Schizophrenia- A Case Study:

Introduction:
Schizophrenia is the major mental illness of our time. It was first described by Kraepelin (1896) as
“dementia praecox” and later given the name “schizophrenia” by Bleuler in 1911. It is a condition
characterised by disturbances of thought, perception and a blunting of affect. These disturbances
“involve the most basic functions that give the normal person a feeling of individuality, uniqueness,
and self-direction” (WHO 1992). In 1959 a German Psychiatrist identified what he considered to be
first rank symptoms of schizophrenia (Schneider 1959). Schneider grouped the collection of
symptoms into three main categories, namely, auditory hallucinations, passivity experience and
delusional thinking. Schizophrenia sufferers experience hallucinatory “voices” which may either
provide a running commentary on one’s movements or instruct the person to carry out certain tasks.
Some sufferers experience voices which are derogatory or insulting. Passivity feelings refer to those
feelings, thoughts or behaviours which the individual experiences as being under the influence of a
third party. Delusional thinking arises from perceptions which may be distorted. Delusional thinking
is often without insight and unamenable to reason. Although these symptoms are no longer used as
the sole diagnostic aid Schneider’s categorisation of the symptoms gives a glimpse of the level of
disturbance those with schizophrenia experience. Schizophrenia however is also associated with a
wide range of other symptoms including social withdrawal, incongruent affect and thought
disturbances, which contribute to the devastating effects this illness can have on the person.

Loss of social contacts and career prospects often go hand-in-hand with the illness.

Objective:
The purpose of this case study is to educate people about the recognizable signs and symptoms of
schizophrenia.

Literature review:
Arguments that schizophrenia is a distinct disease have been “fatally undermined”. Just as we now
have the concept of autism spectrum disorder, psychosis (typically characterized by distressing
hallucinations, delusions, and confused thoughts) is also argued to exist along a continuum and in
degrees. Schizophrenia is the severe end of a spectrum or continuum of experiences. Jim van Os, a
professor of psychiatry at Maastricht University, has argued that we cannot shift to this new way of
thinking without changing our language. As such, he proposes the term schizophrenia “should be
abolished”. In its place, he suggests the concept of a psychosis spectrum disorder. Another problem is
that schizophrenia is portrayed as a “hopeless chronic brain disease”. As a result, some people given
this diagnosis, and some parents, have been told cancer would have been preferable, as it would be
easier to cure. Yet this view of schizophrenia is only possible by excluding people who do have
positive outcomes. For example, some who recover are effectively told that “it mustn’t have been
schizophrenia after all”. Schizophrenia, when understood as a discrete, hopeless, and deteriorating
brain disease, argues van Os, “does not exist”.

Materials:
Materials used for a case study of case of schizophrenia are:
  Through history of the patient
 Proper general physical examination to rule out other causes of the symptoms seen.
 Mental status examination
 ICD 10 TYPE classification:
1. F20- Schizophrenia
2. F20.0- Paranoid schizophrenia
3. F20.1- Hebephrenic schizophrenia
4. F20.2- Catatonic schizophrenia
5. F20.3- undifferentiated schizophrenia
6. F20.4- post-schizophrenic depression
7. F20.5- residual schizophrenia
8. F20.6- simple schizophrenia.
9. F21- Schizotypal disorder.

Methods:
For the case study I have used a detailed history of the patient from his informant, and a mental
status examination as the tools for evaluation of the patient to diagnose him or her as a patient of
schizophrenia using the standard protocol for classifying and diagnosing schizophrenia.

Observations:
From observing the patient, I found out that the patient had following signs and symptoms:

The patient presented with the complaints of restlessness and irritability at the time of admission,
and an incident of a violent attack on his mother just before the arrival in the health care centre. The
main symptoms at the time of admission and during his stay in the hospital: suspicious behaviour,
delusions of reference and persecution (such as: sound of blasts, 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 the patient presents non-specific symptoms like: loss of interest, irritability,
oversensitivity, lack of appetite and insomnia. The parents reflected on his non-compliant behaviour
regarding the medication and reported that which makes administration of medication a difficult for
the parents (who then resort to tricks). In addition to the presence of the atypical clinical features, a
history of head injury was reported when the patient was 10 years old, when a metal rod pierced his
fore brain. Deterioration of psycho-social functioning was observed and reported by the parents.

Investigations included the general physical examination and the routine investigations, along with
the formulation of case history of where he was admitted since diagnosis. There were no positive
findings on CT scan and EEG records. The client first saw a psychiatrist in April 2016, after his first
violent episode. The client was prescribed regular medication after this to alleviate the symptoms of
the disorder. Some of the prescribed drugs (from 2016 to 2024) were: Olanzapine, Divalproex
sodium, Espazine plus trifluoperazine, Trihexyphenidyl, Aripiprezole and Trihexyphenidyl
hydrochloride. He was given drug therapy along with instructional therapy. Parents and a caregiver
were psychoeducated about the disorder of the client, as psycho-education has broad potential for
many forms of mental health problems.

CONCLUSION:
From the above case discussion, I conclude that my patient is a paranoid schizophrenic. The
description, classification and diagnosis of the illness has advanced considerably in the new era of
medicine. Shepherd (1994) conceptualised that homogenous description of the illness will lead to
better identification and understanding among those who work with such patients. Schizophrenia,
some authors suggest, may not be one illness with a few subtypes but many illnesses with dozens of
subtypes. Some authors have suggested for instance that illnesses which are characterised by
primarily positive or negative symptoms may be new subtypes of the illness (McGlashan and
Johannessen 1996). Further advances in our understanding will hopefully produce real gains for
those who have schizophrenia. A holistic environment should be provided to these patients to make
their lives a bit easier than what it was before receiving the consult. Psycho-education, instructional
therapy, along with cognitive behavioural technique are some of the suggested methods to help
them along with drugs for an overall improvement in their health.

References :
1. Article in Journal of Clinical Nursing · December 1998- Schizophrenia: A review of current
research and thinking.
2. Article in International Journal of Psychology and Psychiatry · January 2015- case study on a
young schizophrenic patient
3. Kaplan and Sadock’s Synopsis of Psychiatry.
4. World Health Organization. (2007). The ICD-10 Classification of Mental and Behavioural
Disorders. Delhi: A.I.T.B.S. Publishers and Distributors, 86
5. McGrath, J., Saha, S., Welham, J., El Saadi, O., MacCauley C, et al. (2004). A systematic review
of the incidence of schizophrenia: The distribution of rates and the influence of sex,
urbanicity, migrant status and methodology. BMC Med 2: 1
6. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental
disorders: DSM-IV, 4th ed. Washington (DC): American Psychiatric Association, 886