It could be argued that the successful treatment of schizophrenia requires a greater level of clinical knowledge and sophistication than the treatment of most other psychiatric and medical illnesses. It begins with the formation of a therapeutic psychiatrist–patient relationship and must combine the latest developments in phar-macological and psychosocial therapeutics and interventions.
The psychiatrist–patient relationship is the foundation for treat-ing patients with schizophrenia. Because of the clinical manifes-tations of the illness, the formation of this relationship is often difficult. Paranoid delusions may lead to mistrust of the psychia-trist. Conceptual disorganization and cognitive impairment make it difficult for patients to attend to what the psychiatrist is saying and to follow even the simplest directions. Negative symptoms result in lack of emotional expression and social withdrawal, which can be demoralizing for the psychiatrist who is attempting to “connect” with the patient.
It is important for the psychiatrist to understand the ways in which the psychopathology of the illness affects the therapeutic relationship. The psychiatrist should provide constancy to the patient, which helps “anchor” patients in their turbulent world.
The qualities of the relationship should include consistency, acceptance, appropriate levels of warmth that respect the patient’s needs for titrating emotional intensity, nonintrusiveness and, most important, caring. “Old-fashioned” family doctors who know their patients well, are easily approachable, have a matter-of-fact style, attend to a broad range of needs, and are available and will-ing to reach out during crises provide a useful model for the psy-chiatrist–patient relationship in the treatment of schizophrenia.