Mrs. Mary (pseudonym) is a single mother of two children. Mary is 55 years, and she is a client in our healthcare facility or institution. Mary has been experiencing delusions and hallucinations for more than six months, especially after work. Also, she started to have a disorganized kind of thinking. Such symptoms are usually experienced when an individual has Schizophrenia. Schizophrenia is a lifelong and grave neurodevelopmental disorder that impacts an individual’s thinking, behavior, and feelings (McCutcheon et al. 2020 pg. 201). Usually, schizophrenic individuals experience disorganized speech, delusions, disorderly behavior, hallucinations, and impaired cognitive ability. Delusions are generally false beliefs that are not grounded in reality. Hallucinations involve hearing and seeing non-existent things. Disorganized thinking is deduced from incoherent speech; thus, schizophrenic individuals experience impaired effective communication. Mary’s schizophrenia symptoms can be categorized into three: positive, negative, and cognitive symptoms.
- Positive
Positive symptoms in schizophrenic individuals are supplemental behaviors that are not seen in healthy individuals. The symptoms can be short or long-lasting in various individuals. Mary’s symptoms have lasted for more than six months; thus, they are durable and are progressing in severity. They include;
Hallucinations: Mary has been seeing, feeling, and hearing unreal things. She has heard voices for a very long time.
Thinking disorder: Mary’s way of thinking has changed and is becoming illogical. She has been having difficulties organizing her thoughts because she has been making up words with no meaning (National Institute of Mental health, n.d. pg. 2).
Delusions: Mary has believed in untrue things. For instance, when she is watching television, she believes that the presenters are directly talking to her.
- Negative
Negative symptoms encompass difficulty in displaying emotions and social withdrawal. Mary usually talks in a dull voice without showing facial expressions, and she is having problems in planning and focusing on an activity. She also rarely talks with other individuals, even on important issues.
- Cognitive
Despite cognitive symptoms being hard to see, they are easily recognizable because they make it challenging for individuals to take care of themselves or secure a job. Mary was put on a cognitive test. She was having challenges paying attention, difficulties in information processing to make her own decisions, and problems using the learned information immediately.
There are no known exact causes of Schizophrenia, but researchers believe various factors may contribute to the onset of Schizophrenia. The factors include genetics, environmental and biological. Schizophrenia risk accrues from the influence of the action of genes along with environmental factors. At certain times, Schizophrenia runs in families, but it does not inevitably mean that children with a schizophrenic family history will develop it. Some environmental factors such as substance use, pre-birth malnutrition, poverty, and obstetric complications are connected to schizophrenia disorder. Also, stressful surroundings or events like sexual or physical abuse, early parental separation or loss, and family conflicts are factors that can contribute to the development of Schizophrenia (MIRECC, n.d. pg. 2). Biologically, Schizophrenia can be linked to the imbalance of glutamate and dopamine (neurotransmitters), which are brain chemicals used to communicate information across the brain and the rest of the body.
Particular activity to help the condition’s effect
The activity used to help Mary extirpate schizophrenic effects is Integrated Specialty Care (ISC) (Powell et al. 2020, pg. 1). Integrated specialty care is a treatment model that incorporates psychosocial therapies, employment services, case management, antipsychotic medication, supported education, and family involvement. The treatment method helped in minimizing schizophrenic symptoms and ameliorate Mary’s living standards or life quality.
Antipsychotic medication: Medications are the primary treatment for Schizophrenia, and antipsychotics are usually prescribed drugs. Antipsychotic drugs manage schizophrenic symptoms by impacting dopamine, a brain neurotransmitter (Wils et al., 2017, pg. 43). Due to these drugs’ side effects on patients, Mary will be subjected to different doses and other medications like anti-anxiety drugs and antidepressants. Antipsychotic medication is classified into; first and second generation and injectable long-acting antipsychotics. “First-generation” antipsychotics include perphenazine, fluphenazine, haloperidol, and chlorpromazine. They are suitable for the long-term treatment of the disorder. Mary should take two doses per week. “Second-generation” antipsychotics include clozapine, quetiapine, asenapine, ziprasidone, lurasidone, aripiprazole, and paliperidone. They can be prescribed for Mary as an alternative to first-generation antipsychotics. Injectable long-acting antipsychotics are provided through subcutaneous or intramuscular injection. They include fluphenazine decanoate, risperidone, aripiprazole, haloperidol decanoate, and paliperidone. They should be prescribed to Mary if she finds it challenging to take pills and be administered 2 to 4 weeks based on the type of injectable drug.
Psychosocial treatments: Psychosocial treatment will help the client deal with daily schizophrenic challenges (Varga et al., 2018, pg. 247). The treatments are usually most beneficial after the client gets a working medication. There are various psychosocial treatments that Mary will be given. First, Mary will be provided with monthly family education whereby her family will be taught how to help their loved one and deal with the illness. She will also be taken through rehabilitation to get and keep a job and acquire daily living skills during the 6th month. Weekly peer counseling is another psychosocial treatment, and it will encourage Mary to receive aid from other persons who are ahead in the schizophrenia recovery process. Illness control skills will also be provided to Mary to learn about the disorder and manage it daily.
Therapy: Mary will be provided with two therapies: electro-convulsive therapy (ECT) and CBT (cognitive behavioral therapy). Electro-conclusive therapy will be provided if Mary does not show positive responses to drug therapy, and it is usually helpful when dealing with depressed individuals (Sinclair et al., 2019, pg. 1). Mary will also be provided with CBT to help her identify present problems and ways of solving them. CBT provision will be focused primarily on changing Mary’s nocuous behavior and thinking patterns. The therapies provided will be both individual and family.
Materials or resources used
Flyers and brochures: In the activity, brochures or flyers with a brief description of the disorder were created. They were essential in offering the client psychoeducation to enable her to be familiar with schizophrenic concepts and general literature such as its impact on an individual’s normal functioning, early signs and symptoms, and the significance of early intervention.
Supplies: Financial resources were used to purchase other supplies such as notepads and or pens to record the client’s progress. Financial resources were also necessary, particularly in the purchase of antipsychotic medications.
Centralized phone line: Provision of a solitary phone number was necessary mostly when a client wanted to communicate directly to a clinician concerning privacy issues. Such equipment helped keep the client’s privacy and aided adequate reception and responding to referral inquiries.
Website: There was a need to establish a healthcare facility or institution easily navigable with clients or family members and clinicians sections. The website was useful, especially for inquiries, provision of up-to-date information, and socialization. On the website, a client could interact with other schizophrenic patients who are ahead in the recovery process and even get peer counseling.
Implementation
I carried out the activity with the help of a well-planned schedule that lasted for eight months. The activity was structured monthly to incorporate every process necessary to facilitate the client’s recovery. During the first month, the client was provided with first-generation antipsychotic medication and weekly therapies, and psychosocial treatments. Mary took the first-generation medicines twice a week and had individual therapy (both CBT and ECT) once a week and family therapy once a month. Also, Mary was encouraged to interact with other schizophrenic-recovering individuals in our health facility’s website for peer counseling weakly. First-generation antipsychotics had frequent and notable neurological side effects like tardive dyskinesia symptoms. I informed my client about the illness, including the causes, the signs and symptoms, and the importance of early intervention.
During the second month, Mary was introduced to second-generation antipsychotics twice per week, along with weakly individual therapies (CBT and ECT), monthly family therapy, and weekly peer counseling on the facility’s website. Social skills were also introduced to help the client improve her social interactions and communication skills. The second-generation medication was more effective than the first-generation medication. During the third month, I provided the client with the option of getting injectable long-acting antipsychotics. After every fortnight to one month (four weeks), these medications were administered depending on the available injectable antipsychotic. Individual therapies accompanied the injections after every fortnight and monthly family therapy. The client maintained weekly peer counseling carried out on our facility’s website. Social skills training was also held and was offered after every visit. The practice continued for the three subsequent months. During the 6th month, supported employment and vocational rehabilitation were introduced besides the usual treatment or medication to enable the client to find, prepare, and keep a job. The treatment process ended in eight months.
Consultation and communication
Integrated specialty care refers to a recovery-focused treatment method or program for individuals with schizophrenia or FEP (first episode psychosis). It is a suitable method because it promotes mutual decision-making and utilizes specialists who deal with the client to develop a personal treatment plan. Specialists provide FEP individuals with psychotherapy, family education, medication management, and case management. Therefore, I request my superiors to execute this activity to help individuals with schizophrenic conditions due to its effectiveness.
Safety
Safety refers to the state of being protected from danger or harm or other undesirable outcomes. It includes controlling or managing acknowledged hazards to accomplish an acceptable degree of risk. On the other hand, best practice refers to the technique or a method that is generally approved to be powerful than any other alternatives due to the superior results than those accomplished by other means. Integrated specialty care proved to be a safe method of minimizing schizophrenic symptoms and effects experienced by Mary compared to when a schizophrenic individual is subjected to therapies only or antipsychotic medication only or psychosocial treatments only. For instance, antipsychotic medications are used to manage schizophrenic conditions impacting dopamine neurotransmitters in the brain. Despite minimizing the disorder’s signs and symptoms, the medicines cannot independently solve a patient’s psychosocial issues. Alternatively, psychosocial interventions alone cannot effectively manage the symptoms and signs of the disorder. Therefore, the combination of antipsychotic medication, psychosocial treatments, and therapies becomes a safer and best practice in managing the hazards posed by schizophrenia disorder. The integration of the three methods accounts for a patient’s social needs, personal needs, and career needs, thus improving their lives.
Client care
I applied various principles to provide the client with the best care to enhance her independence and dignity. First, to promote dignity, I treated my client with compassion, kindness, respect, and humanity while having patience and showing empathy. I treated her how I would want myself to be treated by others (Raee et al., 2017, pg. 1). Secondly, I took enough time to know the whole individual I am caring for, including the spirit, body, and mind, and I consciously integrated knowledge into my care. I always look beyond a client’s failing body to see the individual and include their decisions and conversations, either small or large. In enhancing patient independence, I always involved my client in decisions related to her care to avoid making her feel undervalued and disconnected. I usually respected my client’s possessions and space and upheld her privacy issues through having a friendly chat.
Evaluation
Integrated specialty care had a significant impact on the client. The strategy or method took care of the client’s various needs (emotional, physical, and social) in different ways. My client’s physical needs were taken care of through clothing her neatly, providing a well-balanced and highly nutritious diet, clean water, and providing a well-ventilated facility to allow clean air circulation. The healthcare facility always ensures that the client’s physiological needs are fulfilled to provide a conducive environment for better treatment and engagement. My client was comfortable and pleased with the kind of environment created to fulfill her physical needs. Through the integrated specialty care method or activity, the client’s social skills greatly improved because she could interact with other peers who have Schizophrenia on our website. Through such engagements, the client could have a sense of belonging; thus, she felt part of the schizophrenic community. Individual therapies helped improve the client’s communication and social skills. Additionally, through family therapies, the client could feel safe and appreciated by her family members through emotional connection (experience love and friendship) and attention.
Different people respond to medications differently; for instance, Mary did not respond well to first-generation antipsychotics. Thus, it is essential to incorporate diverse alternatives to potential risks during planning to ensure smooth implementation of any hazards. As clinicians, it is crucial to be very observant of our clients’ behavior and attitudes to make the right decisions and prescribe the right medications.
References
McCutcheon, R.A., Marques, T.R. and Howes, O.D., 2020. Schizophrenia—an overview. JAMA psychiatry, 77(2), pp.201-210.
MIRECC, n.d. What id Schizophrenia? pp. 1-8. Retrieved from: https://www.mirecc.va.gov/visn22/schizophrenia_education.pdf
National Institute of Mental health, n.d. SCHIZOPHRENIA, pp. 1-6. Retrieved from: https://www.nimh.nih.gov/health/publications/schizophrenia/19-mh-8082-schizophrenia_155669.pdf
Powell, A.L., Hinger, C., Marshall-Lee, E.D., Miller-Roberts, T. and Phillips, K., 2020. Implementing coordinated specialty care for first episode psychosis: A review of barriers and solutions. Community Mental Health Journal, pp.1-9.
Raee, Z., Abedi, H. and Shahriari, M., 2017. Nurses’ commitment to respecting patient dignity. Journal of education and health promotion, 6, pp.1-17.
Sinclair, D.J., Zhao, S., Qi, F., Nyakyoma, K., Kwong, J.S. and Adams, C.E., 2019. Electroconvulsive therapy for treatment‐resistant schizophrenia. Cochrane Database of Systematic Reviews, (3), pp.1-27.
Varga, E., Endre, S., Bugya, T., Tényi, T. and Herold, R., 2018. Community-based psychosocial treatment has an impact on social processing and functional outcome in schizophrenia. Frontiers in psychiatry, 9, p.247.
Wils, R.S., Gotfredsen, D.R., Hjorthøj, C., Austin, S.F., Albert, N., Secher, R.G., Thorup, A.A.E., Mors, O. and Nordentoft, M., 2017. Antipsychotic medication and remission of psychotic symptoms 10 years after a first-episode psychosis. Schizophrenia research, 182, pp.42-48.
