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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and Psychosis: Schizophrenia Information & Treatment
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bipolar
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& Renate T. (2006). The Boundaries of Consciousness. Amsterdam: Elsevier
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