GRODNOSTATEMEDI

CALUNI
VERSI
TY
Depar
tmentofpsy
chi
atr
yandnar
col
ogy

Teacher:
Mar
inaVi
ctar
avna
Hi
stor
yofdi
sease:11y
ear
s
Diagnosi
s:Progressiv
eTy peof
ParanoidSchi
zophrenia{F20.0ty
pe
(
ICD10classif
icati
on)}
Cur
ator
:ShahJash
Gr
oup:
8a
5th
Year:
Dat
e:8thOct2020i
.et
hrusday

Passpor
tdat
a
Name:
NashNat
ali
aFedor
abna
Dob:
27-
11-
1951
Homeaddress:
str
eetsol
omov
a80,
houseNo.
88,
grodno
RD
Pl
aceofwor
k:no,
disabi
l
ity3 gr
oup
t
h
Dat
eofadmi
ssi
on:
17 oct2019

Compl
aint
s
Atthetimeofcur ati
ont hepati
entcompl ained
ofanxiety
,restl
essness, anddyspnea.She
notedthatherappet i
tewaspoor ,shewas
confusedandt hatshehaddepr essivethoughts.
Shealsocompl ainedaboutsomet remor sand
severefati
gue.Sheal socomplainedofaudi tor
y
deli
ri
um (someonesi ngingloudandspeci f
ic
typeofsound“ aaaaaa”).Shehadv i
sualizati
on
ofherdaught er
’sfacewhenshei saloneina
room.
 Hi
stor
yofl
i
feandmedi
cal
hist
ory
Nashi smat hematical genius, whogotschol arshipi nPr incetonUni v
ersity
.
Hei sdismi ssiveandar r
ogantwi thal lhiscl assmat esexceptoneChar les
andPaul whoi shisr oommat eandonofhi scl osestf riend.Af t
erhi s
graduationf rom Princetonhegotanappoi ntmentatMassachuset ts
Insti
tuteofTechnol ogywi thhi sf r
iendBenderandSol .Ther eheuset o
teachst udent sandsol vedi f
ficultmat hemat i
cal problems.Ov erther ehe
foundgi rlnameAl iciaandgotmar ried.OnedayNashmetPar cherandhe
enli
stNasht owor kasacodebr eakeral ongwi t
hwor kergr oupwhoscans
magazi nesandnewspapert of indRussi anhi ddencodest hatembeddedi n
thattext.ForPr acher, Nashuset okeept hosehi ddencodesi nanenv elop
andputi tinasecr etbox. Nashf oundoutt hatsomeRussi anpeopl ear e
spyingonhi m sohet ell
sPar chert oqui tthej obbutPr achert hreatened
Nasht obeki ll
edonqui tt
ing.Nasht r i
edt oki l
l hisownsonandwi f
ebef ore
Russianpeopl efi
ndst hem .Al i
ciat ellsNasht oconsul tdoct orandhewas
diagnosedwi thSchizophr enia.Char acterlikeChar les, Paul ,Pracherand
Russianpeopl ewer eonl yinhisi magi nati
on.Al lthosesecr etcodesheuse
tosolveandputi tint heboxwer eact uall
yget t
ingpi ll
edup, nooneuset o
readit.

Fami
l
ypsy
chi
atr
ichi
stor
y
Theheredi
tyofpsy
cho-
pat
hologicalmother
,
whodiedwhenshewas30y earsold.Her
motherhadri
ghtsi
dedhemiparalysi
s.

Rev
iewofsy
mpt
oms
General:t
hepat
ient
’smedi
cal
heal
thhasbeen
fai
rl
ystabl
e
Ski
n:gr
oinr
ash
ENT:
nor
mal
Neck:
noswel
l
ingdy
sphagi
aort
hyr
oiddi
sease
Pul
:st
if
fbr
eat
hing
CV:
bp-
130/
90
GI:
nor
mal
Neuromascul
ar:nomusclewast
ing,
li
tt
le
weaknessinext
remet
ies
Phy
sical
exami
nat
ion
Ski
n:dr
y,gr
oinr
ash
Ent:
nor
mal
Lungs:
clear
CV:
nomur
mur
scl
ear
Abdomen:
flatandsof
t
Pul
se:
80bpm andr
hyt
hmi
c
Ly
mphnodes:
nonpal
pabl
e
Extr
emi
ti
es;
noev
idenceofmuscl
ewast
ingand
edema
Neurol
ogi
cal:l
i
ttl
eabnor
mal
gai
tduet
o
weaknessi
nextr
emeti
es
Shehadcy
st(
bigswol
l
en)ar
eaonherhead

Ment
alst
atusexam
Thepati
entappearstobeorientedwithclear
consci
ousness.Hismoodwasl itt
ledepressed
andhisspeechnor mal.Heappearstobei n
contr
olnoaggressiv
ebehaviorhismemor yis
i
ntactherecal
lseveryt
hingf
ine.
Summar
y
Di
sor
derofconsci
ousnesswasnotf
ound
NoPr
obl
em i
nspeechdueaphasi
a
Memor
yint
act
Lev
elofi
ntel
l
igencei
slow
Shehadt
remor
s
Labdat
a
Hi
stoxi
col
ogyscr
eenwasnegat
ive
Bl
oodt
est
Rbc 4.
57/
l
Hb 130g/
l
Hct 40.
1%
MCV 87.
7fL
MCH 28.
4Pg
MCHC 32.
4
Pl
t 226x10*
9/L
WBC 6.
7X10*
9/L
EOSI
NOPHI
LS2%
NEUTROPHI
LS55%
MONOCYTES4%
ESR 10mm/
hr
Bi
ochemi
cal
test
Gener
alpr
otei
n 60g/
l
Al
bumi
n43g/
l
Ur
ea 3.
5
Cr
eat
ini
ne 85
Gener
albi
l
irubi
n 21.
6mmol
/l
Conj
ugat
ed 8.
3
ECG:
nor
mal
URI
NEANALYSI
S
Speci
fi
cGr
avi
ty:
1020
Pr
otei
n: ABSENT
Gl
ucose: negat
ive
Er
ythr
ocy
te: 0%
Leucocy
te: 10-
12
 BACTERI
A: negat
ive
pH:8.
0
Cl
i
nical
diagnosi
s
Accordingtothesympt omsofthepatient
s
suchasanxi et
y,rest
lessnessandsleep
dist
urbances,poordi
sturbances,confusi
on
,depressionthought
s, general
fati
gue,
audit
orydeli
ri
um (someonesi ngi
ngloudand
speci
fict
ypeofsound“ aaaaaa”)and
vi
suali
zati
onofherdaughter’sfacewhensheis
al
onei nar t
oom ,hemostl ikelydiagnosi
sis
Schizopher
nia.I
tispossi
blypar
anoi
d
becausesheoncehadf ear/del
usi
onthat
ther
ewasawarappr oachi
ngandthose
peoplecouldhurther
.
 Just
if
icat
ionofdi
agnosi
s
Her evealscoresy mpt omsofschi zophr enia
suchasdel usions, visualhal l
ucinat i
onsand
negativesympt om –pov ertyofspeech/ alogia,
forthepastfewy ear s.Hisment al state
exami nati
onhelpusi nfurtherestabl ishingt his
diagnosis.Hergai twassl owandbi tofsuf f
li
ng,
herhandswer eshaki ngconst antlywhi ch
showsanxi ety/fear.Herspeechwassl ow, f
low
ofspeechwasst utteringwi t
hshor tphases, her
clari
tyofwor dswer enotnor mal hedi splayed
slurr
yspeecht heseshowchar act eristicsof
retar
dation.
Wecanalsoexcl
udedr
ugabuseand
al
cohol
i
sm si
ncehedeniesusi
ngal
cohol
and
dr
ugs.
 Tr
eat
ment
Schizophr
eni
arequi
resl
i
fel
ongtreat
ment,ev
en
aft
erthesymptomshavesubdi
vi
ded.The
t
reat
mentar easf ollows:
-
Psycologoicalimpact
-
Medicaltherapy
-
Gradualrehabili
tationandv ocati
onalt
rai
ning
-
Acordialandi nteractiv
erelati
onshi
pbetween
t
hepatientandat rainedprofessi
onal

Medi cat i
on:
Neur oleptics:Haloper
idol,Tri
sedi
l
Ant i
depr essants:Amitri
pty
line,Tr
yti
zol,
Clozapi ne
Vitaminsandsuppl ementtherapyfor
restorativepurposes.

Pr
escr i
pti
on::
R.
p: Sol
.Haloperi
dol 0.5%- 1,
0
D.Smor ni
ngandev eningf oranti
psy
coti
cs
ef
fect
R.
p: Sol
.Di
azepami 0.5%- 2,0
D.S10pm ev erynightf orsedat i
veef
fect
R.
p: Aci
diValproici200mgi nt abs
D.S1t abmor ni
ngandev eningasamood
st
abili
zer
Psy
chosoci
alt
her
apy
Oncepsy chosi srecedes, i
naddi ti
ont o
continuingonmedi cations, psy chologi caland
socialinterv entionsar ei mpor tant
Individual therapy:Psy cotherapymayhel pto
normal i
zet houghtpat terns.Al so,l
ear ningt o
copewi thSt ressandi dent if
year l
ywar nigsigns
ofrelapsecanhel ppeopl ewi thschizophr enia
managet heirill
ness
Soci alSki ll
sTher apy: Thisf ocuseson
i
mpr ov i
ngcommuni cationandsoci al
i
nteractionsandi mpr ov ingtheabi li
tyt o
part
icipat eindai l
yact i
v iti
es
Fami l
yt her apy:
Thi spr ov i
dessuppor tandeducat iont o
fami li
esdeal i
ngwi thschi zophr enia
Vocat i
onal Rehabi l
itationandsuppor t
ed
empl oy ment: Thisfocusesonhel ping
peopl ewi thschi zophr eniapr eparef or, f
ind
andkeepj obs.