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Schizophrenia Case Study Report

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This is a 40-year-old female with a 6/18/2010 date of injury, when an agitated patient picked-up a heart monitor machine and slammed it into claimant's head and ribs. DIAGNOSIS: Lumbar disc displacement 12/11/15 Progress Report indicated the patient had denied Topamax increase and complained of diarrhea and worsened mood with Cymbalta. She started Cymbalta on 08/28/15. The patient was noticeably irritable. The patient reported >30 minutes late. She is inconsistent in her recount of medication effects. She said that she is more irritable but less depressed with Wellbutrin. She also noted that Cymbalta was worse, but later asserted that Cymbalta was better. Mental Status Exam showed depressed mood and irritable affect. She was rude and not …show more content…

The patient used and antidepressant Paxil with failure in the past. She self-discontinued all her medications 2 weeks prior to her initial visit. She started Cymbalta on her last visit and discussed about increasing Topamax with her neurologist. The patient reported worsening depression, sleep and persistent diarrhea. Although her neurologist agreed with increase in Topamax dose, she never started the increased dose. The patient is deemed to be at chronic elevated risk for self-harm/suicide and violence. These risk factors are mitigated by the lack of active SI/HI, no history of previous suicide attempts, motivation for treatment, sense of responsibility to family, social support, minor children living at home, safe housing and presence of a safety plan with follow-up care. There is no acute risk for suicide or violence at this time. She also experienced daytime sleepiness with Cymbalta, therefore she changed it to ahs dosing, and has noted an overall improvement in her sleep (which is not typical of Cymbalta). However, she wakes up in the middle of the night around 4-5 am. She then feels a burst of energy soon after she wakes up and she tries to get as much accomplished during this time as possible. The patient also showed pictures of her clean house and laundry in her phone, to prove her peers she is not lazy. She expressed desire to “give up” and stop taking all medications to “ride it out”. Mental Status Exam showed worse moods, anxious affect, dysthymia and irritability. Current medications: Cambia 50 mg, Cymbalta 20 mg, Neurontin 800 mg, Motrin 800 mg, Antivert (meclizine) 32 mg, Depo-provera 150 mg/ml, Amerge (naratriptan) 2.5 mg, Phenergan 12.5 mg, selenium 50 mcg, Treximet 85-500 mg, Tizanidine (Zanaflex) 4 mg, and Topiramate (Topamax) 100 mg. Treatment plan was to start

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