Carter Louis, a 25-year-old male, the eldest of three siblings in a middle class family, was diagnosed with paranoid schizophrenia. He is currently in an inpatient unit.
His parents and a close relative reported he has been reserved and shy since childhood, rarely initiating a conversation or any activity and hesitant to talk to others. Behavioral changes were noticed by members of the family as he entered adolescence but were taken in a lighter vein and ignored. His irritable nature and antisocial behavior worsened over the years, and recently, he had a violent bust out on a minor financial issue with a neighbor.
There was no history of any complicated trauma, no alcohol or drug dependence, nor physical or psychiatric illness of the mother during pregnancy. His was in school from age four through 19. There are no reports of school phobias or any kind of learning difficulty. He quit his studies in accordance with his parents’ advice. He prefers indoor and solo games, such as video games, rarely indulges in group activities, and does not have very healthy relationships with his younger siblings. His activities are mostly sedentary. He at times regrets not being sent to a more established and well reputed high school.
The mental status examination revealed that his eye contact was not continuous and he moved his eyes suspiciously and furtively. He tried a little hard to change the body postures and lethargic movements of the limbs (particularly) were also noticed. Quantity of speech was reduced, and he became hesitant on expression of some of his views and beliefs. During conversation, there were blank intervals and tangentiality in his train of thoughts, with changes in pitch. Generalizations based on inappropriate or limited information were also present. He was not able to understand and use the concepts easily. His attention and concentration were intact to an extent. Reaction time was normal, and no compulsive acts or habits were present. Orientation to time, place, and person were intact. His insight into the illness was minimal, as he completely attributed it to others around him.
Carter’s dad reported suspicious behavior, and delusions of reference, persecution (such as a relative inflicting him with some mantras), auditory (sounds of people talking about him), and olfactory (poisoning of the air). Hallucinations were also present but were rare. On investigation, it was learned that, in the prodromal state Carter presents nonspecific symptoms like loss of interest, irritability, oversensitivity, lack of appetite, and insomnia. The parents reflected on his non-compliant behavior makes administration of medication difficult for them (who then resort to tricks, such as saying, “These drugs are for your psycho-sexual disorder,” as he once had a hallucination that his penis nerve was being cut).
In addition to the presence of the atypical clinical features, a history of head injury was reported when Carter was 10 years old, when a metal rod pierced his fore brain. Deterioration of psycho-social functioning was observed and reported by the parents.
Questions
You are seeing Carter and his family during a family meeting on the inpatient unit. From your perspective as Carter’s psychiatric nurse practitioner, answer the following questions in a two- to three-page double-spaced paper (not including the reference page) and in APA format. Include at least three peer-reviewed, evidence-based references.
What diagnosis would you give Carter? Please match Carter’s symptoms with the DSM-5 criteria.
What recommendations relative to medications would you make? Name the type of typical or atypical antipsychotic you would prescribe and identify the dosing and administration. Please include the dose and time of administration Give evidence to support your decision.
Decide whether you would add any other non-pharmacological treatment. Provide current literature (EBP, research article, or textbook reference) to support your decision.
Based on the medications you prescribe, what education would you provide to Carter and his family?
Identify any laboratory testing you would order and explain your rationale.
Would you refer Carter to any other providers, and if so, to whom? Provide your rationale for any referrals.
