Abstract
ObjectiveWe report a case of a 58-year-old gentleman who was hospitalised intermittently for one year due to treatment resistant schizophrenia. Prior to hospitalisation he had been prescribed standard antipsychotics for decades without full resolution of positive psychotic symptoms. During his final admission lasting six months he was guarded, suspicious, irritable, constantly paced the corridor and displayed thought block and paranoid persecutory delusions. He would not enter the assessment room or allow any blood or ECG monitoring, however, he was compliant with oral medication. He was successfully treated with high dose olanzapine (40mg/day) and was discharged to the community. The aim of this study is to bring awareness and add to the body of evidence for the use of high-dose olanzapine in patients with treatment resistant schizophrenia in whom a trial of clozapine is not possible.Case reportThe patient gave written consent for this case report to be written and presented. An extensive literature review was performed and key papers were identified. Discussion focuses on the key areas in the literature.DiscussionThis case demonstrates that high-dose olanzapine can be used effectively as an alternative to clozapine in treatment resistant schizophrenia.ConclusionThis case highlights the need for further evaluation of high-dose olanzapine as an alternative to clozapine in patients with treatment-resistant schizophrenia.
Highlights
This study aimed to compare patients who received facilitated early discharge (FD) with patients who were discharged without FD to identify whether there were significant differences in terms of social demographics, illness characteristics, health outcome and treatment duration
Using this data we aimed to provide proposals to help advance the effectiveness of FD, as well as suggesting concepts of where future research should lie
A randomised sample of patients who received FD and patients who were discharged without FD was obtained from a South London Hospital
Summary
Obsessional slowness in OCD is a rare phenomenon on which there is minimal published literature. This is a severe and atypical case of early onset OCD with extreme obsessional slowness and mutism. This report seeks to provide discussion of important organic causes that may need to be considered as well as information on treatment approach. Initial differentials included Juvenile Onset Parkinson’s or Wilson’s disease Both were subsequently ruled out and despite multiple investigations, no obvious organic cause was found. It is important for clinicians to be aware of obsessional slowness in OCD and this report highlights a rare and severe example in a young adult who has been difficult to treat.
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