Every now and then a patient comes along and knocks my socks off. I've taken care of many schizophrenic patients. But, I've never really had a patient with an autism schizophrenia combination until now. Most of the schizophrenic folks I take care of say funny schizophrenic quotes about random things that make no sense. Most of the time my schizophrenia patients have no idea about what goes on around them. They live a life of delusional disregard for their surroundings, except for my first experience ever with a variant of schizophrenia. I'm calling it autism schizophrenia. He was 52 years old. He'd been diagnosed with schizophrenia since the age of nine. He spent most of his adult life in a group home with others around him to help him with his daily needs. He was admitted for medical needs unrelated to his schizophrenia. But what he did was amazing. Here's a list of his daily medications.
- Docusate
- Invega
- Loratadine
- Oxybutynin
- Protonix
- Plavix
- Restatsis
- Sulfasalazine
- Dicyclomine
- Lithium
- Verapamil
- Levothyroxine
- Fish oil
- Metoprolol
- Temazepam
- Seroquel
- Polyethylene
- Bisacodyl
- Fleet enema
- MoM
- Lamictal
- MVI with iron
- Buspirone
- Naproxen
- Clonazepam
- Advair
- Ventolin
- Zyprexa
- NTG
- Saline mist
- Guaifenesin
- Tylenol
- Guaifenesin DM
- Hydrocodone
- Lorazpam
- Meclizine
- Effexor
- Simvastatin
- Imdur
- Fludrocortisone
- Invega
That's 41 different medications this schizophrenic patient takes every day. I can't imagine taking five medications a day and remembering to do it accurately. Imagine trying to do medication reconciliation on this patient when they enter the hospital on a Saturday evening. That's exactly what happened here. Mr Autism Schizophrenia showed up in the ER with leg cellulitis on Saturday evening and th nurses had to figure out exactly what he was taking. Are you going to trust a schizophrenic patient to tell you what he's taking? I don't know a doctor or nurse in the world that would believe him.
Medication reconciliation process is a difficult nationwide problem.that is made even more complex on a Saturday evening. Not a day goes by where iatrogenic medication errors aren't introduced into the patient's existence because of the sheer complexity of regimens like this forty-one medication regimen to keep track of. In my autistic schizophrenia patient, I was amazed at his ability to pick out the incorrect dosage of a pill we gave him among 41 other pills in his cup. He could tell which pill was which and which pills were missing and which pills had the wrong dose. He didn't need any help taking his pills.
My honest to God autistic schizophrenic was even able to tell me that his Effexor 37.5 mg dose which we had listed (and is a standard dose) was actually supposed to be 375 mg, a massive dose. And we verified that with his pharmacy once we were able. He was even able to tell me his 800 mg bed time dose of Seroquel he had been getting was actually supposed to be 1000 mg.
I was floored when I stood there and listened to him describe all the medication errors occurring during his stay. Just imagine how many errors occur despite our best intentions. Despite his life long schizophrenia, he carried more intelligence regarding his medications than just about everyone I had ever taken care of in seven years as a hospitalist. I was amazed beyond belief. So I asked him
Happy: I know you've had schizophrenia all your life. But, your amazing ability to describe all your medications blows me away. Do you have autism?
Patient: What's that?
Happy: Never mind. How do you know all your medications so well? This is simply amazing.
Patient: I've been on these medications for 40 years. I've got nothing else to do but keep track of them.
Nah. I'm sure this is a once in a lifetime for me as a hospitalist. An autistic schizophrenia patient. In some ways, I wish all my patients were like him.
