Module Six: Caring for Patients with Mental Health Issues
Part Four: Schizophrenia (Austin, pp. 311-358) (JW)
I have done my best to include all pertinent information, but I would like to point out that, the reading being 47 pages long, all information is not included, and large portions have been briefly summarized → pink is power point info
1. Discuss psychosis and the lived experience of people affected by schizophrenia. Consider the emotional, physical, spiritual, and intellectual significance for patients.
Clinical picture of schizophrenia (means “split mind”) is highly variable and complex; symptoms differ between people and in the same person between episodes
A researcher into schizophrenia, Schneider, split symptoms into “first rank” (psychotic delusions, hallucinations) and “second rank” (all other experiences/symptoms related to the disorder); this split is contested
Onset may be slow and insidious for some, and very sudden for others
Course is unpredictable; about 25-30% experience complete remission after one or more episodes; early intervention (incl pharmacologic and phase-specific psychosocial interventions) is promising for increasing the recovery rate in first-onset schizophrenia
Overview of clinical course:
Acute Illness Period (3-5 years after onset):
Initially, illness behaviours may be confusing and frightening, as the duration of untreated psychosis (DUP) increases pts less able to care for basic needs (eating, sleeping, hygiene), substance use is common, fx at school/work deteriorates and dependence on family/friends increases
Psychosis – a state in which the individual is experiencing hallucinations, delusions, or disorganized thoughts, speech or behaviour
“First episode psychosis” refers to the first time someone experiences psychotic symptoms → early stages of illness, i.e. the first 3-5 years following onset of symptoms considered critical period to intervene: Three phases: Prodromal, Acute, Recovery
A psychotic episode occurs in three stages
Phase 1: Prodrome – early signs may be vague and hardly noticeable and incl changes in the way some people describe feelings, thoughts and perceptions, which may become more difficult over time (as onset is often in late adolescence, this stage of the first episode may be confused with anxiety and moodiness of teenage years)
Phase 2: Acute – clear psychotic symptoms are experienced, such as hallucinations, delusions, and confused thinking
Phase 3: Recovery – psychosis is treatable: most people recover → pattern of recovery differs person to person; with help many people never have another episode
Goals of tx in this period (early intervention):
Reduce DUP
Intervene appropriately at early stage of illness
Prevent subsequent relapse and minimize disability
Treatment
Symptom relief with medication
Decreasing risk with safety measures
Family acceptance of client’s disease
Focus to stabilize symptoms
Understand/manage medication side effects
Stabilization period:
After diagnosis and initiation of tx (which is intense during this period, as med regimens are established and pt learn to deal w/side effects)
Symptoms become less acute but are still present
Ideally substance abuse is eliminated, socialization increases and rehabilitation begins
Pt and family get used to idea of living with a long-term mental illness
Maintenance and Recovery Period:
After stabilization, pt focuses on recovery to regain previous level of functioning and quality of life
Medication generally improves symptom remission, diminishes extremes an individual may experience and makes impairments in functioning less severe when they happen
Family support and involvement very important during this stage; pt and family educated to watch for potential signs of relapse and how to cope
Key long-term goal of tx is to avoid relapses after initial remission; influenced by pt willingness to maintain tx and by supportive resources being in place
Treatment
Adapt/manage medications → often intense
