A clinical case report on haloperidol-induced extrapyramidal symptoms in schizophrenia with small vessels ischemic disease

Abstract

Background : schizophrenia is a severe mental disorder that may cause disability and has a major effect on an individual’s life. Multiple sclerosis is a chronic disease that affects the central nervous system. Schizophrenia and Multiple sclerosis both have a similar influence on the well-being of life. The onset of both diseases may be at the acute or sub-acute level characterized by progressive disability. Both diseases lack of signs and symptoms, common symptoms are seen like headache, and fever in the early stage. Some studies noted that patients with multiple sclerosis have an increased risk of developing schizophrenia. Factors that influence the occurrence of multiple sclerosis and schizophrenia-like gender, ethnicity, geography, and season. Presentation of case : A case 41 years male reported in psychiatric OPD with his wife at that time client was disoriented as verbalization by his wife patient had the complaint of slurred speech, and difficulty in walking, the patient had difficulty performing daily activities for 8 days. Also, the patient complains of sleep disturbances, difficulty in initiating sleep, and shows violent behaviours, he takes the knife out, threatens his wife, has suspicious behaviors towards his wife, and mutters to self. The patient was a known case of schizophrenia for 8 years. The investigation carried out such as history taken a physical examination of muscle stiffness on limbs lower presented, mental status examination of hallucination (visual ), and suspicious, incorporate behaviour present. The patient removed his clothes during the mental status examination. In MRI- small vessel ischemic disease. The psychiatrist diagnosed as extrapyramidal symptoms induced by haloperidol with schizophrenia with small vessels ischemic disease. The patient was treated with Tab. risperidone 3mg OD, tab clozapine 12.5mg hs, tab quetiapine 200mg HS, Tab. Lorazepam 2mg. HS. And symptoms were minimized after a two week of improving the patient’s condition. Prognosis: The patient was treated with antipsychotics, antianxiety and neurotransmitter agents, and supportive therapy, and the patient’s prognosis was improved. Conclusion: Primary managing entails correct diagnosis, risk factor reduction, and supportive therapy. The least likely to result in extrapyramidal symptoms are second-generation antipsychotics, which can be used depending on the patient’s condition.