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Treatment: Identification of Schizophrenic Patients

Rashmi Nemade, Ph.D. & Mark Dombeck, Ph.D.

Treatment

Identification of schizophrenic patients

Schizophrenia is a disease that affects people's basic perceptions and thought processes; it affects people's capability for judgment and reality testing in the most fundamental ways possible. Therefore, it should come as no surprise that few schizophrenic patients recognize what is happening to them and show up at their doctor's office asking for help. At the same time, few families are prepared for the idea that their loved ones are becoming psychotic. Family members tend to minimize the seriousness of their loved one's odd behavior, attributing it to stress or other temporary conditions. Between these two tendencies, the soon-to-be-patient's initial psychosis tends to get pretty florid and severe before anyone recognizes the severity of the problem.

Patients are often identified as possible schizophrenics when they are picked up in a psychotic state by police and brought to a hospital. Patients are evaluated in the hospital setting. History and mental status examinations, physical and neurological exams, basic laboratory work, psychological tests, lumbar puncture, EEG, and radiological scans may be included in a diagnostic workup that doctors may order in their efforts to identify a cause for psychotic disturbance. In a history and mental status exam, the patient is evaluated for visual and auditory hallucinations, headaches, recent head injury, and drug use, prescription or otherwise. This helps to clarify whether the psychosis is substance-induced. A careful physical and neurological exam reveals if the psychosis is due to a medical condition other than schizophrenia. Basic laboratory tests of blood count, blood chemical screen, and urinalysis may reveal endocrine or metabolic imbalances, use of street drugs, or sexually transmitted diseases which could account for symptoms. It is useful to have results from an electrocardiogram (EKG) since some medications used to treat schizophrenia can affect the heart. Psychological tests can also be valuable in making a diagnosis of schizophrenia, particularly in early or borderline cases. As discussed previously, MRI or CT scans may be used to determine whether brain lesions are present. During a lumbar puncture cerebrospinal fluid is drawn from the lower back. Testing this fluid can help rule out alternative brain diseases and viral infections of the central nervous system. An EEG can detect temporal-lobe epilepsy, which sometimes mimics schizophrenia.

Patients rarely get to stay in a hospital for a long time due to insurance limitations. As soon as is practically possible, patients are assessed and diagnosed, and put on medications that can be expected to help reduce their symptoms. Patients may even be released from the hospital before significant symptom reduction has been achieved, so long as they do not appear to be a danger to themselves or others. Outpatient or partial hospital treatment is generally coordinated prior to discharge from the hospital, and picks up where inpatient care leaves off. Also, at this time (or sooner) family members may receive education concerning the chronic nature of schizophrenia, the absolute need for ongoing treatment if best outcomes are to be realized, and their role in helping that treatment become and remain successful. When funding permits, a case manager may be assigned to assist with coordination of patient care and family support. If a patient is non-compliant in taking medications or the medications do not have the desired therapeutic effect, the patient may become (or remain) acutely ill again, possibly triggering a return trip to the hospital (if the patient is lucky or privileged).