Case 4 (use this case to answer the 5 questions that follow)…
Case 4 (use this case to answer the 5 questions that follow) Name: Ash L Age: 25 Gender: Female Medical History: Diagnosed with schizophrenia 9 months ago. No known history of cardiovascular disease, hypertension, or diabetes. Not pregnant. Family History: migraines (maternal side), schizophrenia (uncle, cousin) Chief Complaint: Recurrent severe headaches, weight gain and fatigue with quetiapine. Presenting Concerns: Ash presents with a history of recurring headaches, lasting 4 to 48 hours, characterized by pulsating pain on the right side of her head. These episodes are accompanied by nausea, photophobia, and phonophobia and she denies any aura-like symptoms. She reports a history of similar headaches since adolescence, but they have increased in frequency and severity over the past six months. Usually takes Naproxen 220 mg at headache onset, often repeats dose every 12 hours and sleeps to get relief. Neuro exam within normal limits. No signs of fever, meningeal irritation, or focal neurological deficits. All blood work is within normal limits. Her headache diary indicates episodic occurrences lasting 1-2 days, increasing from two headaches a month to about one every week where she needs to stop everything and rest. Ash has been taking quetiapine for schizophrenia for the last 7 months and it is working well to control hallucinations and delusions. She is employed and living independently. Her mood is good, but she has been overly tired and has gained weight since starting quetiapine which she does not like. She would like to discuss stopping quetiapine. Prior to quetiapine she was prescribed risperidone but had to stop it due to hyperprolactinemia. Current medications: Quetiapine XR 400mg daily at bedtime Naproxen 220mg as needed for headaches Social History: Non-smoker, occasional alcohol consumption
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