Tuesday, February 5, 2013

Schizophrenia


Schizophrenia
Schizophrenia is one of the major mental disorders. Even with the development in research on the disease, it is not well understood. This essay sends light into the symptoms and changes in a person suffering from schizophrenia and the contemporary nursing care and pharmacological treatment for an individual suffering from the disorder. It is characterized by a variety of behavioral changes that lead to detrimental disruption in the functioning and life of the individuals suffering from it. In order to provide a sufficient understanding, they are divided into two major categories: negative and positive. There is the use of antipsychotic medications in two general phases: acute phase and maintenance phase. There are also various psychosocial interventions that are available in the care and treatment of individuals suffering from schizophrenia. The Mental Health Act (2007) is also discussed in the essay.












Introduction
Throughout the history of mental illness, the disorder that is commonly known as schizophrenia has been viewed with bewilderment. It is one of the major mental disorders. This disorder is characterized by disintegrated thought processes as well as emotional receptiveness. The people suffering from this disorder were in the past seen as possessed by demons (Irani, Dankert and Siegel, 2007). They were completely separated from the rest in the society as a result of fear. In spite of the development and understanding of the disorder, its causes and possible treatment, it remains a poorly understood mental disorder in the society. People see it easier to deal with an understood illness like cancer instead of dealing with the hallucinations and strange thoughts of a person suffering from this disorder. Just like many of the other mental disorders, the causes of schizophrenia are not well understood. However, diagnosis from the symptoms and changes in the person suffering from the disorder is possible, and there are available care and treatment for individuals suffering from it (Bengston, 1992). This essay sends light into the symptoms and changes in a person suffering from schizophrenia and the contemporary nursing care and pharmacological treatment for an individual suffering from the disorder.
Definitions
This essay gives some of helpful definitions of schizophrenia. Psychosis: this refers to the lack of touch with the reality. This is one of the phases in schizophrenia. This is where the person suffering may suffer delusions or hallucinations. Individuals in this stage of the disorder are unaware that their experience or some of what they believe is not reality (Eugen, 2004). Psychosis is a major characteristic of schizophrenia, but not unique to it. Schizoid: this is the terminology that is used in describing a personality disorder distinguished by nearly absolute loss of interest in social interactions and a limited scope of expression of emotions in social settings. This makes a person with the disorder to appear aloof and cold (Bengston, 1992).  
Symptoms and changes
In most cases, schizophrenia occurs gradually in young adults. Early warning signs are there when the person begins to show signs of the disorder. Schizophrenia is characterized by a variety of behavioral changes that lead to detrimental disruption in the functioning and life of the individuals suffering from it. During the beginning of the problem, patients may seem to have lost their goals in life, become unmotivated and eccentric. They begin to isolate themselves and become uninvolved in family events and situations. They might quit taking part in other activities they enjoyed in the past such as games and sports. One of the common impairment in people suffering from this disorder is in the way he or she thinks. Most of the patients loose all their ability to think rationally (Kircher and Renate, 2006). His cognitive ability is also affected and his capacity to rationally evaluate interactions with others and the environment is lost. They tend to hallucinate or believe things that are not real or true, and may have problems accepting reality. Schizophrenia is mostly accompanied with hallucinations and/or delusions. This reflects deformations in perception and the way they interpret the reality. The change in their behaviors can be seen in their bizarre actions. They may begin to act in a paranoid manner, for instance believing that there is someone pursuing them even if there is no one. Some examples of the changes that reflect paranoia in these people include acquiring multiple locks to lock their doors, looking behind as they walk in a place with many people, and refusing to communicate over the telephone (Green, 2006).  
Some of the warning signs that a person is suffering from the disorder include: withdrawal or social isolation; irrational, weird or strange speech or beliefs; high level of paranoia or being unsure of the intentions of others; tending to be more emotionless; suspicion or hostility; increased dependent on drugs; insomnia or oversleeping; out of place laughter; lack of motivation; and change in their appearance and hygiene. People suffering from the disorder may seem like they are being under the control of an outside force (Green, 2006).   
For the purpose of understanding the symptoms of the disorder, the symptoms are categorized into two: positive and negative (or deficit) (Eugen, 2004). Positive symptoms are the kinds of symptoms that are not experienced normally by people but are experienced by people suffering from this disorder. Some of the positive symptoms of the disorder are hearing voices, being suspicious, being paranoid or the feeling that there is someone pursuing you, tactile, auditory olfactory, visual, and gustatory hallucinations, delusions, disorganized thoughts and speech, or creating words that have no meaning, loss of train of thoughts, sentences that have loose connections in meaning, and incoherence known as word salad in more serious cases fall under this category of symptoms (Kircher and Renate, 2006). Hallucinations may also be related to what is contained in the delusional theme. Negative symptoms or deficit are deficit of usual emotional reactions or of other processes of thought. Such symptoms tend to respond less well to treatment using medications. Some of the negative symptoms of the disorder include: social withdrawal or isolation, trouble in expressing emotions (this in more serious occurrences is known as blunted effect), trouble taking care of oneself (sloppiness in dressing and hygiene), poverty of speech known as alogia, judgment, lackn of motivation (avolition) lack of desire to establish relationships known as asociality, and incapability to feel happy (anhedonia) (Green, 2006). While positive symptoms are taken seriously, negative symptoms are often dismissed as acts of laziness. Studies have reveled that negative symptoms lead more to low quality of life in people suffering from schizophrenia. They also cause functional disability and a burden on other people as compared to positive symptoms. Individuals with negative symptoms normally have a history of deprived adjustment prior to the beginning of the disorder. There two more categories of the symptoms of schizophrenia: cognitive and affective. Cognitive symptoms are trouble attending to and processing information, trouble understanding the surrounding and interactions with other people, lack of responsiveness and trouble in remembering things even the simplest of tasks. Affective or mood symptoms include depression, depression leads to the high rate of attempted suicide in people suffering from this disorder (Tuominen, Tiihonen and Wahlbeck, 2005).      
Nursing care and pharmacological treatment
Research on the helpfulness of early intervention in the disorder is not conclusive. Even if there is some evidence showing that early intervention in the people in the psychosis phase may enhance short-term results, there are few advantages from the intervention following five years. The benefits of the efforts to prevent the disorder in the predrome stage are uncertain. Prevention is not reliable because there are no pointers for the later onset of the disorder. Nursing care and support is available for individuals suffering from the disorder. With a suitable management plan, care and support for these people has been shown to be effective. There are drop-in centers visits by community mental health team and support groups offering community support. Regular exercise is one of the nursing care interventions that have proven to work. This enhances the physical and mental health of the patient. The contemporary clinical practice has provided hope for patients suffering from schizophrenia and their loved ones. Innovative and safer care and treatment procedures have been developed making it possible to deal with the symptoms without the problem of resistance and to alleviate some of the serious side effects (Tuominen, Tiihonen and Wahlbeck, 2005).   
The primary treatment for the disorder is antipsychotic medications. The medications work better when combined with psychological and social support. For severe cases of the disorder, hospitalization may be necessary. Hospitalization can either be voluntary or, where the law permits, involuntary. Hospitalization is normally necessary for patients who are considered a danger to themselves and others, or those who are not in a position to cater for their own needs. Antipsychotic medications are aimed at reducing the positive symptoms in the patient, especially at the psychosis phase in about one to two weeks (Tuominen, Tiihonen and Wahlbeck, 2005). They have nevertheless failed to considerably alleviate the negative and cognitive symptoms. The option of the kind of medication to use is based on factors like benefits, costs and risks. There is a debate on whether, as a category, typical or atypical antipsychotic medications are more effective. The two categories have equivalent drop-out and the rate of relapse when typical medications are utilized at low to average doses (Jones and Pilowsky, 2002). However, in 40-50 percent, a good response is realized, in 30-40 percent a partial response and a resistance to treatment in 20 percent of the patients. For the patients who do not respond well to other medications, clozapine has been noted to be effective. However, it has a severe side effect of reduced white blood cell count (agranulocytosis) in 1-4 percent of the patients. Some of the side effects of typical antipsychotic medications are a higher level of extrapyramidal side-effects. Atypical antipsychotic medications tend to cause a significant weight gain, diabetes and a higher risk of metabolic problems. Even if atypical antipsychotic medications have less extrapyramidal side effects, the dissimilarities are few. Some atypical antipsychotic medications like quetiapine and risperidone are linked to more demises that atypical antipsychotic medications such as perphenazine. Clozapine has a lower risk of mortality. For individuals who are not willing or incapable of taking medicines on a regular basis, long-acting depot of antipsychotic medications may be utilized in the achievement of control (Tuominen, Tiihonen and Wahlbeck, 2005).
The treatment of the disorder has two general stages. The acute stage involves the use of higher dosages in the treatment of psychotic symptoms. The stage that follows this is the maintenance stage that could be life-long depending with the level of the disorder and its response to treatment (Kraepelin and Diefendorf, 1999). In the second phase the doses are slowly reduced to the minimum necessary in preventing continued occurrences of the symptoms. A temporary increase can be considered in case of a reappearance of the symptoms. Some of the patients have relapses even when they are using the drugs, but higher rates of relapse happen in case the treatment is stopped. Follow-up is necessary to address any problems arising or in case there is need to adjust treatment. When the medications are used together with the psychosocial therapies they enhance adherence to care and management (Jones and Pilowsky, 2002).
There are various psychosocial interventions that are available in the care and treatment of individuals suffering from schizophrenia. Some of the psychosocial interventions include: “family therapy, assertive community treatment, supported employment, cognitive remediation, skills training, cognitive behavioral therapy (CBT), token economic interventions, and psychosocial interventions for substance use and weight management” (Marshall and Rathbone, 2006: 156). Family therapy is the kind of intervention that works with families as well as couples in promoting change and development. It is founded on the idea that change is the system of relationships between members of a family, which is basically the part of the family that is affected in the onset of schizophrenia. Family therapy has been known for its effectiveness in dealing with different family-related issues and dilemmas. Family therapy may help in reducing hospitalization and relapse (Kraepelin and Diefendorf, 1999). This is commonly known as a talking therapy. Cognitive behavioral therapy is a psychosocial intervention that is aimed at solving problems related to emotions, behavior and cognitions. The intervention has been shown to be effective in treating mood, anxiety, and substance abuse. Assertive community treatment involves community mental health service in the treatment and care process. It is an intensive and normally integrated intervention for psychological disorders. Cognitive remediation is aimed at improving neurocognitive abilities like attention, working memory, cognitive flexibility and planning, and executive functioning (Marshall and Rathbone, 2006).    
Home care for people suffering from the disorder depends on the extent of the illness and the capability of the family to adequately care for the patient. The person involved in the care for the patient must make sure that he or she is taking drugs as prescribed. The environment should be safe and caring for the sake of the patient. The person taking care of the patient must maintain a close contact with the involved nurse and the general practitioner or the team involved in the care and treatment of the patient. For home-based care, there should be a treatment plan drawn with the assistance of the medical team responsible for the patient (Marshall and Rathbone, 2006).   
The Mental Health Act (2007)
This is the law in Australia that controls the treatment of individuals with psychological disorders both in hospitals and in the community. People with mental illnesses like schizophrenia have the right to receive treatment just like those suffering from other diseases. The law requires these people to be provided with suitable care. The kind of care given to these people is not supposed put little limitations on the rights and freedoms of the patient. Out of the conviction of the practitioner, the patient can be hospitalized, but this should be voluntary. However, a legal order can be produced by a magistrate allowing involuntary hospitalization. However, for this to happen, at least two professional opinions should be provided. Such a person must display behavior that is not rational, have potential for harming himself and others, have an ongoing condition and no other care that is less restrictive available for him or her. The patient should also be supplied with adequate information to make an informed decision. The health records of the patient should also be kept confidential. Community treatment orders are available for patients who are known to refuse treatment. They are made to avail themselves at a specific place and a particular time to receive treatment and/or therapy (Mental Health and Drug and Alcohol Office, 2007).
Australian community attitudes
Even today, most of the people suffering from schizophrenia are taken to be possessed by some external spiritual forces such as demons. This is not considered a medical condition requiring adequate treatment. Most of the people in our society do not believe in any treatment being available for such people. There also the general belief that people suffering from this disorder are dangerous and are likely to harm others. The society believes that people showing positive characteristics of the disorder are violent. This perception has increased instead of reducing since the 1950s. Social stigma has been noted as the major factor behind lack of treatment and recovery for most of the patients. The extra burden of stigma affects the efforts of the patient to recover. Due to the fear of violence displayed by the patients, most of the families and friends tend to isolate themselves from the patients rather than helping them. Even if stigmatization among the health professions in the country has reduced, current surveys have revealed that some of the mental health professionals in Australia still have some attitudes towards those diagnosed with schizophrenia, similar to those in the mainstream society. MIND’s survey carried out in 1996 revealed that people with mental disorders have been discriminated against by health care providers. Their psychological distress were dismissed or not taken seriously. This greatly affects their efforts to get well (Irani, Dankert and Siegel, 2007).  
Conclusion
This essay sends light into the symptoms and changes in a person suffering from schizophrenia and the contemporary nursing care and pharmacological treatment for an individual suffering from the disorder. Schizophrenia is one of the major mental disorders. It is one of the mental disorders that are not well understood on our society. The traditional idea of a person suffering from this disorder was that he or she is possessed by demons. This led to social isolation, confinement and other discriminative treatments. Even with the increase in the research on the disorder, it has not been sufficiently understood in the society. Schizophrenia is characterized by a variety of behavioral changes that lead to detrimental disruption in the functioning and life of the individuals suffering from it. Symptoms of the disorder are diverse. However, in order to provide a sufficient understanding, they are divided into two major categories: negative and positive. Positive symptoms are the kinds of symptoms that are not experienced normally by people but are experienced by people suffering from this disorder, such as hallucinations and delusions among others discussed in the paper. Negative symptoms or deficit are deficit of usual emotional reactions or of other processes of thought, such as social isolation and inability to express emotions among others. Nursing care and treatment of schizophrenia has developed a great deal. There is the use of antipsychotic medications in two general phases: acute phase and maintenance phase. There are various psychosocial interventions that are available in the care and treatment of individuals suffering from schizophrenia, such as family therapy and cognitive behavioral therapies among others. The Mental Health Act (2007) is the law in Australia that controls the treatment of individuals with psychological disorders both in hospitals and in the community.





















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