Schizophrenia: Psychiatry and Treatment Essay
Schizophrenia is a major mental illness which can be identified through signs and symptoms that can be categorized into positive and negative symptoms. This essay will identify what signs and symptoms go under each category and discuss in detail different care and pharmacological treatments available for people suffering from schizophrenia. Treatment and care requirements under the NSW Mental Health Act 2007 will also be discussed along with my own opinion on the Australian community’s attitudes towards schizophrenia.
This essay will begin by including a brief introduction into the major mental illness schizophrenia. Mosby’s Dictionary of medicine, nursing and health professions defines schizophrenia as ‘a complex mental disorder with active symptoms of psychosis,’ (Harris, P & Nagy, S & Vardaxis, N, p. 1549). Schizophrenia is diagnosed on the basis of the person’s symptoms. The symptoms of schizophrenia can be categorized into two different types, positive and negative symptoms.
Positive symptoms include hallucinations related to seeing, smelling, feeling and the most common hallucination hearing things that aren’t there. Other positive symptoms include delusions of fixed false beliefs that are uncompromised to the person’s cultural religious background. Types of delusions include paranoid, grandiose (the individual believes they are superior to others), religious, jealousy and nihilistic. Another positive symptom is thought disorders and bizarre behaviour. Negative symptoms are associated with a lack in normal individual behaviours and emotions.
These include a lack of range in expressing emotions, alogia (reduced speech), lack of motivation to perform everyday tasks, social withdrawal, affective behaviour, content of thought and formal thought disorder. Other types of symptoms relate to cognitive which include disorganised thinking, social withdrawal, lack of thought formations and concentration. People living with schizophrenia will start to exhibit identifiable changes in their mood, behaviours and psychosocial abilities as well.
Identifiable mood changes include depression, socially withdrawn, flat affect, bi-polar symptoms, depression with psychotic symptoms and anhedonia (lack of pleasure). Changes in behaviour refer to poverty of speech and thought, bizarre behaviours and basic behavioural processes are diminished or absent. Psychosocial changes in an individual with schizophrenia include social withdrawal, apathy and loss of contact with reality. Contemporary nursing care and pharmacological treatments are the most effective treatment options for achieving a greater quality of life for people suffering from schizophrenia.
Treatment needs to involve a whole team of interdisciplinary health care members. Nurses must be educated and liaise with community treatment agencies and other interdisciplinary team members. This is important so that information can be given to patients with schizophrenia about accommodation options, financial help in regards to paying for treatment and certain areas where they can access community support programs within their local areas. According to Mary Ann Boyd, p. 290 about 20% to 50% of people with the diagnosis of schizophrenia attempt suicide. Priority of care is highlighted through this very statistic.
A suicide assessment should be conducted on the patient which involves talking with the patient about their intended suicide plan. This assessment is very important in terms of nursing care requirements when caring for schizophrenic patients. It is important as a nurse to help and be a part of the patient’s and family member’s psychosocial treatment. One of the most important aspects of treatment is patient and family education of schizophrenia. Mary Anne Boyd states that ‘patients need help in accepting their illness and developing expectations for their future that are realistic,’ (Mary Anne Boyd, p. 90). Patient education allows for the patient and family to gain knowledge, skills and acceptance about schizophrenia so that recovery and patient wellbeing can be achieved. Another nursing care requirement while caring for patients with schizophrenia is promoting the patients self-care needs, maintaining hygiene and ensuring adequate nutrition. Some of the symptoms relating to schizophrenia especially those classified as negative symptoms can make these everyday simple activities difficult to fulfil.
Even though most patients know how to perform self-care activities they may not have the motivation to do so. As the nurse, intervention strategies should be implemented these include ‘developing a daily schedule of routine activities such as showering and shaving and emphasizing the importance of maintaining appropriate self-care activities,’ (Mary Anne Boyd, p. 298). The nurse may also need to provide supportive therapy which involves providing the patient with emotional support and reassurance. According to athealth. om ‘individual and group therapy can provide important support, skill building, and friendship for patients during the stabilization phase after an acute episode and during the maintenance phase,’ (Athealth, p. 2). The nurse must also ensure the patient is in a well-supported, safe environment. Patients may become distressed while in hospital because the environment is new to them and it may appear daunting. Their hallucinations and delusional thoughts may have already created fear and anxiety for them.
To create a safe environment it is important to minimize noise and people around them especially around times of rest. Pharmacological treatment is important in the recovery process of patients suffering from schizophrenia. The goals of antipsychotic drug administration are to control the symptoms of schizophrenia especially symptoms of delusional thinking, bizarre behaviour, hallucinations, agitation and feelings of paranoia. According to Murray Bardwell some atypical psychotic medications only succeed in controlling positive symptoms and in some cases they can make negative symptoms worse.
The antipsychotic clozapine is effective at controlling both negative and positive symptoms allowing the individual to return to normal life prior to the onset of the illness. Another goal for antipsychotic drug administration is to prevent the relapse of schizophrenia. Relapse can occur when medication is ceased or the right combination of medicines isn’t correct for the individual. It is important as the nurse to educate the importance for taking medication and make sure that the patient is compliant with their medication.
There are currently three categories of antipsychotics available these are conventional antipsychotics, atypical antipsychotics and clozaril (clozapine). Conventional antipsychotics are proven to be very effective yet they come with serious side effects. Conventional antipsychotics are being used less and less mainly because the side effects are so serious. The positive attributes of conventional antipsychotics is that if patients have difficulty keeping compliant with medication usage conventional antipsychotics such as Prolixin and Haldol can be given in long-acting shots every 2-4 weeks.
Long-acting shots work by slowly releasing the medication in the body over this period. Some examples of conventional antipsychotics include ‘Haldol, stelazine, mellaril, throazine, navane, trilafon and prolixin,’ (Athealth, p. 2). The second category of antipsychotic medications is atypical antipsychotics. This group of medications is the preferred group of antipsychotics as they possess less significance to dangerous side effects which conventional antipsychotics have. Atypical antipsychotic use is becoming the chosen form of pharmacologic treatment.
Some examples of atypical antipsychotics include ‘Risperdal, Seroquel and Zyprexa,’ (Athealth, p. 2). The last category of antipsychotics is Clozaril which can help ‘20%-50% of patients who have not responded to conventional antipsychotics,’ (Athealth, p. 2). Although, Clozaril comes with a very serious but rare side effect, it can decrease the amount of white blood cells essential to fight infection. For a patient to take Clozaril they must have bloods taken and checked regularly.
As a nurse it is important to know the most common adverse effects of antipsychotics, these include ‘peripheral nervous system effects such as dry mouth, headache, constipation, urinary hesitancy, photophobia, decreased lacrimation and sexual dysfunction. Central nervous system effects which include sedation, parkinsonian effects, akathisia and lowered seizure threshold. Severe adverse effects which include neuroleptic malignant syndrome, tardive dyskinesia, agranulocytosis, acute dystonic reaction.
Other effects include photosensitivity, retinal deterioration, weight gain, hormonal interference and anti-emetic effects,’ (Elder, R ; Evans K ; Nizette, D, p. 260). According to ‘Psychiatric and Mental Health nursing, p. 54’ the NSW mental health act is ‘designed to protect people with a mental illness from being treated unfairly, direct the provision of mental healthcare and the facilities; and instruct the practice of mental health,’(p. 54). One of the care requirements under the NSW Mental Health Act 2007 is the need if necessary for a community treatment order. According to Psychiatric and Mental Health nursing, p. 5 CTO’s main aim is ‘to increase engagement with services, and to prevent patient relapse,’ (p. 55). An example of the use for CTO’s would be if a patient who was suffering from schizophrenia wanted to stop taking their medication a CTO can be ordered. That ordered CTO allows nurses and doctors looking after the patient to administer the medication without refusal. The patient’s right to refusal is null and void. This scenario is just one scenario that a CTO could be used for. There are many other ways a CTO can be used such as rehospitalisation or another form of treatment.
The benefits of a CTO include ‘reduced hospitalisation, improved access to services, reduced rates of relapse, and improved social functioning,’ (Wand, T, p. 57). Another care requirement under the NSW Mental Health Act 2007 is patient legal implications and patient rights. Patient rights were implemented into the NSW mental health act 2007 to ensure every patient had rights to procedural fairness, to information, to representation, to dignity, to an interpreter, the right to access medical records, right to apply to be discharged and rights in relation to medication.
These rights are important and allow patients to express how they would like to be treated and allows for an individual’s freedom and autonomy to be upheld. Another treatment and care requirement under the NSW Mental Health Act 2007 is the criteria regarding voluntary and involuntary treatment of psychiatric clients. Voluntary meaning that the patient has admitted themselves into hospital and involuntary meaning the patient has been admitted to hospital against their will. Patients who have been admitted voluntarily and then ask to leave when they are still too unwell to do so can be detained.
This must follow a certain criteria which must apply with the NSW Mental Health Act 2007. It states that for a person to be detained they must ‘appear mentally ill, immediate treatment is required and can be obtained in an approved mental health facility and or because of their illness, the person needs to be detained for treatment as an involuntary patient for their own safety,’ (Wand, T, p. 55). Involuntary patients once reviewed by a psychiatrist can be detained for up to twenty-two days.
Patients, after being detained for the twenty-two day period then have the right to appeal through the Guardianship Board to review their voluntary status. Psychiatric and Mental Health nursing, p. 55 states that for involuntary and detained patients ‘the principle here is that the treatment is in the best interests of the client and that treatment will alleviate their symptoms of mental illness,’ (Wand, T, p. 55). Electro-convulsive therapy or ECT is a treatment which can be given to patients who are involuntary to treatment under the NSW Mental Health Act 2007.
Elector-convulsive Therapy ‘is a series of treatments involving a small electric current being passed through one or both sides of the brain,’ (Mental Health Coordination Council, p. 3). Electro-convulsive treatment has been proven successful in patients with severe depression and patients with depression who cannot take medication due to side effects. There are certain requirements up held by the NSW Mental Health Act 2007 regarding electro-convulsive therapy these include voluntary patients can refuse treatment, have the right to information and must be a written form of onsent if they choose to do so. Involuntary patients can receive Electro-convulsive therapy even if they don’t want it but it has to be stated in writing by two doctors that treatment is both rationale and necessary. That statement must then be approved by the Mental Health Review Tribunal. The Tribunal will then decide whether or not the patient will need ECT treatment. Some treatments have been prohibited under the NSW Mental Health Act 2007 and if performed on patients can lead to a criminal prosecution.
These treatments include ‘deep sleep therapy, inulin coma therapy and psychosurgery,’ (Mental Health Coordination Council, p. 4). Schizophrenia can be associated with many negative labels and connotations that the Australian community may share. I believe that the stigma that follows with the mental health disease schizophrenia can be quite unbearable for individuals suffering from the disease. Psychiatric and Mental Health Nursing states that ‘those experiencing the effects of stigma have been known to say that they are as bad as the effects of the illness itself,’ (Bardwell, M ; Taylor, R, p. 63). Australian community attitudes about schizophrenia include those of shame, shame on the family (for its development), that schizophrenic patients have a violent, aggressive and aggressive nature, and are usually seen as a threat to society. These stigmas and discriminatory attitudes can potentially affect individuals suffering from the disease from experiencing a normal life in areas such as work and employment. In the Australian community people share the idea that individuals suffering from schizophrenia are unpredictable and dangerous. The Overall contribution to the violence found in society by those diagnosed with schizophrenia is small,’ (Bardwell, M ; Taylor, R, p. 262). People who are uneducated about the mental illness schizophrenia may cause more harm to individuals who are suffering from schizophrenia than they would. If an individual who is uneducated about schizophrenia already has the preconceived idea that schizophrenics are violent they may then act violent, aggressive or defensive towards people suffering from schizophrenia. In conclusion schizophrenia is a major mental illness.
I believe that the Australian community needs to be educated more on schizophrenia and mental illnesses alike. Mental Illness is still a fairly taboo and unspoken topic for discussion. There are many misconceptions and preconceived ideas that people with schizophrenia are violent and aggressive. This can cause violent and aggressive behaviour towards people with schizophrenia from the public based on this preconceived notion. I also believe that the NSW Mental Health Act 2007 provide some great treatment and care requirements for individuals suffering from schizophrenia.
Although, some treatment and care requirements such as involuntary patients have no say in regards to electro-convulsion therapy should be re-evaluated as I believe that this criteria is wrong and goes against a person’s autonomy. References Athealth, 2010, Expert consensus treatment guidelines for schizophrenia: a guide for patients and families, viewed 25/09/2012, http://www. athealth. com/Consumer/disorders/schizophreniaguide. html. Dale, A, 2012, schizophrenia final presentation, PowerPoint presentation, Kalparin, Kanahooka.
Boyd, M, 2008, Psychiatric nursing contemporary practice fourth edition, Lippincott Williams ; Wilkins, Philadelphia. Elder, R ; Evans, K ; Nizette, D, 2012, Psychiatric and mental health nursing, Elsevier, Chatswood. Harris, P ; Nagy, S ; Vardaxis, N, 2010, Mosby’s dictionary of medicine, nursing ; health professions, Elsevier, Chatswood. Mental health Coordinating Council, 2011, part 4 section D: Compulsory treatment n hospital under the mental health act 2007 (NSW), viewed 24/09/2012, http://mhrm. mhcc. org. au/chapter-4/4d. aspx#4|D|3.