Dr. Erika Kube, Emergency medicine: Treatment of schizophrenia lifelong

On May 2, 2021

A patient had just arrived in the emergency department in the custody of police. He was upset and agitated and needed to be restrained by hospital security guards so he couldn’t run away. The nurse asked me to see him right away because she was concerned that he might need some medications so we could safely assess him.

I could sense the urgency in her voice so I went to his room right away. I saw a very frightened young man and tried to talk to him. He looked past me and appeared to be talking to someone who wasn’t in the room with us. I repeatedly said his name and tried to get him to calm down, but I could not get his attention. I was concerned that if we let him leave, he might run into traffic or otherwise harm himself.

I went back to my computer to see if he had ever been seen in our emergency department before for similar behavior. He had visited a few times over the years, for minor things but never for psychosis or agitation. I had the nurse give him medication to calm him down so we could figure out what was going on.

What I knew at this point was that the police had been called by the patient’s mother because he had been acting strangely at home. He was hearing voices and thought that people were outside their house, looking in through the windows. When his mother asked him questions, he left the house upset. Police found him in a nearby alley and he seemed to be having a heated conversation with someone who wasn’t there. The police tried coaxing him into their cruiser to get checked out at the ED. He agreed but became increasingly agitated as they drove.

I went back to see him about 30 minutes later after he received some medication and he was calmer. He had changed into a hospital gown and was lying under a thin sheet. At first, he was hesitant to talk with me, but he finally opened up. He said he had been really stressed over the past few weeks because he had just finished school and was trying to get a job but had been unsuccessful so far. He was anxious and wasn’t sleeping or eating. Over the past week he had started hearing voices and seeing things that other people didn’t. He said he he has tried to rest but the voices would get louder and louder and he had to get up and do something to quiet them down.

I was concerned that this episode was due to schizophrenia. A serious mental disorder, schizophrenia is characterized by thoughts that are out of touch with reality (having visual or auditory hallucinations), disorganized speech and behavior, and difficulty participating in daily activities. Patients often lack emotion and have difficulty with memory and concentration. They also may neglect their personal hygiene and lose interest in everyday activities they used to like. The exact cause isn’t entirely known, but genetics, environmental factors, brain chemistry and structure likely all have a role. Schizophrenia usually presents in men in their early 20’s and in women in their late 20’s.

Treatment is typically lifelong and requires a combination of medications and psychotherapy. Untreated, schizophrenia can result in severe problems such as suicidal thoughts and attempts, drug and alcohol abuse, financial problems and homelessness, social isolation, anxiety and depression.

The medications used to treat the disorder are called antipsychotics. They affect neurotransmitters in the brain, which can help with the symptoms. Many of these medications have unpleasant side effects that make it less likely that people will take them as they are prescribed. The medications can be taken daily as a pill or as longer-acting versions that can be given monthly as an injection, which can help ensure they’re taken as needed.

Once schizophrenic patients are stabilized, they can undergo psychotherapy, where they can learn how to cope with stress and identify warning signs of a psychotic relapse. A case manager can help make sure they get their medications and find resources to assist with employment, housing and daily living support.