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 .