BS IN PHARMACY | BAKIL

PATIENT SCZ
Schizophrenia

Introduction

Patient SCZ is a 50 year old male patient who presented to the pharmacy with a prescription for
Quetiapine 300 mg/tablet to be taken orally once a day at bedtime. (Below is a photo of the
prescription presented by the patient).
Background

When Patient SCZ was 20 years old, changes in personality were noted by his mother after
drinking juice (no specific brand mentioned) and cake (no specific flavor mentioned). By the
year 1993 (age 30), the patient was referred to the Institute of Psychiatry and Behavioral
Medicine of the Southern Philippines Medical Center located at Claveria St., Poblacion Dist.,
Davao City.

There, the patient was diagnosed with Schizophrenia and was given an initial treatment plan of
20 mg/mL ampule of Flupentixol decanoate and 100 mg of Sertraline tablet to be taken orally
once a day at bedtime. Patient was also prescribed Vitamin B Complex.

According to the American Psychiatric Association, Schizophrenia is a chronic brain disorder

wherein if active the patient may experience hallucinations, disorganized speech, lack of
motivation and can find it hard to make thoughts. In Nabunturan's regional health center, they
have a total of 157 patients under the mental department with 60% of those patients diagnosed
with Schizophrenia.

The exact cause for the disease has not yet been identified but scientists and medical researchers
believe that a number of genetic and environmental factors as well as life stressors contribute
tothe development of Schizophrenia.

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Note: this photo was taken at the place of internship where patient SCZ was given medications
for free as sponsored by the mental medication program of the Department of Health.

Flupentixol decanoate 20 mg/mL ampule

Flupentixol decanoate is a 1st generation depot medication for

Schizophrenia given via intramuscular route to patients with 20 mg being
initially given as a test dose to the patient. After a week, this medication
can be given every 2 to 4 weeks and can range from 20 mg to 40 mg. The
medication inhibits the postsynaptic dopamine receptors in the CNS
which results in the blockage of dopamine-mediated effects and has an onset of action at 24 to 72
hours after administration via injection. It is distributed throughout the body by crossing the
blood brain barrier and placenta. It is extensively metabolized in the liver via sulfoxidation,
side-chain N-dealkylation, and glucuronic acid conjugation into inactive metabolites; undergoes
first-pass metabolism in the gut wall.

For the patient, he is given one dose of 20 mg/mL ampule every month and has been compliant
with the medication as evident with his monthly visit to the Regional Health Unit's Pharmacy.

Quetiapine 100 mg (immediate-release) and 300 mg tablet (extended- release)

Patient SCZ was newly prescribed with a 300 mg tablet of Quetiapine. He is to take the new
medication by mouth every night before bedtime.

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Quetiapine can be taken as immediate-release or extended release tablets. For this patient, he was
prescribed the 300 mg extended release tablet. It is a dibenzothiazepine atypical antipsychotic
agent. Quetiapine's clinical antipsychotic properties and low extrapyramidal side effects are
mediated through a combination of D2 and 5-HT2 receptor antagonism. The medication has an
affinity for serotonin (e.g. 5-HT2), histamine (H1) and adrenergic (e.g. α1 and α2) and dopamine
(D1 and D2) receptors.

Drug Interactions

The heart-rate corrected QT interval (QTc) of the patient can be increased when Quetiapine is
combined with Flupentixol decanoate. Patient is not known to take any other medications.

Medical Intervention

Patient SCZ was referred very early on to be assessed by a physician from the Institute of
Psychiatry and Behavioral Medicine of the Southern Philippines Medical Center. Due to early
diagnosis and compliance of the patient in taking his medication, his Schizophrenia was managed
and kept at bay. This allows him to proceed on with daily activities in his life.

Intervention Process

The patient was accompanied by his mother to the Regional Health Unit of Nabunturan where he
visits every month to avail of the free mental medications provided by the Department of Health.
There, he proceeds to the outpatient department of the Regional Health Unit to acquire a new
prescription prescribed that same day of visit as to avail the free Department of Health
medications. From there, he proceeds to the pharmacy, acquires the medications, heads back
upstairs to the nursing station to get the medication (Flupentixol decanoate 20 mg/mL ampule)
injected.

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Outcome

Patient knows and understands how to take his medication of Flupentixol decanoate as he has
taken it via injection every month. For the new medication however, he was briefly informed by
the pharmacist and pharmacy intern on how and when to take the medication. He was advised to
take the medication whole night before bedtime every day.

Discussion

The initial treatment plan for the patient was 100 mg of Quetiapine fumarate once a day with
flupentixol decanoate to be given once a month intramuscularly. This has since changed to a 300
mg tablet of Quetiapine fumarate to be taken once a day at bedtime.

Conclusion

In 2018, Schizophrenia is said to affect 1 million Filipinos, that means 1% of the total population.
Some are lucky in receiving medical care early which helps ensure that their schizophrenia is
managed and allows them to continue on with their daily activities. Some are not so lucky and
get diagnosed later on or never at all. These symptoms often begin in late teens to mid-twenties.

The early treatment and intervention of Schizophrenia means better recovery as further
development of psychosis in schizophrenia patients is thought to delay or even prevent the
transition to psychosis and improve outcomes. Not only that, but compliance of the patient also
helps ensure that the disease is kept at bay and does not become active leading to hallucinations
and motor and cognitive impairments.