Reference no: EM133990060

Question

Mr. H. is a 34-year old Caucasian male who comes to the clinic for a medication evaluation. His 42-year-old sister accompanies him. The client is a poor historian and displayed extreme difficulties concentrating on questions asked during the interview. Due to this difficulty, his sister provided a majority of the information. She reports that he has a long history of schizophrenia and recently came to live with her and her family after being contacted by personnel from one of the nearby shelters. She reports that he has lived a majority of his adult life on the streets. She is concerned by his lack of ability to participate in activities of daily living as well as being concerned that he is hearing voices. She laments, 'He just looks tortured.'

Treatment history unknown but was hospitalized during his initial psychotic break at age 17 or 18 when he was diagnosed with schizophrenia. When asking about his previous medications, he replied 'yes' to Prolixin and 'I don't know' to other medications mentioned. He states he has been started on numerous medications but he always stops them because he does not like taking medication. His sister is not aware of past treatment or any other hospitalizations. She reports that he has been 'lost to the family' since age 20.

Sister reports that their mother was diagnosed with paranoid schizophrenia and they have a brother living with bipolar disorder. She believes it is Bipolar I.

Medical history: Sister reports she recently took him for a medical exam and he is in apparent good health with no evidence of any chronic illnesses.

Mr. H. is dressed in clean clothes and a winter coat despite the 70-degree temperature outside. He is cooperative with the interview. He states is name is Edward (and this is not his given name), he is 29 years-old, and he is at the doctor's office. His speech is sparse and garbled at times. Thoughts are loose and tangential. He denied suicidal or homicidal ideation as well as visual hallucinations. He did admit to 'hearing voices in my head.' Memory impaired. Insight and judgment are poor.

Your diagnosis is Schizophrenia, undifferentiated type (295.90)

1. What are your pharmacological goals for Mr. H.? What specific symptoms are you targeting with medication?

2. What medication(s) do you choose? Explain your rationale and specify the mechanism of action of your choice(s).

3. Write out the prescription for an oral medication you would choose for this client. Be sure to include medication name(s), with the number of pills dispensed, instructions for taking, and number of refills given.

4. If you decide on an injectable form of medication, list three possible choices and discuss how you would start the patient on these medications. Write out a prescription for starting one injectable antipsychotic.

5. Specify what monitoring activities and lab studies will be necessary for the medication(s) you ordered.

6.  What teaching information is important for this client? Think about common and serious side effects.