Social, Environment and Financial Impacts of Paranoid Schizophrenia on Individuals and Family, Medication Management of Paranoid Schizophrenia - Case Study Example

TOPIC: PARANOID SCHIZOPHRENIA By student’s Name: Code+ Course: Instructor’s Name: University Name: City, State: Date of submission: INTRODUCTION Schizophrenia is a severe psychological illness where an individual is unable to distinguish between what is real and imagined. This study seeks to explore some experiences of psychotic episodes associated with schizophrenia based on Gloria’s Case Study. It seeks to investigate the impacts of schizophrenia on individuals and family members. The study also seeks to identify social, environmental and financial impacts of schizophrenia to the affected as well as their family since the burden of care of such individuals is shifted to the family as the affected may not be able to adequately take care of themselves due to denial (Brown, Inskip & Barraclough, 2010). Further to minimize the effects of schizophrenia on individuals and make sure they receive necessary care and medical attention, the study explores some of nursing interventions that may be helpful in order to arrest the situation and aid in the recovery from schizophrenia. Some of the nursing interventions that are subject to discussion in this study include; medical management which is one of the most appropriate nursing interventions of the people with schizophrenia by the community psychiatric nurse (CPN). Given that Gloria had many involuntary admissions this intervention is crucial as CPN’s will look for alternative means to help her which will include injections to manage to her condition. The second nursing intervention is psychological therapies that have been found to be successful in treating several mental impairments which include schizophrenia especially when provided at community level. This not only helps the individual to cope emotionally with the illness and reduction of stigma but also enable them to prevent relapse as well as reduction of ‘social disability’ (Stankovic, Britvic & Vukovic, 2009). Similarly the study will explore the causes, implication and management of medication non-adherence. It will seek to identify some of the reasons that will make an individual fail to take medicine at all or doesn’t take required dosage as prescribed by the physicians, implications of non-adherence and how physician and family can intervene to ensure the individual takes the medicine regularly as prescribed. Finally, the study seeks to identify the ramifications of mental illness stigma (Maguire, 2009). IMPACTS OF PARANOID SCHIZOPHRENIA ON INDIVIDUALS AND FAMILY According to research conducted by Devine (2009) persons with schizophrenia usually develop five distinct types of symptoms that may difficult for the individual, brothers, sisters, parents and professionals as well as other members of community as evident from Gloria’s case study. These symptoms are stigma, paranoia, and failure to accept the illness, demoralization and fear of being psychotic. The first impression of schizophrenia may be unappealing and traumatizing to the individual as it is often characterize by weird behaviours. The symptoms of schizophrenia may be confusing to the members of the family as they lose touch with reality. The unexpected adverse psychotic signs are commonly termed as an ‘acute’ stage of schizophrenia which is characterized by hallucinations which are seen as an unreal among the individual as well as the family members. Family members may constantly find it difficult to cope with such mental disturbances. The individual may feel isolated or withdrawn. Bizarre speech may persist, change of behaviour and individual character which may not be consistent with family expectations. People with paranoid schizophrenia often always go through relapse and remission. They sometimes don’t show the symptoms of schizophrenia as this condition is chronic and if not given proper medical care and attention from the family members and friends the effects may be adverse. Often these people may become victims of crime as their behaviours may not be easily contained (Zygmunt et al 2010). A patient with schizophrenia constantly requires family support or community members. Such a patient may resist treatment and he/she may believe that hallucinations are genuine and there is no need of intervention from a psychiatrist. Family members should take an active role in ensuring that the patient is attended to by a professional. Prior to lack of necessary support from, those responsible for taking care of these individuals may feel discouraged and inability to cope leading to relationship break up among the family and the individual with schizophrenia. Furthermore, Schizophrenia is a chronic condition which is more prevalent to elderly people. Inclusive intervention to all family members may be beneficial to the individual as they seek to understand his/her predicaments better (Byrne, Livingston & Regan, 2009). SOCIAL, ENVIRONMENT AND FINANCIAL IMPACTS OF PARANOID SCHIZOPHRENIA Social Individuals with schizophrenia may find it difficult in maintain their jobs, relationships as well as taking care of themselves. The burden of care is shifted to the family who takes care of such a person. People with schizophrenia have abnormal behaviours and the family members may feel embarrassed when friends or relatives pay them a visit. Behaviours associated with schizophrenia may have undesirable impact on individual’s social life and he/she may not be in good terms with friends, relatives as well as family members due to change of mood. Withdraw tendencies from the rest of the people and unpredictable moods can ruin the individual’s relationship. Symptoms associated with hearing of voices may inhibit the individual’s participation in daily chores as well as family life. The person may also develop poor working relationships with his/her workmates and often quarrel with his/ her boss due to inability to report to work or lateness (Maguire, 2009). Financial impacts Due to the feeling of paranoia or the individuals acting out on their delusions, it may not be possible for them to maintain employment. This may result to financial stress to their dependants as well families who are responsible for taking care. Costs associated with the treatment of schizophrenia also lead to financial strain for the relatives and family of the affected as they constantly require medication, basic needs as well as therapy for them to survive. However, certain programs have been put in place that helps to reduce financial burden to the family such programs include Social Security Disability program (Corrigan, Markowitz & Watson, 2010). Environmental impacts Individual may not cope well at different environments, for example in a working environment the person may not be able to socialize well with her workmates due to change of moods and low self-esteem. In the home environment, the individual may not relate well with family members due to denial that she is sick. In the recent past, the real cause of schizophrenia has not been identified. However, several researches have indicated that the disorder may either be genetic or environmental. In study carried out by Devine (2009) to compare brains of those who had schizophrenia and the ones who didn’t it, there were differences in brain structure as well as brain activity. This study has therefore made the researcher believe that the condition is genetic. In line with vulnerability it was found that different environmental conditions or certain people who are in a particular environment may be more vulnerable to schizophrenia over the ones who may not have the gene (Leddy & Pepper 2010). NURSING INTERVENTION Medication Management One of the most appropriate interventions of the people with schizophrenia by the community psychiatric nurse (CPN) is the medication management. Administration of antipsychotic medication has been seen as effective method of dealing with the condition. It is approximated that about 70% of people with paranoid schizophrenia will get some relief to their psychotic symptoms. However, it is estimated there are certain side effects that are associated with antipsychotics. To the elderly people the side effects are usually inform of extra-pyramidal symptoms (EPS) for instance movement disorders, although current drugs are known to have less side effects. Weight gain, sedation and a being sexually inactive are some of these side effects. Community psychiatric nurses ensure that patients adhere to the instructions on medication and take those drugs as prescribed, and also checks on the patients who might have adverse side effects and who might be risk being discontinued from further medication. Identification of such people may help reduce the relapse as they constantly help these patients connect with clinical serves to assess whether they could be having other options for medication. It is recommended that patients may switch between medications if the need arises especially if the prescribed drug may not seem appropriate. CPN’s also monitors the patients to ensure that they that the required dosage. A key aspect of this intervention is to ensure that patients take a dosage which is high enough to facilitate clinical relief, but similarly it should be low enough to reduce side effects (Devine, 2009). Administration of medication also varies across patients as some may have difficulties taking drugs orally, but most of the times schizophrenia patients are normally injected. However, antipsychotic injections are for prolonged duration of time and are normally administered to the patients with severe episodes and those who are known to have problems in taking medicine like Gloria. CPN’s also helps patients to accept the reality that they are sick, as those patients with schizophrenia often live in denial. Giving medical attention as well as providing relevant information forms an integral part of a medical intervention nurses involve themselves with, and that involve discussions on various side effects, noticing symptoms of illness at early stages and some of other issues the patient might be having (Knapp et al 2009). Psychological therapy Psychological therapies like cognitive have been found to be successful in treating an ally of medical mental impairments which include schizophrenia especially when provided at community level. This not only helps individuals cope emotionally with the illness and in stress management but also enable them to prevent relapse as well as reduction of ‘social disability’. Better methods of coping can thereby be improvised and may be most effective when nurses are aware and have sufficient knowledge on specific symptoms that cause distress to people. A good example of these techniques is those that are aimed at distraction people who have auditory hallucinations; listening to music has greatly helped such people (Farina & Felner, 2009). CPN’s also undertake to do counselling to those who are under care. Since the nurses spend most of the time with those people it provides them with an opportunity to learn and understand them better. Hence, they are capable of basing their interventions form previous discussions they hold with their patients. Counselling has been known to reduce nervousness as well as distress, and on the other hand it helps CPN’s to experience difficulties the patient undergoes and improve her ability to access whether the patient is response to this intervention is effective or not. All the information gathered from the patient during psychological therapy is necessary while the nurses carry out assessment capacity inside the care programme. CPN’s can thereby be said to more involved in various ways in dealing with patients’ mental impairment at the community level. They are generally concerned on matters that relate to medication, provision of information as well as giving psychological and psychosocial interventions. Nurses responsible for people with schizophrenia at community setting are more involved with patient care programme, as they provide sufficient mental health services for community based patients (Graves, Cassisi, & Penn, 2010). CAUSES, IMPLICATION AND MANAGEMENT OF MEDICATION NON-ADHERENCE There are quite a number of reasons that would make individuals with schizophrenia fail to adhere to medication. Patients may be not be in touch with reality that they are sick and may not see the need for medication, or may often have mental distortion that which might affect their thinking capacity may have a tendency to forget to take required doses as prescribed. Members of the family as well as friends may not have proper understanding of schizophrenia and may not be able to advise the person with this condition accordingly not to continue taking medicine when the situation improves (Gaebel, Zäske & Baumann, 2010). Physicians who are believed to be at the forefront in assisting these patients may occasionally fail to enquire on how frequent they take their medication, or may be resilient to the patient’s appeal in case he/she need to change dosage, or requires new treatment. It has been noted that some patients usually complain of adverse side effects related to medication that are more serious than illness itself. Additionally, substance abuse may seem to impede treatment process, which may lead to discontinuation of medication. If a sophisticated plan on treatment is implemented to these underlying factors, quality adherence might become more difficult (Awad, 2009). Luckily, there have a number of methods used by doctors as well as family members meant to facilitate adherence and mitigate the risk of illness. They use antipsychotic medications that comprise haloperidol, perphenazine, fluphenazine and some other forms of injection that are long-acting which makes is not mandatory for individuals not to take pills on daily basis. One of the major objective of recent research regarding to treatment of schizophrenia is to have a an ally of long-serving antipsychotics, particularly the newer ones that have less side effects on patients and that can be administered via injection. Designing calendars which contains a label of the days of the week can enable patients as well caregivers to note whether the medicine have been take or not and when to take it. Use of electronic timers which alerts the caregiver or the patient the appropriate time for taking medicine, or timing medication intake with certain scheduled events such as meal time, can facilitate patient’s ability to remember and follow the required schedule for medication adherence. Also, members of the family can ensure adherence by monitoring taking of oral medication by the patient. Similarly, doctors should be well informed on the response of patient to treatment and know when the patient might not be comfortable in taking pills and they can always cooperate with the individual to ensure adherence. Patients should always be motivated to carry on with proper medication. Likewise, education can become one of the adherence strategies when patient and family members are well informed on schizophrenia and its associated symptoms as well as its usual prescribed medication and this may form an integral part of adherence (Knapp et al 2009). RAMIFICATIONS OF MENTAL ILLNESS STIGMA Stigma is a type of social distancing that is observed when people are not willing to be associated with individuals who suffer mental illness. An individual with mental illness may be deprived his/her rights for child care as seen in Gloria’s case study or being excluded from social gatherings. Usually the individual has low self-esteem and self-discrimination. They always have a feeling of rejection and often think that they are not accepted in the society (Corrigan, Markowitz & Watson, 2010). Stigmatization for most people with mental illness is twofold. On one hand they pass through difficulties in dealing with symptoms of the disease as well as its disabilities. On the other hand, they are affected by stereotypes as well as prejudice which result from various misconceptions about their mental state. Consequently these people are deprived of the opportunities that characterize a quality life such as better jobs, safe housing, better health care and good relationship between family and friends. Even though recent research has tried to look into implications of the disease, it has not adequately addressed the area of stigma associated with mental illness. A lot needs to be done in order to understand and help stigmatized people who are often prejudiced against due to mental illness. The scope of the problem should be assessed and given the necessary attention (Leddy & Pepper 2010). Discrimination against mental impaired people has adverse effects on self-esteem as well as their confidence. Personal rejection and inability to accept the realities of the illness are the major cause of stigma. This may increase isolation and the person feels excluded and withdrawn. However, caregivers, government as well as nurses use a number of strategies to reduce the effects of stigmatization on individuals with serious mental illness. Some of these strategies include education, guidance and counselling, protest and encouraging good relationship and support between the members of public and those with disorders (Awad, 2009). CONCLUSION Schizophrenia is an adverse mental condition that affects people of all race and nationality across the world. Its symptoms are often severe and may have a long-lasting effect. However, chronic pattern of this mental disturbance may make victims vulnerable to disability. While suicide rates and mortality rates have increased in the recent past among the individuals with schizophrenia as compared to the rest of the population, most people with schizophrenia are living normal life given better treatment and this improves the quality of their life. In case schizophrenia is regularly treated and proper medication administered to the patients its adverse effects can be minimized (Stankovic, Britvic & Vukovic, 2009). REFERENCES Awad, G.A 2009. Antipsychotic medications: Compliance and attitudes toward treatment. Curr Opin Psychiatry, 17(2): 75-80. Philadelphia: Lippincott, Williams & Wilkins. Brown, S., Inskip, H., & Barraclough, B 2010. Causes of the excess mortality of Schizophrenia. British Journal of Psychiatry, 212-217. Byrne, N., Livingston, G., & Regan, C. 2009. Adherence to treatment in mood disorders. Curr. Opin Psychiatry, 44-49. Philadelphia: Lippincott, Williams & Wilkins Corrigan, P., Markowitz, F., & Watson, A 2010. Structural levels of mental illness stigma and discrimination. Schizophrenia Bulletin, 30, 481-491. Devine, P. G 2009. Stereotypes and prejudice: Their automatic and controlled components. Journal of Personality and Social Psychology, 56, 5-18. Farina, A., & Felner, R 2009. 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Zygmunt, A., Olfson, M., Boyer, C., & Mechanic, D 2010. Interventions to improve medication adherence in schizophrenia. Am J Psychiatry; 1653-1664 Read More