(Please note: Steve is a fictitious character, and although my cat's name is Steve, I am not referring to him...)
Steve is a 21-year-old Caucasian male who presented for treatment, due to what he has termed as some recent disorientation. He indicated that he has had a lot of difficulty focusing on tasks and attending his university classes. He stated that he realizes something is different about him. His friends and family keep asking if he is okay. Steve reported that what prompted him to come to counseling was when he thought he heard someone telling him that his brother was working with the CIA to have him “put away for good.” He reported feeling scared and confused most of the time.
Steve presents with signs of schizophrenia. His self-described symptoms include recent disorientation and difficulty focusing. He reports realizing something is different about him. Most significant to this diagnosis is hearing a voice telling him his brother was working with the CIA to have him put away. This, in addition to his report of feeling scared and confused most of the time indicate symptoms of schizophrenia. Additionally, he is at an age common for onset of of this illness.
The National Alliance on Mental Illness (2010) determines two onset symptoms as (usually) threatening vocal hallucinations and delusions that others are watching and plotting against them. These two, of several common symptoms, are enough to warrant this diagnosis.
According to the National Institute of Mental Health (NIMH) (2012), the second generation antipsychotic medications used in the pharmacological treatment of schizophrenia are clozapine (Clozaril,) risperidone (Risperdal,) olanzapine (Zyprexa,) quetiapine (Seroquel,) ziprasidone (Geodon,) aripiprazole (Abilify,) and Paliperidone (Invega). These drugs can improve symptoms of schizophrenia such as hallucinations, delusions, disorganized thinking, and breaks from reality (NIMH, 2012). Starting treatment with these second generation drugs is preferred because they have been shown to cause a lower risk of tardive dyskinesia, and other serious and often permanent side effects more common in the first generation drugs such as Haldol (haloperidol). I would recommend Zyprexa (olanzapine).
One of the most difficult problems with schizophrenia is non-compliance with pharmacological treatment. The extended release injection of Zyprexa eliminates the need for daily compliance and may help in the successful ongoing treatment of the disease. Because of the compliance issue and the importance of pharmacological treatment in schizophrenia, I would recommend this method of delivery for my client, unless it was otherwise contraindicated. This particular drug has a higher level of sedation, so I would recommend starting on the lowest possible dose (Preston, n.d.).
Prior to prescribing these medications, it is important to determine any Axis III diagnoses (general medical conditions relevant to diagnosis and treatment) such as history of heart problems and allergies, as some of these medications are contraindicated under these conditions. In addition to the long-term treatment needed for schizophrenia and because these drugs have many side effects, it is important for Steve to keep in touch with his mental health counselor as well as his primary care physician on a regular basis. It is equally important for Steve to find relief from his symptoms. If he does not respond to first line treatment with the second generation drugs, clozapine might be the next choice as it often works for those who don't respond to other medications (NIMH, 2012).
Because schizophrenia is ordinarily a lifelong disorder, and can be difficult to treat without an experienced , trained medical professional, I would make an immediate referral to a psychiatrist or other clinical mental health professional for collaborative discussion on the most appropriate medication as well as writing the prescription.
National Alliance on Mental Illness. (2010). About Medications. National Alliance on Mental Illness. Retrieved 2012, from http://www.nami.org/Template.cfm?Section=About_Medications
National Alliance on Mental Illness. (2010). Early onset schizophrenia. National Alliance on Mental Illness. Retrieved 2012, from http://www.nami.org/Content/ContentGroups/Helpline1/Early_Onset_Schizophrenia.htm
National Institute of Mental Health. (2012). What medications are used to treat schizophrenia? National Instutute of Mental Health-Mental Health Medications. Retrieved 2012, from http://www.nimh.nih.gov/health/publications/mental-health-medications/what-medications-are-used-to-treat-schizophrenia.shtml
Preston, J. (n.d.). Quick reference to psychotropic medications. Retrieved February 1, 2010, from http://psychceu.com/Quick%20Reference_BW.pdf