Assessing and Diagnosing Patients with Schizophrenia, Other Psychotic Disorders, and Medication Induced Movement Disorders
History of Present Illness (HPI): P.W. is a 42-year-old Caucasian female admitted to the emergency department after a psychotic episode. P.W.’s best friend, Felicia, called the police because P.W. had intentionally locked herself in the closet for an hour and was screaming. The police arrived, and P.W. was calmed down with a dose of Ativan as they headed to the hospital. P.W. has been reported to the police in the past for assaulting others, including strangers. She accuses the people she assaults, including Felicia, of spying on her. P.W. believes the spies are all over and she is not safe anywhere, including her house; therefore, she takes protective measures such as locking herself in the closet and assaulting any suspected spy. Felicia highlights that P.W. does not sleep at night because she fears being watched. She periodically sleeps during the day for about one hour per episode. P.W. does not believe that she has a mental condition and gets angry whenever Felicia suggests visiting the hospital for a mental examination.
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Past Psychiatric History: P.W. was admitted to the psychiatric hospital exactly one year ago. She has been admitted to the emergency department after a psychotic episode thrice in the past two weeks. A dose of lorazepam (Ativan) injection is usually very effective when administered during P.W.’s psychotic episodes. Previous treatment using clozapine (Clozaril) led to severe adverse reactions and was withdrawn.
Substance Use History: P.W. drinks one glass of wine per week. She does not use any illicit drugs.
Family Psychiatric/Substance Use History: P.W.’s father has a psychiatric history of two inpatient psychiatric hospitalizations due to paranoia. Her mother suffered from bipolar depression. P.W.’s paternal grandmother underwent treatment using shock therapy.
Social History: P.W. was born in Cameron, Montana. Her mother and father brought her up. P.W. has a 47-year-old sister. Her parents died in the last three years. P.W. currently lives with her best friend, Felicia, in a two-bedroom apartment. She is married to her husband, who works as a truck driver. She does not have any children. She has been pregnant once but underwent an abortion for medical reasons. P.W. dropped out of school in the 11th grade and has never had a stable job. She obtains Social Security Disability Insurance. Felicia highlights that the death of her parents traumatized her. P.W. has no current legal charges. She has, however, been reported a few times for assaulting others. She has no history of self-harm.
Past Medical History (PMH): P.W. was pregnant and underwent an abortion. Her immunization status is up to date. She received two doses of the AstraZeneca vaccine for COVID-19.
Current Medications: No medications.
Allergies: Allergic to clozapine. No known food allergy.
Reproductive history: The last menstrual period was two weeks ago. Heterosexual. Not pregnant. Not lactating. Uses condoms as a contraceptive method.
ROS:
General: Reports daytime sleepiness. Denies chills, fever, headache, day sweats, fatigue, weight loss, or weight gain.
HEENT/Neck: Denies difficulty swallowing and rhinorrhea. Denies double vision, itchy eyes, painful eyes, blurred vision, and visual loss. Denies changes in hearing, ear fullness, ear noises, ear discharge, and ear infection. Denies dry mouth, difficulty swallowing, oral lesions, gum bleeding, or nasal congestion.
Skin: Denies rashes and itching.
Cardiovascular: Denies lightheadedness when standing, paroxysmal nocturnal dyspnea, leg edema, slow wound healing, numbness in extremities, palpitations, arrhythmias, dyspnea, chest pains, or orthopnea.
Respiratory: Denies cough, wheezing, choking when swallowing, chest pains, shortness of breath, holding breath during sleep, difficulty breathing, or sputum production.
Gastrointestinal: Denies abdominal pain, vomiting, diarrhea, heartburn, nausea, choking during sleep, indigestion, loss of appetite, acid reflux, constipation, or difficulty swallowing.
Genitourinary: Denies painful urination, urinary incontinence, dribbling, decreased stream, frequent urination, and blood in the urine. Her last monthly period was two weeks ago.
Neurological: