Schizophrenia case interpretation Lurasidone treatment of paranoid schizophrenia

The patient Wang Moumou, male, 27 years old, went to the outpatient clinic on July 8, 2021 because of "hearing people's words out of thin air, the suspect followed up for the persecution for July, which was aggravated by 2 weeks"

History of present illness

Starting from January 2021, no obvious incentives have gradually appeared.

Past history

In May 2021, it was diagnosed as "hypertension grade I"

Personal history

Usually outgoing personality and strong working ability

Family history

Deny family history

Admission check

The vital signs are stable, blood pressure 120/80 mmHg, height 1.

Mental examination

Clear consciousness, complete orientation, passive contact, age-matched appearance, questionable answers, nervous expression, eliciting auditory hallucinations, relationship and persecution delusions, and mild depression

Laboratory examination

There were no abnormalities in hematuria, blood biochemistry, HIV and syphilis, antibody testing, electrocardiogram, thyroid function test, and head MRI

diagnosis

Paranoid schizophrenia; hypertension grade I, intermediate-risk group

Diagnose based on

The patient is a young male with a medical history of six months.

Differential diagnosis

If the patient has no history of serious physical disease and brain trauma, organic mental disorders and physical mental disorders can be ruled out

Medication process

July 9-July 15: Lurasidone 40 mg qd (taken with breakfast), diazepam 2.

The follow-up on July 15th, the lazy movement improved, and I was able to communicate with my family

July 16-July 22: Lurasidone 40 mg bid (with breakfast and dinner), diazepam 2.

Follow-up on July 22: Able to go out with friends

July 23-30: Lurasidone 40 mg bid (with breakfast and dinner), diazepam 2.

Follow-up on July 30: Able to go out with friends and do housework
.
Auditory hallucinations and delusions rarely occur
.
Sitting still does not disappear, blood pressure is stable, and weight does not increase
.
The liver and kidney function was rechecked, and the electrocardiogram was not special
.

During the whole treatment process, rTMS treatment was supplemented
.

At present, the patient has been treated for 5 weeks, the condition is stable, no hallucinations and delusions appear again, he is resting at home, able to do housework, and looks neat and tidy
.
Currently taking Lurasidone 40 mg bid (with breakfast and dinner) and Metoprolol 12.
5 mg po qd
.
Amlodipine has been gradually reduced and stopped
.
The blood pressure was stable and the weight did not increase
.

Experience

Lurasidone has a quick onset and good effect on the positive and negative symptoms of SCZ
.
But be careful to take it with meals, and there may be adverse reactions of akathisia
.

Antipsychotics should consider metabolic risk from the beginning
.
During the treatment, the patient's weight, blood pressure, blood sugar, and blood lipid levels should be actively tested, and if there are changes, the dressing should be considered
.