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After completing this case study, the reader should be able to:

  • Describe the target symptoms of schizophrenia.

  • Manage an acutely psychotic patient with appropriate pharmacotherapy.

  • Identify and manage the adverse effects of antipsychotics.

  • Discuss the role of second-generation antipsychotics in the treatment of schizophrenia.


Chief Complaint

“I want to see my lawyer.”


This is the first inpatient admission for Anita Gonzalez, a 32-year-old Hispanic woman who was brought to the psychiatric hospital by the police. Earlier today she was brought to the crisis center by a friend in her apartment building after the landlord threatened to call the police since Anita was creating a disturbance. At the crisis center, Anita became increasingly agitated and suspicious; the police were called; however, she left before being evaluated by staff. The patient apparently has been delusional and believes people sneak into her room at night when she is asleep and place a thousand worms inside her body. She also believes that she is being raped by passing men on the street. She is quite preoccupied about having massive wealth. She claims to have bought some gold and left it at the grocery store. She believes that her ideas have been given to a Cuban communist who has had plastic surgery to look like her and is using her identification to take possession of all of her property. She states that she is having difficulty getting her property back.

Apparently, the precipitating event today that eventually resulted in her hospitalization was that she created a disturbance at a local fast-food restaurant, claiming that she owned it. Because of the disturbance, police were called, and she subsequently was sent here on an order of protective custody. According to the patient, she bought a hamburger and sat down to eat it, and for some reason, somebody called the police and charged her with illegal trespassing. She claims that 6 years ago she was raped by a relative of a sister and broke her hip in the process. She states that her feet were cut off because she would not do what her impostors wanted her to do, and her feet were subsequently sent back to her from Central America and were reattached.

Her speech is quite rambling. She speaks of having been part of an experiment in Monterey, Mexico, in which 38 eggs were taken from her body, and children were produced from them and then killed by the government. She claims that she has worms in her that are the type that kill dogs and horses and says that they have been put there by the government. She also claims ...

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