The Patient with Schizophrenia

This covers two past placements of mine, one in general medicine and one in an orthopaedics setting.

For those who don't know or haven't seen a patient with schizophrenia before, schizophrenia is a psychiatric condition that is usually characterised by hallucinations, paranoid delusions and/or dysfunctional thinking and mental processes. There are four types, but the most well known is paranoid schizophrenia(I'll refer to it as PS). These patients can experience hallucinations (both visual and auditory) and have paranoid delusions. Knowing this, and seeing some pretty poor portrayals of people who were mentally ill on TV, I was quite nervous about treating such a patient for fear of aggression and violence.

The first patient I saw with this condition had developed PS after years of cannabis abuse. He had been admitted for a BKA after a foot persistent infection secondary to diabetes. With my supervisor, we helped him ambulate with a WZF and treated to prevent a knee flexion contracture. Throughout the entire treatment he was extremely compliant and never became aggressive. I was able to build a good rapport with him, and I felt a bit ashamed that I had immediately expected the worst of him given his condition. I realised that not all patients who had a mental illness were the same, and decided to keep a more open mind about this if I encountered a patient with the same condition again. This was approximately 2 years ago.

Earlier this year I treated a patient who had also had a previous diagnosis of schizophrenia. Armed with the knowledge from my previous patient, I was able to treat this patient without fear or prejudice, and be able to see her as a person, not as a mental illness. As a result, she recovered well from her surgery without any major movement deficits.

What I have learnt from seeing these two patients is that mental illness should not define a patient, and thus in most instances should not change the way you would treat them compared to a person without a mental illness. I also realised that media portrayals of people with serious mental illness can be of a catastrophising nature, and instill fear in the general population by only telling of people who are at the most extreme end of the mental health spectrum. As a result, I am now more open minded about patients with mental health conditions and less likely to flinch when assigned one to treat.