Indiana University Schizophrenia Diagnosis and Treatment Case Study

25yearold woman found unresponsive

History of present illness:

A 25 year old woman is brought to the ER, apparently unresponsive. She was found, lying on a park bench, by the police, and when they could not arouse her, they called an ambulance.Her vital signs are normal: B/P=115/80, HR=76, temp. 98.6F and respiratory rate =16. Physical examination reveals no signs of trauma or obvious injury. The patient is gaunt and looks malnourished. Her eyes are closed, and she does not respond to voice or sternal rub. Strangely, when the ER physician tries to move her arms, he meets strong resistance and moves her arm to a new position only with great effort. Even more to his surprise, he finds that her arm stays in the new position, even after he releases it.

Luckily, the patient had identification in her purse, which, with some prying, was taken from her on admission.Her mother is contacted.Mother states that she is frightened after hearing her daughter’s condition because nothing like this has happened to her before.The mother is relieved that her daughter was found. Until about 3 months ago, the pt. was living with her mother but not had been seen since then.Mother describes her as a cooperative child who never made unreasonable demands and was quiet and introspective while growing up.According to mother, the pt. had finished high school and had started classes at a community college.However, she had stopped school after one semester because of poor grades.The patient spent most of her time doing clerical work in the family real estate business.She had become more withdrawn over the past year, but mother interpreted this behavior as being “a little down” because her only friend had graduated from college and was now engaged to be married.Approximately 7 months ago, the patient’s mother became more concerned because her daughter had become more reclusive, missing work and often spending many days at a time in her room.She would come out only to eat a few morsels of food and then quickly retreat to the confines of her room.At that point in time, she states that her daughter appeared preoccupied with whether the food she was eating had been “killed in a morally acceptable way”.She expected her daughter to “snap out of it” but eventually told her she was going to take her to see a doctor.The next morning the patient disappeared (3 mo. Before current presentation).

Past Psychiatric Hx:

According to mother, the patient has no history of psychiatric illness and, as far as she knew, never used drugs.The mother recalls a cousin with mental illness who is now in an “institution”.

Past Medical Hx:

The patient has no medical problems, takes no medication, and has no known allergies.

Laboratory:

WBC—6,000

Hemoglobin…13.3

Sodium…141

Potassium…4.1

Calcium…10.3

Mg…2.0

Phosphorus…2.1

Arterial blood gasses…WNL

Pulse oximetry…97% on room air

Diagnostic Testing:

Stat CT scan…reveals no evidence of bleeding, mass or infarct

CSF (lumbar puncture) was clear

no signs of infection, cultures and PCR pending.

Mental Status Exam:

The pt. is a slightly cachectic looking woman, lying on a stretcher, with eyes shut. She does not respond to questions or touch.She does not move spontaneously, and when placed, her extremities hold their position.

Limba have cogwheel rigidity on flexion and extension.There is no spontaneous speech, or thought content.Orientation cannot be assessed, nor can judgment or insight.

Questions:

• Any differential diagnoses
• Your diagnosis and reasoning
• Any additional questions you would have asked
• Medication recommendations along with your rationale. Note possible side effects or issues to address if attempting to obtain consent.
• Any labs and why they may be indicated
• Screener scales or diagnostic tools that may be beneficial
• Additional resources to give (Therapy modalities, support groups, activities, etc.)