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1. Identify relevant symptoms/manifestations of schizophrenia; 

2. Classify the presenting symptoms in accordance with the criteria of recognized psychiatric classification system;

3. Formulate appropriate strategies which may be used by nurses and other health professionals to facilitate Julie’s establishing and maintaining a state of mental health and recovery;

4. Provide a rationale for the pharmacological agents and treatment strategies adopted in relation to Julie’s condition;

5. Identify the associated behavioural and psychological manifestations which often accompany schizophrenia;

6. Outline ethical and legal issues that relate to Julie’s compliance with treatment;

7. Outline appropriate strategies for community care and identify possible sources of community support; and
8. Discuss the possible lifestyle impact that a diagnosis of schizophrenia has on the  individual, their family and/or carers and support networks.
 

Nursing Interventions for Julie

The Mental Status Examination conducted on Julie led to the conclusion that the patient under consideration is psychotic. The fact that Julie depicts the attributes of being anxious and guarded plays a role in demystifying the fact that she is suffering from paranoid schizophrenia. Based on this analysis, the current study seeks to suggest the most effective interventions, the rationale for these interventions, an intervention plan, and a discharge plan for Julie.

Julie presents visual sensory perceptions. The patient confesses that she sees people following her in cars and even imagines that they could be following her at the healthcare facility.  According to McDougal and  Sanderson (2016 p.165) visual sensory impressions among patients with paranoid schizophrenia are as a result of psychological stresses, changes in the neurological setup of the patient, biochemical factors and altered sensory perceptions.  The first nursing intervention for Julie will be aimed at acknowledging the reality of the sightings on the side of the patient while stating that such visualizations do not exist. Tham et al.  (2016 p.798) explain that such an approach is aimed at ensuring that the patient becomes uncertain of the soundness of what she purports to see. To achieve this intervention, Giunta et al. (2018 p.27) explain that there is need for the caregiver to he/she does not sense the said visualizations.

Second, McDougal and  Sanderson (2016 p.165) propose that when dealing with patients with paranoid schizophrenia, the caregiver is faced with the obligation of ensuring that the conversations embrace a simplistic fashion, are basic and based on realities. As such, any move to bombard the patient with multiple ideas must always be avoided. Instead, the caregiver must aim at ensuring that the client concentrates on a single idea at a time. The rationale for this intervention is to avoid all factors that may disorganize Julie’s thought processes. According to Rus-Calafell et al.  (2018 p.364), incorporation of reality-based conversations plays a critical role in enhancing the patient’s ability to concentrate.

Julie presents some aspects of interrupted family processes. According to Mubin et al. (2018 p.2), interrupted family processes among patients with paranoid schizophrenia could be as a consequence of developmental crises, situational crises and shifts in the family role. On the other hand, Bighelli et al. (2018 p.317) explain that this symptom is evidenced by lack of mutual support and knowledge deficits on the condition and community support. To intervene, Julie’s father will be taken through a counseling session as a way of determining his coping abilities while discouraging him from using demeanor terms such as “useless” when addressing his daughter. The rationale for this intervention is to help in the processes of stabilizing the patient’s family unit. Further, the counseling process will help Julie’s father to appreciate the efficacy of using positive phrases in preventing relapses and minimizing paranoia on the side of the patient.

The First Nursing Intervention

Upon C.T brain examination, Julie did not reveal extra axial, parenchymal, or ventricular abnormalities. Further, no form of abnormality was evident in Julie’s renal, thyroid and liver functions. The patient’s mean corpuscular volume was slightly elevated even though nothing abnormal was detected. Similarly, the client’s full blood count was within the normal limits. Considering the symptoms presented by Julie, the treatment plan will constitute pharmacotherapy and supportive psychological interventions.

Olanzapine and diazepam will be adopted as the primary antipsychotics for Julie. Bighelli et al.  (2018 p.317) identify olanzapine and diazepam as the standard treatments for paranoid schizophrenia based on their greater capabilities in fostering effective management of the symptoms associated with this condition. Further, González-Pando and Alonso-Pérez  (2018 p.374) explain that antipsychotic medications play a significant role in restoring the natural chemical functioning of the affected patient’s brain, minimizing psychotic symptoms, and reducing drug addiction. A review of Julie’s medical profile reveals critical psychiatric issues such as social isolation, paranoid ideas, reluctance when leaving the house, smoking, accessional alcoholism, and low self esteem. As a consequence, olanzapine (10 mgs Stat in ED) and diazepam (5 mgs Stat in ED) will be adopted.

Cognitive behavioral therapy (CBT) will be implemented as the primary psychosocial intervention for Julie. According to Lang et al.  (2016 p.78), CBT is a psychological intervention that is implemented with the aim of fostering proper acknowledgement of the behavioral changes depicted by the patient under consideration. As such, the intervention aims at recognizing the warning signs and escalating symptoms depicted by the patient, normalizing the lapses associated with drug addiction, coping up with personal cravings and incorporating healthy alternatives through cognitive restructuring and counteraction of positive viewpoints concerning drug use and abuse. Based on the initial intervention plan, Julie will attend counseling meetings with the primary nurse, her grandmother and registrar with the aim of instilling an environment that fosters motivation, positive mood change, cognitive repair, and enhancement of the patient’s social skills. Further, Julie will be allowed the opportunities of watching favorite television shows with her peers in the lounge area, being part of group counseling programs and using about an hour off leave on a daily basis in the hospital’s grounds. Such activities will be of critical significance in alienating attention deficits while boosting Julie’s ability to concentrate on personal activities and foster abstract thought processes. 

The institutionalization of Julie’s discharge plan commenced during hospital admission. The caregiver played an essential role in creating a strong alliance between Julie’s grandmother, the patient and other members of staff that were directly involved with this case. Table 1 gives a summary of the discharge plan adopted for Julie.

Discharge plan for: Julie

Date:

At hospital discharge

Living arrangements

· Julie’s housing will be provided by her grandmother.

· Other basic requirements such as food, clothing, and transportation will be provided by Julies family members (father and grandmother)

Financial needs

· Considering Julie’s position as a minor, all her financial needs will be met by her father and grandmother.

· The patient will be provided with social support contacts to seek assistance.

Daily activities

· In her position as a minor and a delicate person, the patient’s grandmother and father will face the obligation of meeting her daily activities such as cooking, cleaning, and budgeting. However, the patient will be counseled on the importance of coping with these chores.

Medication plan

· Olanzapine (10 mgs Stat in ED)

· Diazepam (5 mgs Stat in ED)

Community treatment plan

· Julie will be accorded 1/7 appointments with the case manager.

· Follow-up psychiatric and rehabilitation programs will be accorded for Julie when necessary.

References

Bighelli, I., Salanti, G., Huhn, M., Schneider?Thoma, J., Krause, M., Reitmeir, C., Wallis, S., Schwermann, F., Pitschel?Walz, G., Barbui, C. and Furukawa, T.A., 2018. Psychological interventions to reduce positive symptoms in schizophrenia: systematic review and network meta?analysis. World psychiatry, 17(3), pp.316-329.

Giunta, S., La Fiura, G., Mannino, G. and Russo, S., 2018. Stigma and mental health: the perception of the health professionals of the future and the feasible interventions. International Journal of Psychoanalysis and Education, 10(1), pp.25-31.

González-Pando, D. and Alonso-Pérez, F., 2018. Integrated Care–‘Schizophrenia’: A Challenge for Psychiatric/Mental Health Nursing. In European Psychiatric/Mental Health Nursing in the 21st Century (pp. 371-383). Springer, Cham.

Lang, F.U., Müller-Stierlin, A.S., Walther, S., Schulze, T.G., Becker, T. and Jäger, M., 2016. Psychopathological symptoms assessed by a system-specific approach are related to global functioning in schizophrenic disorders. Psychopathology, 49(2), pp.77-82.

McDougall, Tim, and Sally Sanderson. "Nursing children and young people with psychosis and schizophrenia." Children and Young People's Mental Health: Essentials for Nurses and Other Professionals (2016): 165.

Mubin, M.F., Riwanto, I., Sakti, H. and Erawati, E., 2019. Psychoeducational therapy with families of paranoid schizophrenia patients. Enfermería Clínica.

Rus-Calafell, M., Garety, P., Sason, E., Craig, T.J. and Valmaggia, L.R., 2018. Virtual reality in the assessment and treatment of psychosis: a systematic review of its utility, acceptability and effectiveness. Psychological medicine, 48(3), pp.362-391.

Tham, X.C., Xie, H., Chng, C.M.L., Seah, X.Y., Lopez, V. and Klainin-Yobas, P., 2016. Factors affecting medication adherence among adults with schizophrenia: a literature review. Archives of psychiatric nursing, 30(6), pp.797-809.

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