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#POV You’re The Doctor (Psychiatry): Season 3, Episode 5

Created with Tyler Beauchamp, medical student & author

#doctor #psychiatry #doctor #medicine #healthcare #medschool #premed #medstudent #jakegoodman

Disclaimer:
My content is for educational and marketing purposes and should not be used in place of therapy or treatment


Answer: A - Discuss antipsychotic medication!

The patient presents with signs of new onset schizophrenia. Schizophrenia must meet at least two of the following conditions (one being from the first three)1: disorganized speech, hallucinations, delusions, disorganized behavior, and negative symptoms (apathy, withdrawal, flat affect, etc.). Apart from ruling out other causes (medical, substance, other psych), symptoms also must be continuous for one month and impairing day-to-day life for six months for a diagnosis, all of which this patient most likely meets.

A young male in college suddenly acting “strange” can often make you think about alcohol and drug use, which is why it’s easy to overlook an underlying mental health condition (C). Involuntarily admitting the patient would be unwarranted as they are neither an imminent threat to themselves and/or others (B). While it is important to first ensure both the patient and care team are safe, the patient is neither agitated nor expressing ideas/actions to indicate a plan to harm. In cases like these, you should focus on establishing TRUST with the patient and try discussing a trial of antipsychotics (A). It’s important to make sure you and the patient are coming together on treatment planning whenever possible, if they struggle with sticking to a consistent regimen, be sure to discuss long acting injectables as an alternative!

One final thought very much worth discussing is the stigma revolving around Schizophrenia and other mental illness. Media and entertainment often portray these patients as unstable or violent, when only a very small fraction of those with Schizophrenia pose any threat to others! These kinds of assumptions urge those suffering to isolate further and not seek the treatment they need. This is why it’s so important for us to help others understand the realities of living with mental illness and encourage better representations to be made. Even small changes, like framing those as “people with mental health problems” rather than “patients with mental illnesses2” can go a long way towards helping others heal.


References:
1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association; 2013
2. Carter, Lucy, et al. “Are Causal Beliefs Associated with Stigma? A Test of the Impact of Biogenetic versus Psychosocial Explanations on Stigma and Internalized Stigma in People Experiencing Psychosis.” Stigma and Health, vol. 4, no. 2, 2019, pp. 170–178