Adherence to Treatment of Schizophrenia - Article Example

Issues of Adherence to Treatment - An Article Review     INTRODUCTION The clinical presentation of schizophrenia occurs in three phases, first entail initial prognosis and first treatment, phase 2 includes periods of relative calm between episodes of overt signs and symptoms but during which the patient needs sustained treatment and phase three includes periods of exacerbation or relapse that require hospitalization or more frequent contact with mental health professionals. The problem that is a standard when dealing with patients at that have schizophrenia is that there is an issue with medicinal non-compliance by way of the fact that more often than not patients tend to disregard prescribed medication, which actually leads to worsening of the situation. In this context the following research will look at the details of three journal articles that look at methods of dealing with non adherence. Abstract The following essay will discuss the role that is played by nurses in dealing with patients suffering from schizophrenia. In this endeavor, the essay will look at an analysis of three journal articles that deal with the factors that form a barrier to the adherence to medication in patients. Also, the research will look at the role that therapy and alternative forms of motivation can play when dealing with the problem non compliance with schizophrenia medication. Literature review and extensive analysis have been undertaken of three basic articles dealing with the issue of non-adherence. The paper finds that pressures from society along with lack of awareness form the crux of the issue where non adherence is concerned and efficient way of dealing with the problem is through the employment of alternative methods of therapy and motivation. ARTICLE ONE The first article entitled, ‘The role of the inpatient mental health nurse in facilitating patient adherence to medication regimes’, by Happel et. Al., (2002) looks at an analysis of the role of the nurse in light of the fact that non-adherence to antipsychotic medication is linked to symptom relapse and readmission to the hospital setting. According to the research, there are several complexities that characterize the non-compliance of prescribed medication where things schizophrenia is concerned. On account of these very complexities it is evident that there could be no single strategy that could be employed towards improving compliance rate of schizophrenic patients. Despite the fact that more often than not there is an absence of a clear agreement with respective to the things that do and do not affect compliance, there is adequate substantiation to establish the fact that factors such as abuse, population variables, knowhow of side-effects and the illness itself, potentially have a major on the probability of patients down with schizophrenia taking his or her medication as prescribed, the recognition of these factors highlights the role that must be played by the nurses in the enhancement of medicinal compliance, thereby aiding the reduction of suffering and ensuring the recovery in affected patients. For most nurses, the biggest factor that affected the management of medication was issues of environmental concern, which stood mostly in relation business of the wards, limitations to the availability of information to the patients, rapid inward changeover of the doctors, conflicting nurse roles, and the patient pressure and rush aggravated further by acuity. Patient adherence was hindered by factors of social stigma attached to psychotic medication, interference from the family, patient acuity touching new highs, shortened duration of stays and a more than normal medical staff turnover. There was also an issue related to training of nurses in the effective instituting of medication. What is needed therefore is a better management of medication, along with more awareness and reinforcements of the positive effects of medication in such scenario. Barriers to effective medication adherence and assessment could also crop up from the patent side of the equation. These would be inclusive of contact related problems, mental, or even emotional issues. There could be problems of prejudice and attitudes to complicate things further; like absence of a pharmacy nearby, absence of transportation to healthcare facility, availability of both but absence of, say, high doses of opioids at the pharmacy, and even the lack of a home caregiver to assist with administering drugs pose major. ARTICLE TWO  In the second article entitled, “Interventions to Improve Medication Adherence in Schizophrenia”, Zygmunt et. Al., (2002), found that interventions that were aimed at psychological education would not have the desired impact if they were not accompanied by behavioral constituents and survives that would support the change, along with them accompanying medicinal adherence in for dealing with schizophrenia. The idea therefore is that there is a need for models of community care to the tune of assertive community aid along with those that promote intervention backed by principles of motivational interviewing, could be of help in a large way. This would entail first and foremost ensuring that every patient was given sure shot information by way of instruction. This means that instructions would need to be clear and precise devoid of all elements that could be potentially confusing. Strategies could include things such as self-and-community-reminders, tools for self-monitoring, reinforcements and cues.   The study itself was based on the objective of finding out a way that could lead to adherence to medication. It was based on the assumption that higher the duration of treatment period and longer the non-compliance to adherence, greater were the barrier to a successful treatment of the illness. All in all another factor is limited available knowledge on how to improve adherence to medication. The study which undertook the method of a comprehensive literature review overtook an examination of psychosocial interventions aiding the improvement of adherence patterns to medication by enlarging focus on certain advanced parameters.   The research itself was made up of studies aiming at the examination of interventions that looked at the modification of medicinal compliance in those that were schizophrenic. It included studies that were published and unpublished in English, along with doctoral dissertations that were completed between the years 1980 to 2000. In the study, the researchers found that there were significant differences across the reviewed articles, along with the fact that of the interventions placed under review, many were complex and multifaceted, which automatically meant that it was tough to distinguish fundamentals that added to the triumph or breakdown of interventions. This also then meant that the conclusions that they were able to derive were necessarily of a tentative nature. The review was suggestive of certain very important hypothesis, and one of them was that in schizophrenia patients psycho-education for patients and their attendants/ families did not aid towards their overall compliance and adherence to the medications. However, in the same breath it was said that it might not be prudent to generalize this statement on account of the variability in psycho-education programs. Psycho-education programs accompanied with non-compliance to as a key treatment modality were generally less likely to lead towards any substantial adherence.   ARTICLE THREE The third article under review is entitled, “Use of Depot Antipsychotic Medications for Medication Non-adherence in Schizophrenia”, by West et. Al., (2008). The aim of the article was to figure out and provide a descriptive analysis of the factors that could be associated with the beginning of the institution of depot antipsychotic medications in patients with schizophrenia characterized by medication non-adherence. The study made use of a data provided by a national sample group of psychiatrists who made a business on reporting about adult patients with schizophrenia who found to be were non-compliant with oral antipsychotic medications the previous year. The study found that the beginning of the use of depot injections could not work in singular tandem but was a joint effort and would work in coordination with the patient, physician, treatment, and setting factors. According to the study, where the prevalence of schizophrenia is concerned, the estimates are influenced quite heavily by heterogeneity among definitions of symptoms and rating instruments used for diagnosis. The study found that non-compliance where antipsychotic medication was concerned was found to be the causal factor for increasing morbidity that was in other instances largely preventable. Estimates found that about a third of with schizophrenia are were non-compliant with the prescribed medicines, and were therefore at increased risk of symptom exaggerations and re-admission. The study found also that overall research stood in support of the usage and deployment of depot antipsychotics as a preservation action for those with a history of non-compliance with oral antipsychotics.   In figuring out the demographic that characterized the non-compliant patient group, it was found that a large part of the schizophrenic patients that had issues with compliance were white males, who were mostly bachelors and were mostly found to be without employment. Most were unemployed at the moment, and were living with friends or friends, with their ages falling between the 35 to 54 years bracket. Also, a large part of these patients paid for medications through public insurance aid. This did not however mean that there was no support, since a majority of them had a weekly-based contact schedule with their families and friends, and assessments were made through their treatment of to be of normal or more than average intelligence. Nursing interventions address the biologic domain-promotion of self-care, activities, exercise, nutritional thermoregulation and fluid interventions. The decided factor here would be the system of motivation, which makes use of the reinforcement theory, also known as the theory of operant conditioning. In its simplest form, the reinforcement theory states that the behavior is a function of its consequences. If the consequence is pleasant, chances are that the behavior that led to it will be oft-repeated. Similarly if the consequence is negative, the repetition of the behavior is less. In this case here, the employee would be motivated to repeat the current behavior or would be motivated to engage in different behaviors as may be the case.   CRITICAL EVALUATION Although a number of psychological treatments for schizophrenia have been introduced in recent years, knowledge is limited about their effectiveness in the reduction of medication related non-compliance. The effectiveness of some programs and models such as psychotherapy, social skills training, family psycho education, assertive community treatment and case management in improving compliance has been reviewed extensively in literature. Research pertaining to this has attempted to study impact of psychosocial interventions that can improve medication along with the compliance and the review has concluded in absence of behavioral components psychosocial interventions with allied support services are not likely to be help towards compliance improvement. However they observed that things as assertive community treatment and intervention based driven by motivational interviewing, which fall under models of community care, offer more hope than other psychosocial interventions only. Again the role of motivational interviewing in the promotion of compliance could often be useful. The idea is to aid the encouragement of patients to articulate the positive consequence of taking medication. CONCLUSION An evaluation would show that there are a number of points where both the articles have their own positives and negatives. What is interesting to note and needs to be stated right at the beginning of this particular analysis is the fact that the two articles are remarkably similar in style and in structure. The purpose of both is the division and decimation of certain international laws that related to international commercial arbitration. Both follow a style of citation that makes it evident that they are well researched works of high literary standards. The two articles that have been summarized would give anyone trying to understand the existing framework on non-adherence in schizophrenia principles enough scope to validate research. There is a thorough recording of facts and cases, article numbers and revisions that have been made. There is however no analytical thinking that goes on behind the composition of these three works. If one was to evaluate the works, what becomes obvious is they are packed with facts and references, the perfect starting point for further research as it explains in some clarity the nuances of the non-adherence in schizophrenia related medication.   References: Happel, et. Al., (2002). ‘High levels of patient acuity, shortened lengths of stay and a high turnover of medical staff’. International Journal of Mental Health Nursing. Vol. 11. Pp252-259 West, et. Al., (2008). ‘Antipsychotic Medications for Medication Nonadherence in Schizophrenia: Background Patient Charactertistics’. Schizophrnia Bulletin. 34(5). pp995-1001.< http://www.medscape.com/viewarticle/579953_3> Zygmunt. Et. Al., (2002). ‘Interventions to Improve Medication Adherence in Schizophrenia’. Am J Psychiatry 159:1653-1664. < http://ajp.psychiatryonline.org/cgi/content/full/159/10/1653> Read More