talking to folks with schizophrenia

[elizabells, BSN, RN]

Urg, my clinical instructor is no help at all. She seems to think the best way to teach is to turn us loose on a schizophrenia floor and then criticize us at the end of the day. We're supposed to do a thirty minute psych interview with our pts each day on the floor. So my specific question is this: is there any good way to keep a schizophrenic pt on topic? We're supposed to be finding out what triggers their symptoms, not on the symptoms themselves. She's not a believer in CBT or meds, particularly. Just find out how they feel. This could be a whole rant, but I'll keep it short. How do you have a conversation with a schizophrenic pt if you have no therapeutic communication experience other than med-surg? Is it possible?

[Thunderwolf, MSN, RN]

not too hard really. the topic of discussion goes where the patient takes you. if attempting to uncover a rationale for why a patient says or does a particular behavior, simply ask. for example, "i notice when a paticular tv show comes on, you do x, y, and z. how come?"...pretty simple. keep it objective, respectful, genuine, and realistically honest. sometimes, offering a little benign self disclosure can open the door too. "you know, when i watch that tv show, i usually just fall asleep, become a little irritated too, etc, etc"...take your pick. most folks with schizophrenia, if not extremely paranoid, will share and discuss their symptoms and what triggers them. sometimes, i'll bring up a past observation...if similar and relevent...and compare it to the current situation/observation with the patient. then, i invite the patient to discuss the similarities and differences (to explore symptom triggers) between the two events. another way is to convey empathy (this is not pity) and to enlist your therapeutic use of self by simply stating that "it must be difficult at times dealing with x symptom. how do you do it or cope with this? how can i help prevent the symptom getting worse for you?"...is another way to invite a discussion. another way is to invite the patient to instruct you how schizophrenia impacts a person's daily life. admit your ignorance and need to learn. a very honest statement. the patient may very well respect you for it. you have no better instructor than the patient him/herself. he/she deals with it on a daily basis. the key thing is honesty. when you are not honest, folks with schizophrenia can pick up on this readily, especially if paranoid. so, another part to this is that your body language and facial expressions need to match what you say or convey. lastly, many folks with this disorder have been therapized,analyzed and juvenilized to death in the course of their illness. being respectful also means being sensitive to this. there is nothing worse than to "talk down" to a person with schizophrenia. treat and respect the person as an individual, as an adult, and worthy of your time. use everyday words, not "ten dollar ones" to impress. remember, they probably have seen alot of professionals and students in their lives and probably have seen it all and seen all types...good and not so good. if you haven't guessed, folks with schizophrenia were my most enjoyable patients. they live through so much.

it's all in the approach.

oh, one last point, medication is crucial with this disorder. non-compliance is a big issue as well...a major factor for relapse. learning about the medications used with this disorder is vital in your training.

i wish you the best.

i hoped this helped some.

[Cute_CNA, CNA]

I think a good way to keep a schizophrenic on topic is by placing him/her in an environment where there are few distractions, such as an area of the ward that's a bit off to the side. Just make sure people know where you are. Also, speak in concrete terms and as the above poster alluded to, have your body language match your speech and intentions. Make nothing ambiguous.

If you want to find out what triggers their symptoms, ask them just that. "What makes you angry?," "What causes you to lose control of yourself?" for example.

I think the most important thing is to treat them as humans. Don't act like you are some high-and-mighty figure just because you're not a patient like they are. Treat them as an equal, while remembering you are not equals.

Your instructor doesn't believe in meds, and yet she is instructing you about psychiatric patients? Meds are only one of the most important treatments for mental illness, why does she not believe in them?!

[elizabells, BSN, RN]

Your instructor doesn't believe in meds, and yet she is instructing you about psychiatric patients? Meds are only one of the most important treatments for mental illness, why does she not believe in them?!

Thank you both tons and tons. I haven't actually done the interviews yet...Wednesday should be the day. I don't know what's up w/ my instuctor and meds, she's just made a lot of disparaging comments about them. For example, one of the pts on our floor was taken off his meds when he came in. He became nearly comatose. She was very skeptical that this was because of suddenly being taken off 5 different psych meds. She said many people get worse when they enter the hospital because they no longer have to try to hold it together like they do on the outside. Jeebus, give me strength!

[Thunderwolf, MSN, RN]

She said many people get worse when they enter the hospital because they no longer have to try to hold it together like they do on the outside. Jeebus, give me strength!

There is truth to that statement.

However, usually with folks having Schizophrenia, the reverse is somewhat more true. The structured milieu of the MH unit actually provides a safe haven with decreased loads of environmental stress. The "outside" typically is more stress ridden, which jacks up more symptoms.

I wish you the best in your course of study.

[RNin2007]

not too hard really. the topic of discussion goes where the patient takes you. if attempting to uncover a rationale for why a patient says or does a particular behavior, simply ask. for example, "i notice when a paticular tv show comes on, you do x, y, and z. how come?"...pretty simple. keep it objective, respectful, genuine, and realistically honest. sometimes, offering a little benign self disclosure can open the door too. "you know, when i watch that tv show, i usually just fall asleep, become a little irritated too, etc, etc"...take your pick. most folks with schizophrenia, if not extremely paranoid, will share and discuss their symptoms and what triggers them. sometimes, i'll bring up a past observation...if similar and relevent...and compare it to the current situation/observation with the patient. then, i invite the patient to discuss the similarities and differences (to explore symptom triggers) between the two events. another way is to convey empathy (this is not pity) and to enlist your therapeutic use of self by simply stating that "it must be difficult at times dealing with x symptom. how do you do it or cope with this? how can i help prevent the symptom getting worse for you?"...is another way to invite a discussion. another way is to invite the patient to instruct you how schizophrenia impacts a person's daily life. admit your ignorance and need to learn. a very honest statement. the patient may very well respect you for it. you have no better instructor than the patient him/herself. he/she deals with it on a daily basis. the key thing is honesty. when you are not honest, folks with schizophrenia can pick up on this readily, especially if paranoid. so, another part to this is that your body language and facial expressions need to match what you say or convey. lastly, many folks with this disorder have been therapized,analyzed and juvenilized to death in the course of their illness. being respectful also means being sensitive to this. there is nothing worse than to "talk down" to a person with schizophrenia. treat and respect the person as an individual, as an adult, and worthy of your time. use everyday words, not "ten dollar ones" to impress. remember, they probably have seen alot of professionals and students in their lives and probably have seen it all and seen all types...good and not so good. if you haven't guessed, folks with schizophrenia were my most enjoyable patients. they live through so much.

it's all in the approach.

oh, one last point, medication is crucial with this disorder. non-compliance is a big issue as well...a major factor for relapse. learning about the medications used with this disorder is vital in your training.

i wish you the best.

i hoped this helped some.

great post and very helpful info t-wolf. :)

~j

[SuesquatchRN, BSN, RN]

My sister has schizophrenia, has for 30+ years, and her favorite joke is about the guy whose car breaks down on a rainy day in front of a psych hospital. Guy can't get it started. He hears a voice from behind the gates say, "Try drying the distributor cap and the wires." He's kind of mystified, but does as is suggested. The car starts. He says to the guy, dumbstruck, "How'd you know that?" The man answers, "I'm here because I'm crazy, not stupid."

Remember that they're there because they have decompensated big time, not because they're stupid.

And Thunderwolf, great post. I wish I could manage that with my sister when she's in the throes of a psychotic break, but can't always.

When Cindy is on a tangent it is very difficult to keep her on a topic, largely because of the paranoia that has been mentioned.