Schizophrenia & Primary Care

Schizophrenia affects 1 percent of the general population in the United States. Unfortunately, this common illness is often poorly understood and feared by many health care professionals. Whether nurse practitioners who work in primary care are aware of it or not, they inevitably come into daily or weekly contact with schizophrenics. Patients with schizophrenia represent a vulnerable population with high medical needs that are often missed or undertreated. Primary care providers have the potential to reduce health differences of this disease. This provides Primary Care providers with a general understanding of the psychiatric and medical issues specific to patients with schizophrenia.

Schizophrenia is a major psychiatric disorder, or cluster of disorders, characterised by psychotic symptoms that alter a person’s perception, thoughts, affect, and behaviour. Each person with the disorder will have a unique combination of symptoms and experiences. Typically there is a period often characterized by some deterioration in personal functioning. This includes memory and concentration problems, unusual behaviour and ideas, disturbed communication and affect, and social withdrawal, reduced interest in daily activities.

Over a lifetime patients with schizophrenia represent a vulnerable population with high medical needs that are often missed or undertreated . The first symptoms tend to start in young adulthood, but can occur at any age, usually at a time when people are trying to make the transition to independent living. The symptoms and behaviour associated with schizophrenia can have a distressing impact on family and friends. The diagnosis of schizophrenia is still associated with considerable stigma, fear and limited public understanding.

Most patients with severe mental illness are in frequent contact with primary care services, and for many this is their only contact with health services. However, such contact does not necessarily ensure that they receive good physical health care. The orientation of primary care is reactive, and this does not fit well with patients who may be reluctant, or unable, to seek help. Short consultation times make it difficult for doctors to assess mental state and conduct a physical assessment, especially in vague or suspicious patients. When patients are accompanied by mental health staff more emphasis may be given to psychological and social issues. Doctors who are inexperienced in, or uncomfortable with, mental health work may resist engagement with a patient by actively asking about symptoms and performing a physical examination.

The lifestyle of patients with severe mental illness suggests a need for health promotion—which can be effective. Several factors prevent people with mental illness from receiving good physical health care. People with schizophrenia are less likely than healthy controls to report physical symptoms spontaneously. evidence suggests that it is possible to improve the physical health of this vulnerable section of the population. Progress will, however, depend on both mental health and primary care staff being aware of the problem and being willing to find imaginative solutions which are acceptable and useful to patients.

In short, Patients with a diagnosis of schizophrenia are less likely to receive some important general health checks than patients without schizophrenia. Schizophrenia is a highly disabling disorder with many comorbidities and increased mortality. Although it has no pathognomonic features, its positive and negative symptoms are helpful in making the diagnosis. Primary care providers and allied health professionals can play a key role in reducing the havoc wreaked by schizophrenia because early detection, intervention, and adherence can prevent the physical deterioration of the brain and even repair it.

Celeste Botonakis

On the Nursing Assistant Guides blog, certified medical assistant Celeste Botonakis explores the daily life of a CMA. She'll keep you up-to-date with the latest on what’s happening in the field, and provides tips for those who are interested in becoming a medical or nursing assistant. Celeste has served in the medical field for over six years, and is passionate about helping people. She currently works at CSR Primary Care in Skokie, Illinois. Click here to learn more about Celeste Botonakis and