Psychological Disorders: A General Overview

In the United States, one out of every five adults, or roughly 40 million individuals, experiences some form of mental illness each year.1 As a healthcare provider, you will likely be called to assist a psychiatric patient for what could be a variety of reasons. In some scenarios, the patient’s chief complaint or illness may be obvious, while in others it may be more subtle. Depending on where you work, your healthcare system/facility may be experiencing an increase in the number of patient visits/contacts involving mental illness. Emergency departments are reporting a significant increase in the number of patients with mental illness seeking care across the country. This increase is not only reported to be taxing emergency departments, it is also impacting hospital and healthcare system resources.1–4 It is likely that EMS providers are going to be called upon to assist patients with mental illnesses with increasing frequency, and familiarity with common psychiatric conditions and problems is essential to managing these calls appropriately.1–4

Individuals experiencing a mental health or psychiatric disorder can be found in any cross-section of the population. Of those afflicted with a mental health disorder, 5% have more serious conditions, including schizophrenia, major depression or bipolar disorders. Given such reports, ensuring that patients receive appropriate and timely care from the point of initial patient contact is critical. The following provides an overview of select psychiatric conditions that may be encountered by healthcare providers.1–4

Schizophrenia

It is estimated that at least 1% of the U.S. population, or more than 2 million people, exhibits symptoms of schizophrenia and that 100,000 to 200,000 new cases are diagnosed annually. Schizophrenia has also been identified as one of the top 10 most debilitating human diseases.5,6

Schizophrenia, a disorder of the brain, is usually first recognized in individuals between ages 17 and 35. Onset tends to occur earlier among males, with symptoms being first noted when the individual is in his teens or early 20s. Although a single cause has not been identified, genetics and environmental factors are felt to be strong contributing factors. It has been reported that the brain of the schizophrenic is structurally different than brains of those who do not suffer from this disease.5,6

Schizophrenia can be disabling and may prevent victims from doing seemingly routine tasks. Activities like participating in a conversation, showering or preparing a meal can become challenging. The individual’s ability to think clearly is impaired, often resulting in confusion between reality and fantasy. Emotional control and decision-making ability can be inhibited. The person may believe he is under the control of an outside force, such as aliens. Schizophrenia can result in significant changes in behavior. Social withdrawal and depersonalization may develop.5,6

Schizophrenia can involve two phases: active and passive. In an active phase, the victim may speak in a rambling manner using illogical sentences and may react to seemingly inconsequential situations with uncontrollable anger or violence. In the passive phase, the same individual may appear to lack a personality or any emotions. The schizophrenic individual may fluctuate between active and passive phases with behavior that is often unpredictable.5,6