Psychotic Patients

I had the distinct pleasure of interviewing a schtizophrenic patient last week. Let me tell you, it was a trip.

So we learn how to conduct a psych interview in our first year, but in learning the parts of the interview, you're lead to assume that the patient will be cooperative, forthcoming with his history and somewhat talkitive. Talking to someone who is a) schitzophrenic, b) heavily medicated and c) not really understanding why they're talking to you is not exactly the best learning situation. The psych faculty also did a crappy job of introducing techniques in dealing with different interviewing situations, making my interview with a patient in the grips of the negative symptoms of schitzophrenia EXTREMELY difficult.

Here's a little taste of the interview:
Me: Could you explain to me why you're here?
Psychotic Gangsta Guy: I dunno. [pause] My mom says I need to take my medicine
Me: What medications are you on?
PGG: I dunno
Me: Do you know what your medications are for?
PGG: I dunno...[pauses, stares off into space]...they make me tired, so I don't like to take them
Me: Do you remember when you took them last?
PGG: I dunno...
Me: Days, weeks, months?
PGG: I dunno...
Me: [getting a bit flustered, but remainging calm] Ok, so lets go back for a minute, could you tell me who brought you to the hospital?
PGG: The police
Me: Why were the police involved?
PGG: My mom called them?
Me: Why???????
PGG: I dunno...[staring at the wall behind me]...because she wants me to take my medicine... because of what I was saying to her
Me: What did you say that caused her to call the police?
PGG: I dunno...
Me: What were you doing before your mom called the police?
PGG: Chillin' on the porch
Me: Did the police tell you why they were bringing you to the emergency room?
PGG: Cause my mom called...[long pause, then with a smirk]...and they told me I had a bat in my hand

Needless to say, after another painful 15 minutes of questions, the patient finally gave me enough pieces of the puzzle to tell that he was schitzophrenic, off his meds (depakote and an anti-psychotic), and sitting on the porch holding a bat in his hand because he was scared shitless that the police were coming to get him and that he was hearing people talking about him.

Then, after the patient leaves, the Psychiatrist running the session tells us that sometimes the best way to deal with a patient with negative schitzophrenic symptoms is to sit there in the silent pauses until they give you an answer. Great, buddy, thanks for sharing that little nugget before hand...

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