Concurrent medical illness in the schizophrenic patient. Epidemiology, diagnosis, and management

The management of the medically ill schizophrenic patient presents a dual dilemma for the physician. The patient may have a serious medical illness that must be diagnosed and effectively treated, yet the patient's psychiatric disorder may interfere with effective management. Thus, undiagnosed and untreated medical illness can result in significant morbidity for schizophrenic patients. Because schizophrenic patients may appear to be less cooperative than medical patients without concurrent psychiatric illness, they can cause countertransference reactions on the part of physicians and nursing staff that can interfere with treatment. Schizophrenic patients also have deficits in the processing of sensory information. These deficits require the staff to make changes in management in order to facilitate the patient's ability to cooperate with treatment and to give reliable informed consent. A host of other factors complicate the medical management and treatment of schizophrenic patients. Such factors include medication side effects of psychotropic medication, the potential interactions between medications used to treat the patient's physical illness with psychotropics, pregnancy in the female patient, and the strength of the patient's support system. The ability to successfully diagnose and treat concurrent medical illness in the schizophrenic patient will depend on the physician's ability to be flexible and to understand the implications of the patient's underlying disorder for his relationship to hospital staff. This paper reviews some of the relevant literature and describes possible treatment strategies integrating what we know about schizophrenia with medical management.