Progressive Cognitive Decline and Social Withdrawal in Schizophrenia: A Case Report Highlighting the Role of Multimodal Interventions

Abstract Schizophrenia is a chronic psychiatric disorder marked by cognitive, behavioral, and emotional dysfunctions. This case report presents a 30-year-old male with progressive cognitive decline, social withdrawal, and wandering behavior. Symptoms intensified after a job loss, with reduced responsiveness, repetitive speech, and wandering episodes. Initial treatment with amisulpride and trihexyphenidyl yielded a partial response. Psychometric evaluations revealed moderate depression on the Hamilton Rating Scale and persistent symptoms on the Positive and Negative Syndrome Scale. Magnetic resonance imaging showed nonspecific findings, including widened fronto-parietal sulci. Laboratory investigations were normal. The patient received olanzapine, fluoxetine, and eight cycles of electroconvulsive therapy (ECT) under a multidisciplinary approach. Posttreatment, significant improvement was noted in social functioning, and wandering episodes decreased. This case report highlights the diagnostic and therapeutic challenges of schizophrenia with predominant cognitive and behavioral symptoms. It emphasizes the value of integrated care, including ECT, as a vital adjunct to pharmacotherapy for enhancing clinical outcomes and quality of life in schizophrenia.