You are a registered nurse working in an acute inpatient mental health facility.
following issues relevant to their care.
1. Please provide a summary of the person’s diagnosis.
2. Identify the signs and symptoms of your patients diagnosed mental illness.
3. Highlight your patients legal status and explain what it means to your patient and the care you provide. Outline any relevant issues.
4. Discuss the medication prescribed to your patient. Discuss use, dosage and possible side affects.
5. Report on your patients physical well-being. Highlight any current or potential future concerns.
6. Discuss your patients risk assessment. Identify any issues.
7. Consider any potential stigma and discrimination that may impact on your patient’s recovery process
8. Report on your patients social welfare. Outline any potential issues.
9. Discuss the support you could provide to your patients family, and or carer.
Signs and Symptoms of the Patient’s Diagnosed Illness
Researcher Dennis Thompson describes Schizophrenia as “a chronic but treatable disease.” Writing in the Web Med Journal, Thompson says that Schizophrenia often manifests in ‘delusions of grandeur.’ In this context, a patient has false beliefs about his personal importance. He might, for instance, believe that he’s ‘a famous political leader’ and no amount of reasoning on the absurdity would convince him otherwise (Lieberman, & Murray, 2012). Quoting the US National Institute of Mental Heath, the writer added that other patients suffer delusions of persecution.
Carolyne Smith exhibited some of these signs of psychotic illness (Killackey, 2014). She was paranoid and restless and was aggressive towards others. The medical personnel suffered the brunt; she seldom cooperated or followed instructions. She was notably irritable and disorganised in thought and actions (Killackey, 2014). Her bed remained unmade, and her personal effects were scattered. The patient showed signs of delusion; she repeatedly shouted and claimed that ‘the water on the ceiling’ would deluge the room.
An article in the Mayo Clinic journal entitled: ‘Patient Care and Health Information’ describes the symptoms of schizophrenia as occurring in adolescents. It said that most afflicted teenagers tend to withdraw from family and friends. A sharp drop in class performance typically follows. Many suffer from insomnia, irritability and depression (Andreasen, 2010). In advanced situations, such children exhibit or harbour suicidal behaviour. Though not a child, Carolyne had most of these symptoms.
An issue of the online journal, The Health Line Newsletter, offers more information on this subject. The paper, edited by Timothy J. Legg, PhD, describes varied symptoms of schizophrenia including disorientation, confusion, the overall dysfunctionality of the individual, lack of desire to socialise, less self-care of the person, dressing and grooming issues, difficulty in thinking and remembering, immobilisation of the individual and episodes of stupor ("Schizophrenia and Other Psychotic Disorders | Behavenet", 2017). Remarkably, Carolyne had almost all of these symptoms of psychosis illness. Schizophrenia is also marked by symptoms that are associated with certain factors. The Mayo Clinic journal outlines a few such symptoms that may occur in patients who tend to misuse drugs and alcohol, like Carolyne. It lists these as paranoia, hallucinations, muscle problems, chills and sweating and reduced inhibitions.
The journal ‘Behave Net,’ published in 1995 and updated in 2017, outlines other symptoms that may be recognised in schizophrenia patients. These include derailment or incoherence in speech as a result of disrupted thought patterns, social and occupational dysfunction and mood disorders. A discussion with Carolyne revealed the possibility of at least ninety-percent of these symptoms in her case ("Mental Fitness Tips - Canadian Mental Health Association", 2017). The journal advised diagnostic physicians to ensure that most of these symptoms had occurred for a duration of six months and more. This helps to rule out other disorders.‘The Healthline’ newsletter recognises that positive symptoms of schizophrenia do respond well to medical intervention. It was encouraging that Carolyne could recover from such symptoms like hallucination and delusion which are characterised as positive (Kelly, 2008). The Journal explains that positive symptoms may not be right but, because they activate certain brain parts positively, the result is encouraging response to treatment.
The Patient’s Legal Status and Implications on Provision of Health Care
According to the journal Victoria Legal Aid (Lawyers and Legal Services), the rights of the patient are critical, and medical personnel have to respect these when administering care to patients. The self- help guide to the Mental Health Act, published in 1989 and updated in 2010, outlines the following fundamental rights of patients:.
- No patient should suffer discrimination. All are equal before the law. None should be denied the right to life.
- None should suffer cruel degradation and inhuman treatment.
- A patient has freedom of movement.
- Enjoyment of privacy and protection of reputation.
- Freedom of religion, thought, conscience, expression and belief.
- Enjoyment of liberty and security.
- The right to fair hearing.
- No patient should be detained for more than three months unless under exceptional circumstances (Nelson, 2009). These might include the fact that the symptoms of illness continue or because the patient threatens peace and social order. Also, it must be evident that the health facility can cope with the patient’s needs.
Obviously, these restrictions affect the delivery and quality of care to patients. Health caregivers may feel that a patient requires more time to access treatment in a given facility but have to adhere to legal restrictions.
Prescribed Medication, Use, Dosage and Side Effects
The ‘Oregon Am Farm Physician,’ a journal published in 2010 provided useful information. Writing in this publication, researcher John Muen, an Assistant Professor of Family Medicine, outlined several side effects of anti-psychotic medication ("Mental Fitness Tips - Canadian Mental Health Association", 2017). Some common side-effects Included: sedation, hypotension, cognitive problems, blurs, dyskinesia, Urinary retention, dry mouth, constipation, seizures, the risk of cardiac death, sexual dysfunction.
The following medication was prescribed and administered to the patient: Olanzapine: This was prescribed to help deal with the patient’s alcohol troubles (Boer, Westenberg, & Praag, 2010). The dosage was increased to 10Mg note. Diazepam PRN was prescribed to address anxiety attacks. Olanzapine: The prescribed oral dose for adults was used; 10mg, two times a day. This was in spite of expected side-effects: increased appetite, weight gain, headache, dizziness, tiredness, restlessness, and memory problems. Diazepam was administered to alleviate anxiety effects. It was used as follows: Oral dose for adults: 10 mg twice a day. The Expected side effects were as follows: allergic reactions, confusion, muscle twitching, tremor, loss of bladder control, drowsiness, tiredness
The Patient’s Physical- Well-Being; Potential, Current and Future Concerns
The journal ‘Oxford Academic’ (2014) said that people with schizophrenia were always at a higher risk of developing heart diseases and succumbing to premature death compared to other patients. It advised patients to join support groups that could enhance personal well-being.The publication said that this was the case because the vast majority of patients were physically inactive. They led an unhealthy lifestyle. It suggested that greater physical activity resulted in reduced mortality and had a positive effect on mental health and the quality of life. Medics were counselled to assist patients to do this.
Carolyne had problems with physical fitness. A physical examination indicated that the excessive weight gain was a result of an unhealthy diet and lack of exercise (Castle, & Buckley, 2011).. A discussion with the patient revealed that the symptoms of her illness (schizophrenia) contributed to this. It became necessary to design an action plan to help the patient overcome the situation.‘The Oxford Academic’ journal gave other reasons why many patients with schizophrenia fail to attain physical fitness. It listed the following additional grounds: chronic tiredness, fear of social activities, common ailments such lung disease and lack of resources to visit a gymnasium.
The Centre for Addiction and Mental Health Journal provides timely counsel for schizophrenic patients. The journal states that modern medical and technical advances have led to greater knowledge and better treatment that enhance patient welfare.It discussed some current challenges in treating the disease. The Journal noted that some schizophrenia patients respond well to treatment, recovering fully, while others fail to resume normal employment or studies. It advises the latter to try vocational rehabilitation in order rebuild their skills and boost personal confidence (Dickerson, Sommerville, Origoni, Ringel, & Parente, 2012). This would also help them to identify alternative occupations that better suit their circumstances.
Discussing the physical effects of schizophrenia treatment on patients, the journal Health Central said that many patients have to deal with challenges that affect them daily ("NIMH » Schizophrenia", 2017). It listed such problems as unusual eating and sleep patterns that, in turn, lead to obesity and physical fitness issues. It outlined other challenges that face individual patients. These included the fact that some have to deal with slowed physical movement or odd posturing. According to the publication, in addition to the physically debilitating schizophrenia, many victims also have to deal with such ailments like depression, anxiety, moodiness and ambivalence, conditions that have a major physical effect. Such conditions also affect the victim in other ways, including their natural sense mechanisms, thought patterns and overall physical behaviour. As a result, schizophrenia patients should treat their health with utmost care.
Information accruing from this source proved to be beneficial in dealing with Carolyne Smith’s case ("DSM-5", 2017). The patient shared some childhood experiences that indicated a possible predisposition to her current schizophrenic condition. Her description suggested that, in her childhood, Carolyne suffered from a possible impairment of the motor functions and intermittent verbal memory deficits.
Risk Assesment of the Patient’s Condition and Other Vital Issues
The Cochrane Review, a journal of the Cochrane Library, defines risk assessment as ‘the process of identifying people at the highest risk of perpetrating violence or aggression (Chung, 2008).’
Having sampled some aggressive patients who are admitted to hospitals, the study revealed that a majority were schizophrenic. Quoting the Mulidharan study of 2006, the report found that this situation placed the medical staff at high risk. As a result, it often became necessary to take unusual measures to contain violent patients (Lawrie, 2014). Some of these actions could be unlawful but still necessary. Such measures include: placing a patient in a seclusion room, Mechanical ( physical) restrictions, the Physical holding of a patient and involuntary medication(Dickerson, Sommerville, Origoni, Ringel, & Parente, 2010). In 2001 another study conducted by Philip J. Candilis MD came out with similar conclusions. The scholar found that between 10 to 33 percent of nurses had been assaulted by violent patients. 90 percent of such violent patients had exhibited suicidal tendencies. The period of onset of illness and a person’s upbringing were contributing factors.
The Impact of Stigma and Discrimination on the Patient’s Recovery Process
The British Journal of Psychiatry (2007), published a study of stigma on psychotic patients. The research was done in Tanzania. It defined stigma as ‘problems of knowledge, ignorance, behaviour and attitudes (Weinberger, & Harrison, 2010).’ The study listed the following types of stigma:
- Perceived public stigma (stigma originating from the patient herself and people in general
- Personal stigma (individual attitudes to stigmatised groups).
- Self-stigma (that endorsed by the patient herself).
- Attitudes towards help-seeking( affecting the patient’s likelihood to seek help).
Carolyne suffered stigma in the family, at work and in her community("DSM-5", 2017). The lack of understanding and empathy among some family members is especially hurtful. She felt discriminated against whenever workers were considered for a pay rise.
‘The Schizophrenia Bulletin (2010) published an article on this. The article was entitled: ‘Experiences of Stigma among Outpatients with Schizophrenia.’ The writer, Faith B. Dickerson listed some common situations of stigma suffered by patients as follows: In the work setting, Denial of treatment due to lack of insurance coverage, Exclusion from social or volunteer activities, Unsupportive co-workers and supervisors and Health insurance turn-down.
Social Welfare of Patient and Associated Significant Issues
According to the Journal,(2016) ‘the Conversation- Africa Pilot’ the impact of Schizophrenia is huge. The journal established that a top priority of many patients with psychotic disorders like schizophrenia is finding a job. Quoting Kevin Andrews, a Minister for Social Welfare, it was said that ‘work is the best form of social welfare.’The The study suggested that, with the right efforts, between 61 to 85 percent of such patients could be helped to return to productive life (Crane, & McDonough, 2014). The paper established that it was vital to help patients achieve economic independence and social functionality.
‘The Psychiatric Services’ Journal Volume 51 No.2 published in 2000 also reported similar findings. It described government support to patients as ‘a good safety net’ noting that a half of the patients under study were socially isolated and a third had lost jobs (Mueser, & Jeste, 2011). The paper concluded that, given the proper support, many psychiatric patients could be successfully integrated into the community. Carolyne was self-supporting but would need help to cope with employment dynamics.
Support to Patient and Family- 515
Researcher Samantha Gluck (2016) gave suggestions on how afflicted families could be helped. The practical suggestions would be used to help Carolyne and her family to cope with her illnesses. In the article, Ms Gluck stated that it was important for caregivers to allow the patient a measure of independence in personal life. This means that the caregiver would desist from carrying out every task for the patient. Given some freedom, she suggested, the patient’s dignity and confidence grow (Crane, & McDonough, 2014).
The researcher advised that caregivers should not try to reason away such challenges as paranoia, hallucinations or delusions (Tsuang, Faraone, & Glatt, 2011). Instead, they should try to help the patient in other ways. Whenever they made mistakes, caregivers should learn to forgive themselves instead of wallowing in self-blame (Nodgvist, 2017). They should also learn to forgive others who make similar mistakes.Caregivers should learn to distinguish the difference between schizophrenia as an illness and the patient herself per se. This was important since it would help them to care for the patient lovingly even though the symptoms of the disease are unpleasant (Ando, Clement, Barley, & Thornicroft, 2011). They would hate the disease but love the patient. Ms Gluck counselled that it was toxic to feel shame due to having a schizophrenic patient at home. Instead, caregivers should accept the illness and consider it similar to any other disease.
Another publication, ’Self –Help Tools and Tips for Patients’ also provides practical suggestions (Mahoney, 2011). It advises patients to participate actively in the treatment regime as outlined by doctors (Nodgvist, 2017). The patient is encouraged to access self- education on her illness, treatment, warning signs and other relevant information that could help her recover quickly. She should build a relationship of mutual trust with the doctor or therapist (Ando, Clement, Barley, & Thornicroft, 2011).
The patient is counselled to adhere to the prescribed dosage requirement. To succeed during times of turmoil, the patient is advised to create reminder lists on the medication schedule (Szasz, 2010). This could be a digital reminder or computer-based. Also, patients who are dealing with drug and alcohol issues are advised to seek help to stop the habit.
According to Walsh (2011), caregivers to recognise individual indicators of danger in schizophrenic patients.Such warning signs may include suicidal tendencies and behaviours, self-injury, increased anxiety disorders, drug and alcohol abuse and financial problems directly associated with such habits.
Finally, the journal, schizophrenia. Com offers more help to caregivers. It advises supporters of patients to care for themselves to achieve better results. It cautions against self-neglect (Alanen, 2010). The Journal suggests that, in spite of the situation, the patient’s needs do not always come first, ahead of the caregiver’s. In cases where the patient is prone to violent episodes those who provide care are advised to put measures in place to ensure personal safety. The caregiver is also reminded not to forget humour as the natural antidote for such trying situations as caring for the chronically ill.
Alanen, Y. O. (2010). Schizophrenia: Its origins and need-adapted treatment. London: Karnac Books.
Ando, S., Clement, S., Barley, E., & Thornicroft, G. (2011). The simulation of hallucinations to reduce the stigma of schizophrenia: A systematic review. Retrieved 18 April 2017,
Andreasen, N. C. (2010). Schizophrenia: Positive and negative symptoms and syndromes. Basel: Karger.
Boer, J. A., Westenberg, H. G. M., & Praag, H. M. (2010). Advances in the neurobiology of schizophrenia. Chichester: Wiley.
Carlson, R. W., & Carlson, K. (2012). Schizophrenia? Huh?: Stories for children. New York, NY: iUniverse.
Castle, D. J., & Buckley, P. F. (2011). Schizophrenia. Oxford: OUP Oxford.
Chung, M. C. (2008). Reconceiving schizophrenia. Oxford [u.a.: Oxford Uni. Press
Crane, L., & McDonough, T. (2014). Living with Schizophrenia: Coping, Resilience, and Purpose. Oral History Review. https://dx.doi.org/10.1093/ohr/ohu010
DSM-5. (2017). Psychiatry.org. Retrieved 19 April 2017, from https://www.psychiatry.org/psychiatrists/practice/dsm
Kelly, E. B. (2008). Coping with schizophrenia. New York: Rosen Pub.
Killackey, E. (2014). Welfare to work: a different approach for people with mental illness. The Conversation. Retrieved 19 April 2017, from https://theconversation.com/welfare-to-work-a- different-approach-for-people-with-mental-illness-22293
Lawrie, S. (2014). Schizophrenia: From neuroimaging to neuroscience. Oxford [u.a.: Oxford Univ. Press.
Lieberman, J. A., & Murray, R. M. (2012). Comprehensive care of schizophrenia: A textbook of clinical management. Oxford: Oxford University Press.
Mueser, K. T., & Jeste, D. V. (2011). Clinical handbook of schizophrenia. New York: Guilford Press.
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Mahoney, J. M. (2011). Schizophrenia: The bearded lady disease. Bloomington, IN: AuthorHouse.
Maj, M. (2013). Schizophrenia. Chichester: John Wiley & Sons.
Mental Fitness Tips - Canadian Mental Health Association. (2017). Canadian Mental Health Association. Retrieved 19 April 2017, from https://www.cmha.ca/mental_health/mental- fitness-tips/#.WPffRG6C3IU
Nelson, H. E. (2009). Cognitive behavioural therapy with schizophrenia: A practice manual. Cheltenham, U.K: S. Thornes.
NIMH » Schizophrenia. (2017). Nimh.nih.gov. Retrieved 19 April 2017, from https://www.nimh.nih.gov/health/statistics/prevalence/schizophrenia.shtml
Nodgvist, C. (2017). Schizophrenia: Symptoms, causes, and treatments. Medical News Today. Retrieved 18 April 2017, from https://www.medicalnewstoday.com/articles/36942.php
Schizophrenia and Other Psychotic Disorders | Behavenet. (2017). Behavenet.com. Retrieved 19 April 2017, from https://behavenet.com/schizophrenia-and-other-psychotic-disorders
Szasz, T. (2007). Schizophrenia: The sacred symbol of psychiatry. Syracuse, N.Y: Syracuse University Press.
Tsuang, M. T., Faraone, S. V., & Glatt, S. J. (2011). Schizophrenia. Oxford: Oxford University Press.
Walsh, M. (2011). Schizophrenia: Straight talk for family and friends. New York: Morrow.
Weinberger, D. R., & Harrison, P. (2010). Schizophrenia. New York, NY: John Wiley & Sons.