Case presentation
The patient is a 52-year-old female with a 23-year history of schizophrenia, aggravated in the last 2 years. She has hypertension, hyperlipidemia, and coronary heart disease. And she is allergic to penicillin. In her family, a maternal aunt has a history of psychiatric disease.
This case first became ill in 1999 (Age 29), with the symptoms of soliloquy, delusion of persecution and reference, and social withdrawal. She was diagnosed of schizophrenia and treated with sulpiride and perphenazine (dosage unknown). The psychotic symptoms were controlled after a month of medication, and the drug regimen was maintained for another 3 months. Then she interrupted medication on her own due to the disappearance of symptoms, and had no recurrence in the next 6 years. In 2006 (Age 36), the symptoms of sensitivity and suspiciousness reappeared, accompanied by headache and abdominal pain. She resumed therapy and her condition improved after treatment with sulpiride and quetiapine (dosage unknown) for a month. Thereafter, she persisted her medication and her condition was stable from 2007 to 2013. From 2014 to 2020, her condition deteriorated twice with the symptoms of delusion of persecution and reference, soliloquy, sensitivity, depression, suicidal ideation, as well as abdominal discomfort and constipation. And she was also diagnosed with hypertension, hyperlipidemia, and coronary heart disease during this period, then she started taking jiangzhining tablets and propranolol (unknown dosage).
Over the following years, she refused to seek medical help and gradually upregulated the dosages of APs on her own by reading package inserts online because of the poor effects of APs on her symptoms. Until 2020, details of the doses she took are given in Table 1 . Over the next 2 years, she did not adjust her medication regimen. In 2022, she was unresponsive and scatterbrained with delusion of reference and jealousy, hypomnesis, aprosexia, lack of insight, and hypersalivation. To seek further treatment, she was again hospitalized.
The timeline of this case is presented in Figure 1 .