SCHIZOPHRENIA

Nursing care of a patient suffering from Schizophrenia

Nursing care of a patient suffering from Schizophrenia

Schizophrenia

Although nonadherence with the antipsychotic medication regimen is a common barrier to the effective treatment for schizophrenia, knowledge is limited about how to improve medication adherence. This systematic literature review examined psychosocial interventions for improving medication adherence, focusing on promising initiatives, reasonable standards for conducting research in this area, and implications for clinical practice.

Studies were identified by computerized searches of MEDLINE and PsychLIT for the years between 1980 and 2000 and by manual searches of relevant bibliographies and conference proceedings. Key articles were summarized. Thirteen (33%) of 39 identified studies reported significant intervention effects. Although interventions and family therapy programs relying on psychoeducation were common in clinical practice, they were typically ineffective. Concrete problem solving or motivational techniques were common features of successful programs. Interventions targeted specifically to problems of nonadherence were more likely to be effective (55%) than were more broadly based treatment interventions (26%).

One-half (four of eight) of the successful interventions not specifically focused on nonadherence involved an array of supportive and rehabilitative community-based services. Psychoeducational interventions without accompanying behavioral components and supportive services are not likely to be effective in improving medication adherence in schizophrenia. Models of community care such as assertive community treatment and interventions based on principles of motivational interviewing are promising. Providing patients with concrete instructions and problem-solving strategies, such as reminders, self-monitoring tools, cues, and reinforcements, is useful. Problems in adherence are recurring, and booster sessions are needed to reinforce and consolidate gains.

Schizophrenia is a mental illness characterized by perceptional impairments and impairments in expression of reality manifesting as auditory hallucinations, paranoid delusions in the context of significant social or occupational dysfunction (Castle et.al, 1991). Diagnosis is based on the patient's self-reported experiences and observed behavior. An increase in dopaminergic activity in the mesolimbic pathway of the brain has been found to be associated with the disease (American Psychiatric Association, 2004). Treatment by pharmacotherapy is done with antipsychotic drugs that suppress dopamine activity. Schizophrenia patients usually show comorbid conditions, including clinical depression and anxiety disorders (Parnas J et.al, 1989). Disorganized thinking, auditory hallucinations and delusions are common symptoms. Patients in advanced stages of schizophrenia exhibit frequent agitations and bizarre postures (Amminger et.al, 2006).

Psychiatric nurse care

The nurse may assess a client with a known history of schizophrenia or a client with an unknown to the mental health care system. Assessment begins with an interview and focuses on establishing the client's signs and symptoms, degree of impairment in the thought process, risk for self injury or violence towards others, and available support systems. The nurse may wish to interview the client with a family member or a friend to obtain all information regarding family history, previous episodes of psychotic symptoms, onset of symptoms, and thoughts of suicide or violent behaviour.

Availability and responsiveness of a social support network and the client's role in the family and community are important factors in nursing ...