First-Episode of Schizophrenia

In an earlier post, “Mental Illness is a Brain Disorder,” a young man, in his first year of college, starts to exhibit symptoms of schizophrenia. And now the young man’s parents are trying to help him get treatment so that he can return to school. What typically happens next?

Many first-episodes come to the attention of law enforcement and emergency department staff. Once in the emergency department, if the person is exhibiting symptoms and signs of psychosis, the person may be put on a physician’s emergency hold order (PEHO), which allows for a 72-hour evaluation in the hospital. This will help trained professionals to determine what is going on with the person. Are there physical problems causing the symptoms? or medicines? or even street drugs?

Once it is determined that the young man is experiencing signs and symptoms of schizophrenia, the first-line of treatment is to give an atypical psychotropic medicine. The psychotropic will act on receptors in the brain and reduce the severity of the symptoms like hallucinations. See “Medicines: Help but not a Magic Bullet”:

It’s important to note that the young man has the right to refuse the medicine. At this point, this is where treatment often becomes challenging to a treatment team, family and patient: the team, including the psychiatrist, needs to make a decision about whether the situation is an emergency or not. If it is not an emergency, then the young man can refuse the medicine. However, if it is deemed an emergency, then the medicine can be authorized to be given.

Another scenario involves the county: a pre-petition screening is conducted by a trained social worker, who interviews the patient. Based on information from the patient and collaborating information from family, the school, and mental health team in the hospital, the social worker returns to his office and reviews the report with a team.  The team will make a determination on whether to begin a civil court process to commit the young man or not.

In a future post, I will discuss the commitment process.  






2 Responses to “First-Episode of Schizophrenia”

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