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HPI- History of Present Illness

PMH- Past Medical History

PE- Physical Examination

VS- vital sign

HEENT-Head, Ears, Eyes, Nose, Throat

PERRLA- Pupils Equal, Round, Reactive to Light and Accommodation

EOMI- Extraocular Movements Intact

GU- Genitourinary

NAD- No Acute Distress

MSE- Medical Screening Exam

Gait - A particular way or manner of moving on foot

Grandiose - extravagantly or pretentiously imposing in appearance or style

Persecutory delusion - A fixed, false, and inflexible belief that others are engaging in a plot or plan to harm an individual.

TPP impaired attention – time, place, person

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HPI- History of Present Illness

PMH- Past Medical History

PE- Physical Examination

VS- vital sign

HEENT-Head, Ears, Eyes, Nose, Throat

PERRLA- Pupils Equal, Round, Reactive to Light and Accommodation

EOMI- Extraocular Movements Intact

GU- Genitourinary

NAD- No Acute Distress

MSE- Medical Screening Exam

Gait - A particular way or manner of moving on foot

Grandiose - extravagantly or pretentiously imposing in appearance or style

Persecutory delusion - A fixed, false, and inflexible belief that others are engaging in a plot or plan to harm an individual.

TPP impaired attention – time, place, person

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Question 12: What is the rationale of giving benzhexol to TA

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Question 12: What is the rationale of giving benzhexol to TA

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benzhexol is also known as trihexyphenidyl. Trihexyphanidyl is an antimuscarinic medicine. It is prescribed for people who have unwanted movement disorders as a side effect of taking other medications.

Haloperidol can cause these effects (sudden, jerky involantary movements)

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White cell counts - Performed before the start of, and during, clozapine therapy.

- Treatment should not be started if the white blood cell count <3500 cells/mm3 and the absolute neutrophil count (ANC) <2000 cells/mm3

- Monitoring should continue throughout therapy and for 4 weeks after withdrawal.

In the USA, white blood cell and ANC are monitored weekly for the first 6 months and then every 2 weeks thereafter; after 1 year of therapy, patients may be monitored every 4 weeks.

Clozapine should be withdrawn if the white blood cell count falls below 2000 cells/mm3 or the ANC drops Eosinophil count In the EU, clozapine should be withdrawn if the eosinophil count is greater than 3000 cells/mm3; it should only be restarted once the count has fallen to below 1000 cells/mm3. Platelet count European licensing information states that clozapine should be stopped if the platelet count falls below 50 000 cells/mm3.

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c.Significant social dysfunction

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Question 8: Which of the following symptoms does TA have?

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Question 8: Which of the following symptoms does TA have?

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Auditory hallucinations

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Tardive Dyskinesias are involuntary movements of tongue, lips, face, trunk and extreamities in patients treated with long term of dopaminergic antagonist.

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Substitute phenytoin with sodium valproate .It is taken by oral route where initially 600mg daily in 1-2 divided doses,increased gradually every 3 days

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7. Is TA a good candidate for clozapine?

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7. Is TA a good candidate for clozapine?

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No.Because the patient will suffer from more serious constipation side effect. Haloperidol will also interact with clozapine which increases the sedative effect.

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6. C . Significant social dysfunction

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Hallucination, delusions, disorganization, cognitive impairment, mood & anxiety symptoms, neurological disturbances, catatonia, metabolic disturbances.

*Delusions -- false belief that are not based in reality.

*Catatonia -- state of apparent unresponsiveness to external stimuli in patient who appears to be awake.

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Haloperidol decanoate available in injection form : 50mg/mL

Therefore, 10mg = 10/50 = 0.2 mL

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1. Drug-drug interaction

- Haloperidol & Benzhexol.

Haloperidol increases the effect of benzhexol by synergism which is an additive anticholinergic effect.

- Phenytoin & conjugated estrogen

Phenytoin decrease effect of estrogen. Phenytoin is an enzyme CYP3A4 inducer.

2. Pharmaceutical Care

- Haloperidol dose has been recently decreased. Thus, drug may not have achieved therapeutic effect. So, patient experiencing auditory hallucination for past 2 weeks.

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Question7: The most common type of hallucination seen in schizophrenia is auditory hallucination. Auditory hallucination usually involves voices talking to or about the person. The imaginary voices heard by schizophrenic individuals can be disturbing. Voices that tell them what to do are command hallucinations. These can be harmful if the voices are giving a suicidal thoughts.

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Question7: The most common type of hallucination seen in schizophrenia is auditory hallucination. Auditory hallucination usually involves voices talking to or about the person. The imaginary voices heard by schizophrenic individuals can be disturbing. Voices that tell them what to do are command hallucinations. These can be harmful if the voices are giving a suicidal thoughts.