interviewing techniques in order to get the patient’s cooperation in disclosing additional information. In order to win the patient’s trust, caregivers need to acquire the skill of active listening and exercise it often. We need to make C. Z. feel heard and understood when we speak to him because he might be anxious about the conversation. It is essential for caregivers to keep in mind that the patient views their hallucinations and delusions as genuine experiences. It is suggested that antipsychotics be used as the first line of treatment for the symptoms of an acute episode of schizophrenia while the patient is being managed medically with medication. When it comes to the management of treatment-resistant schizophrenia, clozapine is the most effective antipsychotic. When compared to the combination of chlorpromazine and benztropine, which only has a 4% efficacy rate in managing schizophrenia episodes in treatment-resistant individuals, this medication has an approximately 30% efficacy rate in controlling these episodes. Antipsychotics are effective because they prevent the brain from experiencing the positive effects of the neurotransmitter dopamine. Risperidone and olanzapine, two antipsychotics from a more recent generation, have been demonstrated to be more effective in maintenance treatment, as well as to have a more favorable side effect profile, in comparison to antipsychotics from more traditional generations. If patients’ hallucinations and delusions can be brought under control, there is a greater possibility that they will be able to live normal lives while adhering to their treatment plan.
References
Müller, N. (2018). Inflammation in schizophrenia: pathogenetic aspects and therapeutic considerations. Schizophrenia Bulletin, 44(5),
973-982. https://doi.org/10.1093/schbul/sby024 (Links to an external site.)

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