Transcript:
Hi, my name is Amber Hoberg. I'm a psychiatric mental health nurse practitioner from the San Antonio, Texas area. I currently work with MorningStar Family Medicine and Baptist Health system here in the San Antonio, Texas area. I am so excited for you to be here today to join me for "Patient Case Study: Real-Life Impacts of Schizophrenia." So, without further ado, let's get started.
So, I recently had a 37-year-old Hispanic male patient who had been diagnosed 13 years prior, in his mid-twenties.
He has had 5 inpatient hospitalizations, with the most recent being 4 months ago. That admission occurred after he stopped taking his oral medications because he felt he no longer needed them.
Medication adherence is common in schizophrenia care, with approximately 50% to 60% of people with schizophrenia meeting the criteria for nonadherence based on oral pill counts.
With this patient, the most recent admission was triggered by the presence of positive symptoms.
Within the frame of schizophrenia, positive symptoms are those that are “abnormally present.” Symptoms like hallucinations, delusions, and disorganized speech or behavior are perhaps the most noticeable facets of schizophrenia.
Patients may also experience negative symptoms, which are “abnormally absent.” They’re a reduction in behaviors that are relative to normal. Negative symptoms include a flat affect, depression, and a lack of motivation. In addition to positive and negative symptoms, cognitive decline is common in schizophrenia.
In this patient, we documented reports of negative auditory hallucinations and delusions, characterized as internal voices convincing him that the government was coming to kick him out of his home. He is suspicious of others because he feels they all work for the government and are trying to “get him.”
He also reported negative symptoms such as blunted affect and social withdrawal. He stated that he has difficulty engaging in conversations with others due to the lingering internalized belief that everyone is potentially out to get him. There was also evidence of depression, possibly due to self-isolation and social withdrawal.
He reported never being offered a long-acting injectable, or what we call an "LAI," despite having 5 relapses and was initially hesitant to change his medications. Once we discussed how it worked—that it will give him his life back, slow further decline, and hopefully help him have more meaningful friendships and meet his goals—he agreed to try the new treatment.
He started on his risperidone subcutaneous injection and has been relatively stable outside of some occasional depression and blunted affect.
As a result of his symptoms, he demonstrated poor judgment when he decided he didn’t need his medications and stopped taking them, leading to his most recent relapse. Upon seeing me post-hospitalization, he was on PO risperidone, a D2 antagonist, and his symptoms were mostly controlled.
Given his history of non-compliance, we discussed moving his PO medication to an LAI version to help him more successfully control his symptoms.
Now that his symptoms are better controlled, his goal is to get a consistent part-time job to keep him active and engaged 2 to 3 times per week. Eventually, he plans to transition into a living environment where he can be a little more independent.
He sees me in the clinic twice a month, where we provide him with the subcutaneous treatment, discuss his experience, and level set on where he is with his goals and how they’ve changed.
He has found a small group for individuals with schizophrenia, which he enjoys attending 5 days per week.
Well, thank you so much for watching. I hope you enjoyed this case study and have a great rest of your day.
References:
- Velligan DI, Maples NJ, Pokorny JJ, Wright C. Assessment of adherence to oral antipsychotic medications: what has changed over the past decade? Schizophr Res. 2020;215:17-24. doi:10.1016/j.schres.2019.11.022
- Correll CU, Schooler NR. Negative symptoms in schizophrenia: a review and clinical guide for recognition, assessment, and treatment. Neuropsych Dis Treat. 2020;16:519-534. doi:10.2147/NDT.S22564