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PS4.1 | Psychotic Disorders — Assignment
CLINICAL SCENARIO
You are a medical officer at a Community Health Centre (CHC). A 26-year-old male, Mr Arjun S., is brought by his elder brother. Over the past 8 weeks, Arjun has been speaking about invisible forces controlling his mind, refusing to eat food prepared at home (believing it is poisoned), stopped going to work, and speaks very little. His brother reports he has had one similar episode 2 years ago but recovered with some treatment (details unknown). He is calm and cooperative during the interview. No substance use. Vitals and physical examination are normal. No ECG abnormality. You diagnose a relapse of Schizophrenia.
Using this clinical vignette, complete the structured assignment below. Apply ICD-11 diagnostic criteria, evidence-based pharmacotherapy guidelines, and primary care referral pathways.
Instructions
Write a structured management plan of 600–900 words. Use the section headings provided. Support your decisions with reasoning from ICD-11 criteria, pharmacotherapy principles (drug choice, dose, monitoring), and the primary care physician's scope of practice. Where relevant, reference the treatment gap for schizophrenia in India and the importance of family engagement.
Length: 600-900 words
What to Submit
1. Diagnostic Formulation
Identify and categorise Arjun's symptoms into positive, negative, and/or cognitive domains. Apply the ICD-11 criteria for Schizophrenia to justify your diagnosis. Note any features that would prompt you to rule out organic causes or drug-induced psychosis before confirming the diagnosis.
2. Immediate Pharmacological Management
State your first-line drug choice (class and specific agent), starting dose, and rationale. Explain why you are not choosing clozapine at this stage. Outline the baseline investigations you would order before initiating the antipsychotic (e.g., metabolic panel, ECG, prolactin).
3. Safety Assessment and Referral Decision
Assess whether Arjun can be managed as an outpatient or requires urgent psychiatric referral or hospital admission. Identify the red-flag features that would change this decision. Describe the primary care physician's scope of practice for follow-up versus when to escalate.
4. Psychosocial Interventions and Family Engagement
Outline the psychosocial components of Arjun's management plan, including family psychoeducation, addressing the brother's concerns, safety planning at home, and support for medication adherence. Reflect on how the treatment gap in India affects the management approach.
5. Monitoring Plan and Follow-Up
Specify what you will monitor at each follow-up visit (symptom response, adverse effects — EPS, metabolic, prolactin, NMS warning signs) and the frequency of review. State the specific adverse-effect features that would require you to stop the antipsychotic immediately and refer as an emergency.
Grading Rubric — Primary Care Schizophrenia Management Plan — Marking Rubric
| Criterion | Points | Full-marks descriptor |
|---|---|---|
| Diagnostic accuracy and ICD-11 application | 10 pts | Correctly categorises all symptoms into positive/negative/cognitive domains with clear ICD-11 justification; includes relevant organic exclusions (substance use, medical cause); no diagnostic errors. |
| Pharmacotherapy decision-making | 10 pts | Correctly selects SGA as first-line with specific agent, dose, and sound rationale; clearly explains why clozapine is deferred; lists all relevant baseline investigations with clinical reasoning. |
| Safety assessment, referral decision, and scope of practice | 10 pts | Clear outpatient vs inpatient decision with explicit reasoning; red-flag features correctly identified (violence risk, suicide, inability to care for self, NMS, agranulocytosis); primary care scope and escalation triggers well-defined. |
| Psychosocial management and family engagement | 10 pts | Comprehensive family psychoeducation plan including expressed emotion, adherence support, relapse recognition, safety planning; addresses India's treatment gap with practical strategies; culturally sensitive approach evident. |
| Adverse-effect monitoring and emergency recognition | 10 pts | Structured monitoring plan addressing EPS, metabolic syndrome (weight, glucose, lipids), hyperprolactinaemia, and NMS with correct frequency and clear emergency triggers (NMS = stop and refer immediately; agranulocytosis with clozapine); all adverse effects named accurately. |
PEER REVIEW
Review your peer's management plan using the rubric criteria above. For each section, provide: (1) one specific strength — a point that is clinically accurate and well-reasoned, and (2) one constructive suggestion — a factual error, omission, or reasoning gap that could be improved. Be specific: cite the criterion (e.g., 'Criterion 2 — Pharmacotherapy') and explain your reasoning. Avoid vague praise ('good job') or unsupported criticism. Your review should help your peer improve their clinical reasoning, not just their writing.