- Jerry’s Story: Understanding Paranoid SchizophreniaFree Chapter19:24No, The Theme’s Not Halloween1:03Vestibular Neuritis21:56Paper Chase 1: PPIs and MIs7:22Primary Nocturnal Enuresis30:34Paper Chase 2: Can you say 'Alirocumab'?7:26Defensive Medicine? The Antibiotic Conundrum23:43Remember HM? He Doesn’t2:14Paper Chase 3: Benzo + Opiate = Increased Mortality Risk7:01Polycystic Ovarian Syndrome23:41Paper Chase 4: Surgery vs PT for Lumbar Stenosis5:13Thanks, War.4:24Dermatology Primer: Scabies19:20Paper Chase 5: Crime and Varenicline7:03The Summary16:03
Jerry’s Story: Understanding Paranoid Schizophrenia
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Discuss the patient experience of schizophrenia, depot haloperidol therapy.
One of the great joys of primary care is the relationships that we develop with patients over time. Jerry is in his early 60’s, and he has paranoid schizophrenia. James has been seeing him every three weeks for over a decade. Jerry’s life mission is to help improve awareness and treatment of schizophrenia. He also has a daily goal of helping one person every day.
Jerry’s first memory of auditory hallucinations was when he was five years old. He recalls playing with his mother’s old Singer sewing machine and hearing a voice telling him to put his finger underneath the needle, pull the pulley, and cause the needle to go through his finger. The hallucinations increased when he was eight, often speaking to him in a negative way while he attended Catholic school. By ninth grade, Jerry had become so paranoid that he could no longer function in the school environment. He dropped out of high school and joined the army.
In the army, life was great. The voices were gone, and he was a good soldier. He was promoted several times. Jerry fell in love with his high school sweetheart and was married at the age of 20. After seven years in the army, he was having no auditory hallucinations and minimal paranoia. He left the army and got a management position working for McDonald’s. He took additional coursework specializing in management and excelled in his career. He enjoyed his work.
After 11 years of marriage and the birth of two children, Jerry and his wife divorced. Six months later, at the age of 31, the voices returned and he was diagnosed with schizophrenia. Jerry’s auditory hallucinations manifested as a spiritual warfare battle that he was fighting against evil spirits. He believed he was chosen to fight a war against demons. This six month period of time was hell for Jerry. Trying to fight the war was exhausting. He often would go two to three nights without sleep. Unlike some patients with psychosis, when Jerry was very ill, he was still self-aware. He knew he was Jerry, the father of his children. His family tried to be supportive, but they didn’t understand schizophrenia.
The medications and treatment for schizophrenia were worse than fighting the demons of his disease. He stopped medications several times due to side effects, including uncontrollable twitching and jaw subluxation. He couldn’t work or function on the therapy. Jerry tried several medications, but none of them seemed to work.
Finally, Jerry was started on a medication that worked: haloperidol. Yet over time, as his symptoms improved, he felt like he didn’t require medicine anymore and stopped taking it. Predictably, his condition would deteriorate. At that point, his psychiatrist recommended injection therapy, which continues to be an effective treatment option. Jerry recommends it to all patients with schizophrenia. Injection therapy guarantees compliance which is reassuring for the treating physicians and family members. It also provides a built-in accountability; if a patient doesn’t show up for his/her injection, the health provider knows and can investigate what is wrong. Jerry’s current dose is 75 mg of haloperidol every three weeks with oral cogentin to manage side effects. James feels that her schizophrenic patients who are on depot therapy have fewer psychotic breaks and are hospitalized less frequently than those on oral medications.
Jerry’s insight into his illness provides us with a glimpse of what others with this disease might be going through. Jerry’s religious faith played a big role in his life. Whenever he was ill, he knew there were better days ahead. His faith was a source of hope and comfort. This protected him from depression and thoughts of suicide. On occasion, the spiritual beliefs of his physician didn’t align with his own. This polarization of religious beliefs set up a barrier that poisoned the therapeutic relationship. At times, he had to switch physicians.
When treating a schizophrenic for the first time, Jerry recommends being patient. Even when the patient is out of touch with reality, try to be a good listener and get to know him/her. Don’t just write a prescription and wave goodbye. Get to know their lives, their story, and their struggles. It is so easy to dismiss the cognitive meanderings of the schizophrenic patient. But in the midst of the thought disorganization, there is sometimes a kernel of insight.