History

Name: Mr. R
Gender: Male
Age: 68 years
Presenting Complaints:
A/c to Client:

A/c to Informant:

Mr. R, 68 years old male, married, educated till Matric, Retired from GHQ. The patient’s
illness is continuous and progressive in course for at least past 3 decades. The client’s illness is
characterized by suspiciousness against family, neighbors, and some unknown people alike. Due
to his suspiciousness he got into several fights at his workplace before finally being removed from
his service. He divorced two of his wives and kicked his son out of home when they were too
young and doesn’t keeps any contact with any other family member.
Driven by his paranoia, he also becomes aggressive at times, both verbally and non-
verbally. The patient also indulges in self talking and making gestures in air. He has been noticed
swearing as if he can see someone when there’s no one around. He has been hoarding waste
materials in his home for past 3 years.
The patient’s self-care is poor, he appears not to have taken bath in several months. He
used to roam around in streets at night and comes home a few hours before dawn. His sleep is
reduced to 4-5 hours/day. Appetite is adequate. The patient is noncompliant and doesn’t take
medication.
The patient has never received any psychiatric treatment before. The client came to the
OPD 2 weeks ago. Detail is not provided, apparently he was hit by a taxi causing injuries to the
left foot.
After assessment the Client was diagnosed with Paranoid Schizophrenia.
Treatment:
Tab Haloperidol .5mg TDS
Tab Procyclidine 5mg TDS
Fluphenazine decanoate (medicate) 12.5 mg was injected to stabilize the patient.
The Client was admitted in the hospital and discharged after almost 4 weeks. The discharge
summary has been attached.
Management plan after discharge:
Tab Olanzapine 5mg BD
Tab Kempro (Procyclidine) 5mg OD
Class of Drugs
Antipsychotic drugs
 Haloperidol
 Olanzapine
 Fluphenazine
Anticholinergic drug
 Procyclidine
Mechanism of Action
Haloperidol is a typical antipsychotic which rebalances dopamine to improve thinking,
mood and behavior. It is an inverse agonist in dopamine D2 receptor in the mesocortical and
mesolimbic pathway. Haloperidol blocks the dopaminergic D1 and D2 receptors in the brain
resulting in reducing the positive symptoms of psychosis.

Fluphenazine also a typical antipsychotic.

Procyclidine is used to treat symptomatic Parkinsonism and extrapyramidal dysfunction

caused by antipsychotic agents. The mechanism of action of procyclidine is unknown but it is
thought that is acts by blocking central cholinergic receptors and balancing cholinergic and
dopaminergic activity in basal ganglia.

Olanzapine is an Atypical Antipsychotic which block the receptors for serotonin,

dopamine, histamine, acetylcholine and norepinephrine. Olanzapine works by blocking the
receptors in the brain that dopamine acts on. This prevents the excessive activity of dopamine and
helps to control symptoms of schizophrenia and mania.

Therapeutic Dose
Tab Haloperidol .5mg TDS
Tab Procyclidine 5mg TDS
Fluphenazine decanoate 12.5mg
Tab Olanzapine 5mg BD
Tab Kempro (Procyclidine) 5mg OD
Duration of Treatment
The treatment duration will be minimum of 2 years.
Side Effects
Tab Haloperidol
Haloperidol is a typical high potency antipsychotic drug. Its common side effects include
EPSE. They are abnormal involuntary, repetitive, aimless movements. They can create
contractions, contorted positions and pain. Neuroleptic malignant syndrome is a rare but
potentially life-threatening disorder characterized by muscular rigidity, elevated temperature and
high blood pressure

Tab Procyclidine
Procyclidine is an anticholinergic drug which is used when the low dose of antipsychotics
is not effective in eliminating the EPS.
Tab Olanzapine
Olanzapine is an atypical antipsychotic drug which have high metabolic side effects
(weight gain, diabetes, cardiac problems, etc.)
Fluphenazine decanoate
Side effects include seizures, neuroleptic malignant syndrome, aplastic anemia,
agranulocytosis, cholestatic jaundice, nausea, anorexia, headache, depression, leukopenia,
hyperprolactinemia, tardive dyskinesia, sedation, pseudo-parkinsonism, drowsiness, blurred
vision, dry mouth, constipation, photosensitivity, and urinary retention.

Psychoeducation regarding the side effects of medication

The client and care taker will be psychoeducated about the side effects, duration of treatment and
the importance of compliance.