Simple Schizophrenia, a Rare and Under-Diagnosed Clinical Condition: A Case Report

Abstract

Introduction: Schizophrenia is characterized by positive psychotic symptoms such as hallucinations, delusions and disorganization and motivational and cognitive dysfunctions. A typical case of simple schizophrenia is very uncommon and very difficult to diagnose. It is considered to be a controversial clinical entity. This treatment-seeking effort was seen when a patient started to have severe socio-occupational dysfunction. This case report discusses an interesting and rare case of simple schizophrenia and its management. Case History: Presented with the total duration of illness being around 4.5 years, continuous course, insidious onset, no obvious precipitating factor could be elicited, no past or family history of psychiatric illness with no major medical or surgical illness, no history of use of alcohol or other illicit substance, and a well-adjusted pre-morbid personality characterized by withdrawn behavior, intermittent unprovoked anger or abusiveness, abnormal changes in temperament and overall behavior along with poor appetite, disturbed sleep, and poor personal hygiene with significant socio-occupational dysfunction. The patient was treated in an outpatient setting. Basic investigations of the complete blood count, thyroid profile, vitamin B12, and folic acid were within normal limits. The patient was started on 7.5 mg of olanzapine per day and asked to follow up after 3 weeks. On the first follow-up visit, the father reported about 25–30% improvement in overall behavior and general condition. Hence, the dose of olanzapine was increased to 10 mg per day, and we were asked to follow up after 4 weeks. On the second follow-up visit, the father and patient reported 50–60% improvement; thus, the dose of olanzapine was further increased to 15 mg per day and asked for follow-up after 4 weeks. On the third follow-up visit, the father and patient showed about 90% improvement in overall functioning, and the patient started to help in the occupation of his father. Thus, the patient was continued on the same dose of 15 mg of olanzapine and asked for monthly follow-up. The patient and his father did not report any major side effects of the medicine. Conclusion: It is important to address such a clinical condition so that patients can get an evidence-based treatment for this type of under diagnosed or controversial clinical entity.