Nathalie, a 28-years-old woman was diagnosed with schizophrenia 7 years ago

Nathalie, a 28-years-old woman was diagnosed with schizophrenia 7 years ago. During the first year in college, Nathalie experienced her first psychotic episodes with symptoms of difficulty in concentrating, social withdrawal, reduced motivation, paranoia, anger, and hallucinations. She also engaged in substance abuse of alcohol and marijuana use. After she was arrested because she was threatening to hurt her course director due to her low grades, Nathalie was hospitalized and diagnosed with schizophrenia. Since that time, Nathalie dropped out of college, has alienated herself from family and friends, spending much of her time locked in her apartment where she watches television and smokes marijuana and tobacco much of the day, without being able to hold on to a job for more than several weeks. In the early course of her illness, Nathalie’s psychiatrist had prescribed her several trials of various typical antipsychotics including chlorpromazine, haloperidol, and loxapine; however, these drugs were only partially effective in reducing Nathalie’s symptoms and caused her some mild tardive dyskinesia. More recently, her psychiatrist prescribed her several different atypical antipsychotics including clozapine, aripiprazole, and lurasidone, but the metabolic side effects of these drugs, which include weight gain and hyperglycemia have caused Nathalie to be intermittently adherent to her therapy. As a result, Nathalie has been hospitalized 10 additional times in the last 6 years for acute psychotic episodes and is on the verge of being evicted from her apartment.

Nathalie and her family meet with her psy­chiatrist to discuss ways they can support her treatment. Her psychiatrist faces a dilemma of balancing the need for efficacy when addressing metabolic, safety and adherence concerns in this patient.

Discuss Treatment-planning for the Schizophrenic Patient