Interpretation of Schizophrenia Cases: Treatment of 1 Case of Paranoid Schizophrenia

He Mou, female, 33 years old, repeated gibberish, sensitive and suspicious for more than 13 years, and then recurred for 2 months
.

History of present illness

In 2008, the patient was nervous about studying for the college entrance examination.
On May 8, he was excited and talked a lot.
He heard human words out of thin air and was suspicious
.

About 2010, her condition fluctuated, and she was treated with risperidone 4 mg/d, clozapine 150 mg/d, and magnesium valproate sustained-release tablets 0.
75 g/d, and diagnosed as "undifferentiated schizophrenia"
.

At the beginning of 2017, the patient returned from a trip to South Korea organized by his father’s unit and experienced repeated symptoms, manifested as excitement, noisy, poor sleep, and gradually talked and talked gibberish, telling him that there were many dead souls on his body, and suddenly ran to choke someone else’s neck.
cursing her ex-husband, he said he was beaten himself, a man not a good thing, and so on
.

In December 2019, the patient traveled with her parents and developed mental disorders again.
He could not fall asleep at night, had many dreams and was easy to wake up.
He often talked to himself and talked nonsense at home.
Will hit people without warning
.

Two months ago, the patient relapsed without obvious cause.
The main manifestations were tantrums, standing in a daze by the window, saying that there was a ghost at the door of the house, talking indiscriminately, saying that many people died during the Anti-Japanese War at home, buried under the ground, and talking.
Lazily talked, talked to himself, talked to the air, stayed up at night
.

Past history

Deny the history of "hyperthyroidism, hypothyroidism", deny the history of "hypertension, diabetes, coronary heart disease", deny history of infectious diseases such as hepatitis, tuberculosis, no history of major trauma and surgery, no history of blood transfusion, no history of food or drug allergy, routine vaccination History, denied the history of new crown vaccination
.

Personal history

Maternal pregnancy conditions: normal; birth conditions: normal delivery; growth and development conditions: normal; school age: 7 years old; education: high school; academic performance: good; labor and work conditions: good; bad habits: none; poison and contaminated water Contact history: None
.

Deny the history of living in a special area within 14 days, no confirmed cases of COVID-19 in the surrounding communities, no history of travel or residence in the community of COVID-19 cases, no history of contact with confirmed or suspected cases of the new coronavirus, denial of clusters of patients in the surrounding areas, and no overseas epidemic areas History of residence, no history of contact with people returning from epidemic areas abroad
.

Marriage and childbirth history: divorced and childless; menstrual history: 13-year-old picture, unknown last menstruation, unknown previous menstruation
.

Pre-illness personality: tendency: intermediate; stability: poor; special personality: none
.

Family history: None; Family diagram: None
.

Physical examination

T 36 ℃, P 86 times/min, R 20 times/min, BP 129/92 mmHg
.

Development: normal; nutrition: good; consciousness: clear; posture: automatic; cooperation: yes; skin and mucous membrane: normal; superficial lymph nodes: normal
.

Head: head: normal; eyes: normal; ears: normal; nose: normal; oropharynx: normal
.

Neck: neck: normal; trachea: centered; thyroid: normal
.

Chest: thorax: normal; lung percussion: normal; breath sounds: normal; heart: normal; heart rate: 86 beats/min; heart sounds: normal; rhythm: uniform; heart murmur: none
.

Abdomen: appearance: flat; abdominal muscles: soft; abdominal tenderness: none; liver: untouched; spleen: untouched; percussion pain in the kidney area: none; bowel sounds: normal; mobile dullness: none
.

Anus and external genitalia: normal; spine and limbs: normal; nervous system: normal
.

Mental health check

General performance: Appearance: neat and clean, behavior: normal, conversation contact: passive, uncooperative, answering questions: relevant to the topic, awareness: clear
.

Orientation: Time: Good, Location: Good, People: Good
.

Daily life: self-care and self-awareness: lack
.

Raising activities: illusions: no, perceived barriers to integrated: no
.

Thinking association: relaxation, thinking logic: other, thinking content: other, for example: gibberish, speech babble
.

Attention: loose, memory: normal, for example: attention is easily shifted with the external environment
.

Intelligence: normal, understanding, judgment and common sense: average, calculation ability: average
.

Emotional activity: irritating, for example: lose your temper when you feel unhappy
.

Volitional activity: decline, for example: no plan for the future
.

Instinctive activity: weird behavior, for example: often standing by the window and talking to himself
.

Auxiliary examination

2021.
07.
24 The new crown nucleic acid test in the outpatient department of our hospital was negative; chest CT showed no obvious abnormalities
.

Admission diagnosis

Paranoid schizophrenia
.

The patient had repeated gibberish, sensitive and suspicious on the basis of clear consciousness for 13 years, and then recurred for more than 2 months
.

Differential diagnosis: (1) Mental disorders caused by physical diseases and organic brain diseases: The patient has been physically healthy, and there is no obvious abnormality in physical examination and neurological examination, and there is no other clinical evidence of organic diseases, so it is not Support the diagnosis
.

After treatment

2021.
07.
24 Lurasidone hydrochloride tablets 40 mg Qn controlled psychotic symptoms, magnesium valproate sustained-release tablets 250 mg Bid stabilized mood, and estazolam injection was injected intramuscularly 2 mg Qn for 12 hours for sedation
.

2021.
07.
26 Increase magnesium valproate sustained-release tablets to 250 mg tid
.

2021.
07.
28 Increase lurasidone hydrochloride to 80 mg qn
.

2021.
08.
02 Add haloperidol injection 2.
5 mg q12 h to control psychotic symptoms
.

2021.
08.
06 Reduce eszolam injection to 2 mg qn for sedation, reduce haloperidol injection 2.
5 mg qn to control mental symptoms
.

2021.
08.
09 Stop eszolam injection and haloperidol injection combined with 6 ECT treatments
.

The patient was discharged from the hospital on August 12, 2021, and his condition improved significantly when discharged
.

Experience

Lurasidone rarely causes increases in body weight and prolactin levels
.
For this unmarried young and middle-aged woman, during the medium and long-term treatment, lurasidone can not only continuously improve her symptoms in multiple dimensions, but also does not affect her weight gain and women's menstrual problems
.