The name of the patient is Ms. Atheer. She is a 22 years old girl, and she is a dependent daughter. It has been known that she is dealing with the disease named Paranoid Schizophrenia. Las time she was admitted to the hospital in 2013. In her recent visit to an outpatient clinic, the chief complaint is that she is suffering from sleep disturbance as well as severe anxiety.

History of Present Illness (HPI)

It is mentioned earlier that Ms. Atheer is having Paranoid Schizophrenia, and it was first identified in 2013. But lately, she was going well due to regular follow up check-ups as well as good compliance. It is important to mention here that Atheer is studying at Dammam University as a final year student in Islamic Studies. It has been observed that Atheer has been good in her social as well as academic performance. She lives at her home with her mother, and her father works somewhere in the remote area. It was noticed by her mother that Atheer was having sleep disruption, continuous anxiety as well as lack of focus in her studies. Moreover, she was also having a poor appetite. She was actually afraid of her father that her mother will explain the situation to father when he gets back home. When her father came back home, and she came to know about it, she got more afraid and emotional. She was not feeling well so she was brought to an outpatient clinic, where her check-up was done. The clinic offered that if her mother wants a safe and controlled environment to manage the emotions and anxiety of her daughter, then they can admit her in the clinic. It is important to mention here that Atheer was not found with any hallucinatory experience, suicidal ideas or death wish.

ROS of Patient of Disease, Paranoid Schizophrenia

As per reports, Atheer was dealing with issues such as concentration, sleep, appetite, and energy, which have been mentioned above. However, it is noted here that she had not reported any issues such as nausea, chest tightness, muscle tension, headache, and difficulty in breathing or a racing heart.

Past Medical & Family History of Disease, Paranoid Schizophrenia

As per her past psychiatric history, for the last 6 years, she is diagnosed with Paranoid Schizophrenia. Previously, she had been admitted to a Basic Health Unit. It is important to mention that Paliperidone 6 mg was being used to maintain her. It has also been observed that she has shown great compliance with her treatment, that’s why she has been extremely stable as compared to many other patients in this similar situation. As per family history, she denied any psychiatric issues earlier in any other family member. She is a dependent daughter of her parents and she has 2 sisters and 2 brothers as well. She has not been involved in any kind of drug or substance use.

Mental State Examination of Disease, Paranoid Schizophrenia

It is vital to elaborate that she looks well dressed and appropriate in her appearance. Her behavior is very normal and she used to speak softly. As far as her mood is concerned, she has been tearful and anxious. Her thought processes, as well as thought content both, have been identified as normal. Her insight, as well as judgment, is good, and she has grossly intact with regards to her cognition.

Medication and Discharge Plan

As per current admission in the clinic facility, she is given a variety of medicines. Around 9 types of medicines are given to her so that she can be kept normal. It is estimated that she will remain under observation for around one to two weeks. She will only be discharged from the clinic, once it is made sure that she is physical and mentally stable, and can handle the real-world situations as a normal person.

Pathophysiology of Disease, Paranoid Schizophrenia

It is important to understand what pathophysiology is, before understanding the pathophysiology of Paranoid Schizophrenia. It is basically developed due to the convergence of physiology and pathology. It is a kind of study, where any patient is dealing with disordered physiological processes due to any injury or disease. So, basically, it is a concept, which explains the abnormal or disturbed condition of a patient, which he/she has developed due to any particular disease (Orlov, Churilov, & Stroev, 2011). It is important to know that there are different types of symptoms associated with Schizophrenia. The first category is its positive symptoms. In this category, the patient may feel hallucinations or delusions; it means that the individual has lost a sense of reality. The second category is called negative symptoms, where an individual having Schizophrenia will be identified with acts such as social withdrawal, loss of spontaneous speech, and impaired motivation. The third category of Schizophrenia deals with cognitive weakening. It is often observed in some patients that their positive symptoms may start to remit or relapse, but for some patients, the issue remains the same with regards to psychotic symptoms. It has also been observed that cognitive and negative symptoms tend to stay longer, having severe effects on the patient, and his/her capability of performing societal functions (Fatani, et al., 2017)

It has been observed that various research studies have been trying to find a relationship between Schizophrenia signs and functions performed by specific regions of the brain. The research has observed that grey matters had seen reductions, as well as white matter, and have also seen irregularities with regards to various areas of the brain. It is seen that when the progress of grey matter decreases, then it is related to the illness. In addition to that brain imaging as well as pharmacological literature has revealed that when a patient starts to feel hallucination or delusions, it means that his/her dopaminergic neurotransmission is in the state of dysfunction. It is also a fact that such type of condition is not only associated with schizophrenia, but various other psychiatric conditions are also attached to it. Looking at these facts as well as important information, it is evident that brain areas are related to schizophrenia in so many different ways (Fatani, et al., 2017)

Etiology of Disease, Paranoid Schizophrenia

It is vital to know that research has been extensive in nature to identify the actual causes associated with schizophrenia, but investigators are still trying to get precise information in this regard. It is true that a lot of progress has been made in this regard, but still, there is a lot more to investigate. However, it is agreed that multiple factors can play a part in developing schizophrenia in patients. The two most important relevant factors are environmental influences as well as genetics. As far as schizophrenia’s development is concerned, it is found that utero is the origin of this disorder. There are various issues, which have been linked with schizophrenia, and some of these issues are low birth weight, asphyxia, the emergency section of cesarean, gestational diabetes, as well as bleeding at the time of pregnancy. The researchers have taken a keen interest in the disturbances of fetal at the time of 2nd trimester. It has been observed that when there is an excessive level of stress and infections issue is also there, then the development of schizophrenia is the most likely thing to happen (Patel, Cherian, Gohil, & Atkinson, 2014)

The scientific research has also proved the fact that schizophrenia can happen due to genetic factors. The research studies have come with evidence that if a 1st-degree relative had this issue, then the person will have 10% chance of developing schizophrenia, and if a person is a 2nd-degree relative, then chances of developing schizophrenia is 3%. If there are monozygotic twins, and one of them is having schizophrenia, then there are 48% chances that the second one will also develop schizophrenia. If parents of a child are having the disease of schizophrenia, then there are around 40% chances that the child will also get this disease. It shows that genetic part is very important to understand the causes of schizophrenia. However, genetic factors are not the only one to associate with schizophrenia, rather social & environmental factors can also play a major part. The individuals, who are having vulnerability towards schizophrenia, they can develop it due to social factors. There are various stressors linked with environmental factors such as social isolation, resident of urban region, minority ethnicity, and childhood trauma; and these stressors can be a reason to develop schizophrenia. There are various stressors associated with social elements such as economic adversity or discrimination, which can develop schizophrenia (Patel, Cherian, Gohil, & Atkinson, 2014)

Prevalence Statistics

It is crucial to look at some prevalent statistics associated with schizophrenia all around the globe as well as in the Kingdom of Saudi Arabia. It is a well-known fact that schizophrenia is one of the severe diseases and mental disorders. So, here are some of the major facts & figures:

· According to the World Health Organization, around 21 million people all over the world are affected by schizophrenia.

· It is essential to know that schizophrenia is also considered to be a disability all over the world, which means that it can have a serious negative impact on professional and educational performance.

· It is quite shocking to know that a person having schizophrenia will likely to die 2-3 times earlier than a normal person, which shows its severity. It has also been observed that rate of schizophrenia in males is more than females all around the globe (World Health Organization, 2018).

· It is vital to explain here that when statistics are analyzed to see the prevalence of schizophrenia in Saudi Arabia, the evidenced-based data is lacking. There have been various research studies to see the prevalence of mental illness in different regions, and each study came up with different results, but it is quite unfortunate that Saudi Arabia has not been able to get accurate numbers in this regard, which is necessary to get, otherwise considerable measures cannot be taken to deal with schizophrenia (Almutairi, 2015)

· However, different studies have been conducted regarding mental illness. For instance, one study was conducted to observe the mental illness issue in high school students, and result showed that 48% observed population had mental illness issues (Almutairi, 2015)

· One more study was conducted to know about the psychiatric diagnoses related to inpatient as well as outpatient settings for psychiatric issues. The data shows that out of these psychiatric patients, 55.8% inpatients were dealing with the issue of schizophrenia, whereas 28.9% outpatients were having the issue of schizophrenia (ALOSAIMI, et al., 2017)

Signs and Symptoms of Paranoid Schizophrenia

There are various symptoms, which are associated with schizophrenia, and it is vital to notice such symptoms in people living around so that they can be helped in treating the disease. The patient having schizophrenia will always face difficulty in his/her thought process, which means that he/she will lack clarity in thoughts, and confusion will always be in his/her mind. The thought process is not the only affected thing, but feelings, emotions as well as the capability to communicate with others are also negatively affected by schizophrenia. A person can look for various symptoms such as having hallucinations, delusions, lack of motivation, disorganized & disturbed thought process, slow movement, disturbance in sleep, lacking attention & focus, low sex drive as well as lacking interest in several other things. It is critical to mention that a person having schizophrenia will not experience all of the above-mentioned symptoms, rather a combination of symptoms will be observed in variety of patients. These symptoms will most likely start to emerge from the age of 16 years old to age 30 years old. It is interesting to mention some examples like how a patient may start thinking due to schizophrenia. For instance, a person may have fixed delusion in his/her mind that life partner is having an affair with someone else, where in reality, it is totally untrue. But still, a patient of schizophrenia will continue to believe this untrue fact due to his/her abnormality and delusion, where a belief is fixed regardless of its actual state. It has been observed that patients having schizophrenia have not been associated with violence, but still, the risk will always be there (WebMD, 2019)

Diagnostic Procedure of Paranoid Schizophrenia

It is quite critical for everyone to know that there are no laboratory tests available to diagnose paranoid schizophrenia. A doctor will try to diagnose schizophrenia by completing a detailed medical history of the individual. A physical examination along with some diagnostic tests will also be conducted so that schizophrenia is identified, and any other physical illness problems are ruled out. If a doctor sees that there are no physical pieces of evidence to find a disease, then he/she will refer the patient to a psychiatrist or mental illness experts so that they can talk to the patient, and diagnose what kind of mental illness he/she has. In this process of diagnosis, the mental health experts and psychiatrists will get to know by analyzing symptoms, whether someone is suffering from schizophrenia (Cleveland Clinic, 2018)

Prevention and Medical Treatment

It may not be possible to completely prevent schizophrenia, but still, there are various prevention methods, which can be adopted to at least lower the risk of developing schizophrenia. It has been observed that different environmental and social stressors are there, which can be a reason to cause schizophrenia in individuals, especially when they are going through childhood and adolescence period. A vulnerable person will easily develop schizophrenia; if these stressors will put more stress on his/her mind. For instance, if a person is having a genetic risk of developing schizophrenia, then his genes can get active in social environments, where relevant stressors are present. If relevant stressors will not affect that person, then he/she may be prevented from schizophrenia. Both primary and secondary level measure should be taken by the people so that they can avoid schizophrenia and they can also help their loved ones to stay safe from this disease (Brown & McGrath, 2011)

Once the prevention was not made sure, and a person has been diagnosed with paranoid schizophrenia, then it is important to get medical treatment, otherwise, the situation can get worse. First of all, antipsychotic medicines will be given to the patient as prescribed by the relevant doctor or psychiatrist. It is important to know that long term based injections are available to treat schizophrenia in patients. Such long term medication is useful in situations, where a patient is not ready to accept that his disturbing thoughts and delusions are actually due to schizophrenia, and he/she refuses to take regular medicines. The positive symptoms of schizophrenia can only be treated with these antipsychotic medicines. So, in terms of negative symptoms of schizophrenia, the psychotherapy can play a major role. This therapy can help patients to get back to normal life, and socialize so that they can get back to reality. The role of friends and family will also be crucial during the treatment of schizophrenia because they work like a support system, which helps patients to get back to normal relations (Cagliostro, 2019)

Conclusion of Disease, Paranoid Schizophrenia

It can be concluded in the end that Ms. Atheer is having paranoid schizophrenia, which is basically a mental disorder, and that’s why she is afraid of her father without any reason. It is something that a patient of schizophrenia will always have like they will develop a false belief in their mind. There are various factors such as environmental and genetic factors, which can be a major cause of schizophrenia in the patients. So, they should be properly treated by experts and doctors, otherwise, the situation can get worse.

References of Disease, Paranoid Schizophrenia

Almutairi, A. F. (2015). Mental illness in Saudi Arabia: an overview. Psychology Reseacrh Behavior Management , 8, 47–49.

ALOSAIMI, F. D., ALZAIN, N., ASIRI, S., FALLATA, E., ABALHASSAN, M., QRMLI, A., et al. (2017). Patterns of psychiatric diagnoses in inpatient and outpatient psychiatric settings in Saudi Arabia. Archives of Clinical Psychiatry (São Paulo) , 44 (3).

Brown, A. S., & McGrath, J. J. (2011). The Prevention of Schizophrenia. Schizophr Bulletin , 37 (2), 257–261.

Cagliostro, D. (2019). Paranoid Schizophrenia. Retrieved December 2, 2019, from https://www.psycom.net/paranoid-schizophrenia

Cleveland Clinic. (2018). Schizophrenia: Diagnosis and Tests. Retrieved December 2, 2019, from https://my.clevelandclinic.org/health/diseases/4568-schizophrenia/diagnosis-and-tests

Fatani, B. Z., Aldawod, R., Alhawaj, F. A., Alsadah, S., Slais, F. R., Alyaseen, E. N., et al. (2017). Schizophrenia: Etiology, Pathophysiology and Management - A Review. The Egyptian Journal of Hospital Medicine , 69 (6), 2640-2646.

Orlov, S., Churilov, L., & Stroev, I. (2011). [What is pathophysiology nowadays? The reflections of the participants of ISP-2010 Congress in Montreal]. Patol Fiziol Eksp Ter. , 3-12.

Patel, K. R., Cherian, J., Gohil, K., & Atkinson, D. (2014). Schizophrenia: Overview and Treatment Options. P&T , 39 (9), 638–645.

WebMD. (2019). What Is Paranoid Schizophrenia? Retrieved December 2, 2019, from https://www.webmd.com/schizophrenia/schizophrenia-paranoia#1

World Health Organization. (2018). Schizophrenia. Retrieved December 2, 2019, from https://www.who.int/news-room/fact-sheets/detail/schizophrenia