Case Report: Schizophrenia Discovered during the Patient Interview in a Man with Shoulder Pain Referred for Physical Therapy

Abstract

Purpose: The purpose of this case report is to demonstrate the importance of a thorough patient interview. The case involves a man referred for physical therapy for a musculoskeletal dysfunction; during the patient interview, a psychiatric disorder was recognized that was later identified as schizophrenia. A secondary purpose is to educate physical therapists on the recognizable signs and symptoms of schizophrenia. Client description: A 19-year-old male patient with chronic shoulder, elbow, and wrist pain was referred for physical therapy. During the interview, the patient reported that he was receiving signals from an electronic device implanted in his body. Measures and outcome: The physical therapist's initial assessment identified a disorder requiring medical referral. Further management of the patient's musculoskeletal dysfunction was not appropriate at this time. Intervention: The patient was referred for further medical investigation, as he was demonstrating signs suggestive of a psychiatric disorder. The patient was diagnosed with schizophrenia by a psychiatrist and was prescribed Risperdal. Implications: This case study reinforces the importance of a thorough patient interview by physical therapists to rule out non-musculoskeletal disorders. Patients seeking neuromusculoskeletal assessment and treatment may have undiagnosed primary or secondary psychiatric disorders that require recognition by physical therapists and possible medical referral.Key Words: patient interview, physical therapy assessment, psychiatric disorder, referral source, schizophrenia Shah N, Nakamura Y. Case report: schizophrenia discovered during the patient interview in a man with shoulder pain referred for physical therapy. Physiother Can. 2010;62:308-315 RÉ SUMÉObjectif : L'objectif de cette é tude de cas consiste à dé montrer l'importance de ré aliser des entrevues en profondeur avec les patients. Le cas é tudié concerne un homme dirigé vers la physiothé rapie en raison d'une dysfonction musculosquelettique. Au cours de l'entrevue avec ce patient, un problè me psychiatrique a é té dé celé ; par la suite, de la schizophré nie a é té diagnostiqué e. Le deuxiè me objectif de cette é tude de cas est d'é duquer et de sensibiliser les physiothé rapeutes aux signes et aux symptô mes aisé ment reconnaissables de la schizophré nie. Description du client : Le patient est un jeune homme de 19 ans qui souffre de douleurs chroniques à l'é paule, au coude et au poignet et qui avait é té dirigé en physiothé rapie. Au cours de l'entrevue, le patient a dé claré qu'il recevait des signaux provenant d'un appareil é lectronique implanté dans son corps. Mesures et ré sultats : L'é valuation pré liminaire du physiothé rapeute a permis d'identifier un problè me qui né cessitait que le patient soit redirigé vers un mé decin. Une gestion plus poussé e de la dysfonction musculosquelettique de ce patient a é té jugé e inapproprié e à cette é tape. Intervention : Le patient a é té dirigé vers une investigation mé dicale plus approfondie, puisqu'il m...

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