John has hepatitis and schizophrenia

Abstract

John is a 52 year old man who is currently hospitalized with a diagnosis of schizophrenia and hepatitis caused by chronic infection with hepatitis C virus. He has a hepatic encephalopathy that is partially controlled with lactulose which lowers ammonia levels in his blood, but does not affect the progression of his hepatitis. His schizophrenic symptoms have been resistant to treatment by a variety of anti-psychotic medications alone and in combination, including clozapine. Despite treatment he remains delusional believing that he is extremely wealthy, and that he does not have either liver disease or mental illness. He does not appear to experience distress as a result of these delusions, although is angry and upset that he is held in a psychiatric facility against his will. He denies symptoms of depression or anxiety and does not demonstrate significant agitation.