Schizophrenia Management in Ireland - Term Paper Example

RELAPSE PREVENTION IN SCHIZOPHRENIA AND HOW IT IS RESEARCHED SCHIZOPHRENIA MANAGEMENT IN IRELAND Written by [writer’s name] presented to [mentors name] in partial fulfillment of the requirements of [course name] [date] Table of Contents Table of Contents 2 RELAPSE PREVENTION IN SCHIZOPHRENIA AND HOW IT IS RESEARCHED 3 SCHIZOPHRENIA MANAGEMENT IN IRELAND 3 VISION OF CHANGE 5 FRAMEWORKS FOR RESEARCH 7 CASP FRAMEWORK 8 LITERATURE REVIEW 8 MEDICATION AND NEUROLEPTICS IN THE PREVENTION OF RELAPSE 10 DETAILED DISCUSSION OF STUDY CARRIED OUT BY MEIJEL ET AL 10 SELECTION OF THE PATIENTS 10 ASSESSMENT OF SCALES USED IN THE STUDY 11 RESULTS OF THE STUDY 12 CHALLENGES FOR THE PATIETNS WITH RELAPSE TENDENCY 12 CONCLUSIONS 13 REFERENCES 14 RELAPSE PREVENTION IN SCHIZOPHRENIA AND HOW IT IS RESEARCHED SCHIZOPHRENIA MANAGEMENT IN IRELAND The UK mental health care system is starting new methods and strategies to ensure that the patients suffering from mental ailments are ensured treatment and are followed correctly. This is not only desirable but also a need for the health care system as the numbers of patients with some sort of mental problem is high. The global incidence of mental illness among people is as high as one in four persons. The costs thereby are also higher, which consume 3 to 4 % of the GNP. For Ireland this cost has been found to be at Stg 2.8 billion, which makes the annual cost of mental illnesses in Ireland to be 11 billion euros (Press Briefing, 2006, pp 5). As in many other developing nations, the role of nurses in the various aspects of health care has been established and appreciated. The need for nurses to be more involved and have autonomy on various medical decisions and issues is an area of debate for a long time; however, there are many who do acknowledge this. Therefore, the Ireland medical council and various other health institutions agree on the knowledge that nurses should possess to provide care to the patients and having the right to administer some drugs which may be necessary for the patient’s situation (Harris et al, 2007, pp 114). Nurses are perhaps one of the most diversified health providers there are since they are able to perform from one in patient service to outdoor and community health providing services. All these are part of the nursing career. In this regard, the nurses can be of immense help in deciding and creating various health policies due to their increased exposure to different health care and community settings. The many changes that have taken place in mental health have in fact included the role of nurses and how they will go about managing the various situations and cases (Harris et al, 2007, pp 114). Schizophrenia represents a range of disorders that alternate between periods of stability and periods of psychotic symptoms. The patients are usually given information about their diagnosis in order for them to understand their condition better and to comply with the treatment plan. However, the diagnosis of schizophrenia is essentially a very disturbing thing for the patient as well as the family. The treatment of the patient is a combination of pharmacological therapy as well as for the psychosocial interventions (Tait et al, 2002, pp 144). However, the relapse tendency is very high in these patients, the treatment requires a constant intervention for the patient in different phases. The relapse in schizophrenic patients is usually high, at about 35%, where as with proper treatment and care, this percentage can be reduced by 15 to 20 percent (Meijel et al, 2006, pp 42). It is these relapse cases that require constant intervention and care. In this particular case, the nurses are essential helpers in preventing and treating the patients. Since the nurses are in more touch with their patients and their families, and are mostly involved in the community practices, they can detect early cases of schizophrenia relapses, and thereby can help in preventing and controlling them (Meijel et al, 2006, pp 42). The symptoms usually consists of three phases of treatment plan, the phase 1 is called the normal and stable, the level 2 is known as the light to moderate, and the third level of signs and symptoms is called serious. Based on the information, the nurse formulated the treatment plan and decides the type of psychotherapy and pharmacological intervention required (Meijel et al, 2006, pp 43). The prevention of these episodes of relapse through early intervention has been an important contributor in the field of schizophrenia research. Previous treatment methodology essentially consisted of treating the person when an attack took place. Usually the patient would come into the rehabilitation with severe symptoms, and distress over his or her condition (Tait et al, 2002, pp 149). This not only included the patient himself, but also the family. Also, in the past, the non structured mental health system did not allow for good understanding and intimacy between the physician and the patient, which could help in the understanding the various issues that affect the person’s mental condition. There is now evidence that should one physician take care of the patient through out and regular follow-ups are carried out, the chances of relapse and negative symptoms are considerably reduced (Tait et al, 2002, pp 150). VISION OF CHANGE The program “vision for change” has been a fairly recent endeavor to help in the treatment of mental patients in Ireland. This community-based initiative is aimed at creating a health care system where the patients are given individual attention to their condition, and the treatment is more holistic in approach. In the past, the mental health care programs and initiatives have lacked in many areas of the total rehabilitation programs, which have led to their reduced efficacy. Lack of coordination between the different units that are involved in patient care is the main culprit in the lapses of care in mental patients. It also aims to create a multidisciplinary approach to treatment of mental health and is therefore, involved in creating a system that is more organized and complete ((Press Briefing, 2006, pp 1). In the past most of the mental health programs would have a single or a limited few nidi, which would then operate within a limited radius of the setup, and provide treatment for mental conditions. With the increase in distance from the health center, there was a reduction in the number of families being reached in the program and their effectiveness in the provision of care. This program aims to eliminate all the problems that are related to these problems. Another major step that this program has undertaken is to specialist expertise and therefore, the various health workers must be given full support and teaching about the management of such patients (Press Briefing, 2006, pp 2). With the addition of capital and non capital investments of more than 21.6 million euros per year, the program is hoped to lead to some very significant improvements in the care for mentally ill patients (Press Briefing, 2006, pp 4). The Vision for Change program has introduced many suggestion for increasing the functioning of the mental institutions within the country. The in patient units have been increased to provide service to 300,000 people per catchments area. Most of these locations are to be within a major hospital or service provider in the area, with four intensive care rehabilitation units (Press Briefing, 2006, pp 7). For children’s mental health, there are proposed two CMHTs per 100, 000 population. These centers are to ensure the provision of individual multidisciplinary care for children. For adults the CMHTs proposed are one for each 50,000 population, which will operate from community mental health centers. Again the main aim is to provide an individual care system with four intensive care units. This particular area is also launching a pilot series of early intervention services. For older people, there is proposed one multidisciplinary CMHT for 100,000 persons each, which will operate from the community mental health setups. These areas are to provide multidisciplinary assessments and treatment as well as community mental health steps (Press Briefing, 2006, pp 8). FRAMEWORKS FOR RESEARCH For any framework in mental health nursing, one essential and crucial component remains vital to its success. It is the autonomy and the immense knowledge that the nurses must have about the medications and the dosage regimes and how are they to be administered along with their effects. Since most of the nurses are working on the field or in community based settings, the immediate availability of the doctor may not be there or the patient’s situation may not allow for delay. In such cases, with good knowledge, the nurse can be able to handle situations and improve outcomes for the patient. Health care professionals question whether these interventions carried out for the prevention of schizophrenia relapses actually work or not. There are many researches that are looking into the efficacy of treatments. But even more so is important is to find out if the nurses are following the proper protocols in the treatment plan and whether they are the right strategies in the care for patients. The current need for introduction of psychopharmacology along with psychological intervention has been regarded as an essential tool in the reduction of relapse among patients. This is confirmed by the fact that more than half of the patients who are not given any psychological intervention after their treatment and discharge are likely to suffer from relapse. This tendency can drop by half should psychological interventions become a routine treatment plan for these patients (Meijel et al, Part I, 2002, pp 348). The recognition of prodromal symptoms in the schizophrenic prior to relapse is now an essential part of the treatment of schizophrenia (Meijel et al, Part I, 2002, pp 357). CASP FRAMEWORK The CASP framework has been created to give a proper guideline to understanding and evaluating various research based studies and initiatives. It looks into the methods which have been applied to the research, their credibility, verification and authentication and how are they appropriate in reaching the desired result as per the requirement of the research. Through this method, the person is able to analyze the various medical projects and articles and to assess their appropriateness in the research design. The same methodology has been applied in the making of this article. LITERATURE REVIEW The treatment and prevention of relapse in schizophrenia patients remains to be a challenge in today’s psychiatric treatment strategies. Most of these cases can take a lifetime to get the desired results, but some continue these treatments until they die. What makes it so difficult to prevent the schizophrenia attacks is another topic of discussion. However, a main concern is what measures are there to prevent such occurrences from taking place and the various methods that can help reduce these incidences from taking place. The role of nurses is very essential in creating a very good mental health care project. In this regard, their thoughts and opinions in this matter are essential components of success. Inventories taken from various nurses have confirmed that nurses agree they should be given more information about the medication regimes as well as the various treatment strategies about various conditions (Harris et al, 2007, pp 115). Most agreed that the service user should be able to make a valid treatment decision, and that there autonomy regarding care should be acknowledged. Most nurses feel that advanced directives is an important area that should be developed. The nurses should be trained so that they are confident in their role in management of patients and the administration of medication (Harris et al, 2007, pp 115, 118). Therefore, for any treatment of the mental conditions and not only patients with schizophrenia, the main concern should be the advancement and training of nurses so that they are able to handle such situations with ease, confidence, knowledge and competency. Since the prodromal symptoms of such patients can be highly variable, and can included symptoms such as anxiety, agitation, dysphoria, mistrust and others. A behavior change such as wearing of odd clothes or odd hairstyles etc. is also a very common finding (Meijel et al, Part I, 2002, pp 348). As mentioned the main treatment strategy begins with the diagnosis of the condition of schizophrenia and then informing the patient as well as his or her family about the treatment plan and strategy. The cases of the patients are studied and the plan is devised based on the information and the individual case of the patient (Meijel et al, 2006, pp 43). The nurse then evaluates and assesses the presenting symptoms and signs of the patient, and recognizes and organizes them in the various phases of schizophrenia (Meijel et al, 2006, pp 43). Researches carried out in this regard have shown that the self-management of the patients increases when the patients are given a good follow up after discharge of their mental condition. Education of the patient about their condition and how to manage it, and to recognize the prodromal symptoms of self helps in the prevention, delay and timely treatment of the condition. With constant record of the patient’s condition and how they feel during the various stages of their illnesses, the nursing professionals will be able to provide a good follow-up and record of their condition. In the case of children, family therapy and education is also a fundamental step in improving results and outcomes (Meijel et al, Part I, 2002, pp 353). MEDICATION AND NEUROLEPTICS IN THE PREVENTION OF RELAPSE The role of neuroleptic and various drugs is a very tricky business and can act as a two way sword. The reason is that many of these drugs carry their own side effects and can lead to many new symptoms and complications, which must be monitored and guarded against at all times. Therefore, the key towards establishing the correct drug regime for a patient lies in proper experience and understanding of the drugs and how they can benefit or harm the patient (Harris et al, 2007, pp 113). DETAILED DISCUSSION OF STUDY CARRIED OUT BY MEIJEL ET AL The study carried out by Meijel et al in 2006 is a very good case study in understanding some of the methods that are used for schizophrenia relapse prevention, and the challenges that can take place in doing so. The study was carried out in the time frame of one year. SELECTION OF THE PATIENTS The trial was randomized controlled trial, where the patients were selected who were diagnosed with schizophrenia. Only severe cases of relapse in schizophrenia were selected. The PANSS scale scorings of these patients was 4, and the contact frequency in these patients was once every two weeks. Patients were not selected should they had organic brain disorder or mental retardation. The patients selected for the study were from three mental institutions, one outpatient care institute and two inpatient mental health care institutes (Meijel et al, 2006, pp 43). These were then randomly assigned to the nurses that were included in the study. The nurses were not aware of whether they were assigned in the control group or in the intervention group. (Meijel et al, 2006, pp 43). The control care group nurses were informed not to use these intervention strategies in the care of the control group patients. The nurses were told to treat the patients according to the relapse prevention program. The other important entity involved in the treatment included the psychiatrist. The patients were selected on the basis of symptoms of delusions, hallucinations, disorganization of thinking and chaotic or aggressive behavior (Meijel et al, 2006, pp 43). ASSESSMENT OF SCALES USED IN THE STUDY The method of diagnosis was carried out by the PANSS method. This scale was used to assess the patients in various stages of the interventions, which was carried out on T1 stage and then finally when the study was reaching its conclusion. Alongside the scale used was the Insight Scale, for learning about the patient’s illness. The report assesses the various dimensions of the person’s insight of his or her own illness. These include attribution of symptoms, awareness of illness and the need for treatment (Meijel et al, 2006, pp 43). The working alliance inventory or the WAI was included to study the therapeutic alliance and its quality. The inventory was aimed to assess the goal dimension, the task dimension and the bond dimension. The Clinical Global Impression or the CGI has also been included, but the Global Impression scale is the only scale that has been used. The sections 1 and 4 of the scale, Comprehensive Assessment of Symptoms and History (CASH), were included for this study. The section 1 contains the sociodemographic data, where as the section 4 consist of illness history. RESULTS OF THE STUDY The results showed that there was a decrease in the early signs among the patients in the experimental group; however, the number of dropouts from this group was also high. This could be attributed to the inability of the patients to sustain the new interventions carried out for the patients. The experimental group was already found to be of lower general level of functioning and had more psychopathological symptoms. The intervention however, was able to prove that such patients could be detected earlier with serious symptoms of relapse. However, the relapse figures and changes were not significantly different between the two groups. The main problem that was found in the study was the increased numbers of dropouts in the experimental groups that affected the outcome of the study (Meijel et al, 2006, pp 47). This study was not able to statistically demonstrate any effectiveness of the early intervention studies that were carried out. There is therefore, need for more of such researches in this area (Meijel et al, 2006, pp 48). CHALLENGES FOR THE PATIETNS WITH RELAPSE TENDENCY There are certain challenges that the patients with schizophrenia and relapse tendencies face. First of the challenges is the inability of the patients to come to terms with their symptoms when they begin to suspect a relapse. In this particular problem, the patient may start to focus on the inner self more than on the problem, which may prevent treatment. The second challenge is the facing of the negative symptoms (Meijel et al, Part II, 2002, pp 362). Most of the patients start feeling symptoms of anxiety, depression and other such problems which may prevent them from taking therapy. For this the presence of a health professional such as a nurse is very important as they can recognize these symptoms early and help in the prevention of the relapse episode. Cognition issues are the third most important and significant complication that arises as a response to relapse attacks. Functional disorders and other problems as such should be managed with the nurse in an organized fashion following therapy guidelines. Pp 361. An assessment of possible personality disorders is also important in such cases (Meijel et al, Part II, 2002, pp 363). CONCLUSIONS Current researches point to the need for active participation in treating patients suffering from relapse tendencies in schizophrenia. Without the proper support and help from the government, these programs cannot function adequately. The aim should therefore, be to create good programs and evaluate them on constant basis so that productive results are attainable. REFERENCES Harris N. Lovell K. and Day J. C., 2007. Mental Health Practitioner’s Attitude Towards Maintanence Neuroleptic Treatment for People with Schizophrenia. Journal of Psychiatric and Mental Health Nursing 14 , 113-119. B Van Meijel, C. Kruitwagen, M van der Gaag, R. S. Kahn, M. H. F. Grypdonck, 2006. An Intervention Study to Prevent Relapse in Patients With Schizophrenia. Journal of Nursing Scholarship 2006; 38:1, 42-49. B. Van Meijel, M Van der Gaag, R. S. Kahn and M. Grypdonck, 2002. The Practice of Early recognition and Early Intervention to Prevent Psychotic Relapse in Patients with Schizophrenia: An Exploratory Study. Part I. Journal of Psychiatric and Mental Health Nursing 2002, 9 , 347-355. B. Van Meijel, M Van der Gaag, R. S. Kahn and M. Grypdonck, 2002. The Practice of Early recognition and Early Intervention to Prevent Psychotic Relapse in Patients with Schizophrenia: An Exploratory Study. Part II. Journal of Psychiatric and Mental Health Nursing 2002, 9 , 357-363. Press Briefing, A Vision for Change, 2006. Report of the Expert Group on Mental Health Policy. Available at http://www.dohc.ie/press/releases/2006/briefing_20060124.pdf?direct=1. last accessed on Nov, 19th, 2008. Alison Tait, Lisa McNay, Andrew Gumley and Margaret O Grady, 2002. The Development and Implementation of an Individualized Early Signs Monitoring System in the Prediction of Relapse in Schizophrenia. Journal of Mental Health,2002, 11; 2: 141-153. Read More