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Chronic Mental Illness- Schizophrenia

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Sarah Maglaque

on 30 October 2014

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Transcript of Chronic Mental Illness- Schizophrenia

Chronic Mental Illness
"Schizophrenia"

Illness Trajectory and the changing impact on the patient
Illness Trajectory
Prodromal phase

Acute Phase

Chronic phase


Changes in Role functioning
Isolation
Work, education and socioeconomic status

Chronic Mental Illness
Role of the multidiscplinary team
Support Groups
• Sane Australia – National
• Reachout.com
• After Care NSW
• ARAFMI (NSW) Inc.
• GROW
• Bidgee group –Wagga consumer Group
• Brookvale Early Intervention Carer Support Group
• Northern Beaches Mental Health Support Group
• The Equalisers – Kempsey
• Psychiatric Rehabilitation association.

Impact on the patient and family

1. Life changed
2. Difficulty in coping with Social, emotional, physical and mental
3. Frightening experiences
4. Losing the "will" or energy
5. Isolation
6. Financial difficulty (Briggs et al., 2008), (Tracy, 2012)
7. Grief; denial and impatience (lack of acceptance).
8. Anger and striking out.
9. Guilt and self-blame.
10. Depression; hopeless, helpless feelings; demoralization.
11. Regression to earlier levels of functioning.


Epidemiological Data
45% of Australians will experience mental health in their life time
1 in 5 Australian will experience mental health
1 in 10 people with schizophrenia will attempt suicide
10.5% Australian aged 15-24 dying by suicide in 2012
26% young Australian experienced mental health per year
According to ABS, 48.1% of men were reported to have mental illness, whilst 43% in women
Women with schizophrenia are better at recovery
Substance used was more common in men than women
Unemployment was higher for those with a mental illness
Challenges related to schizophrenia from a nursing perspective and a possible intervention
Concept Map
Schizophrenia
Changing impact on the patient

Psychological

Physical

Social

Environmental

Spiritual
Bardwell & Taylor (2009)

Social Impact
Environmental Impact
Availability of support and services
Family and Friends
Community and organization

Spiritual Impact
Challenges related to chronic mental illness from a patient and family perspective and possible intervention
Models of care and recent innovations in care
• Stigma
• To maintain good primary medical care
• Level of denial of illness by the patient
• Self-recovery and self-management process
• Social Isolation
• Self-Care Deficits
• Complaints with medications
• Significant side effect of medications such as weight gain, diabetes, dyslipidemia and sexual dysfunction
• Lack of resources and funding in health
• Increase adherence includes psychosocial skills training and targeted adherence training
• Educating about their mental and physical health

Nursing intervention
• Drug and psychosocial interventions for the symptoms of schizophrenic disorders
• Nurse/patient relationship should be the central concept for psychiatric nursing
• Use of care pathways to enhance mental health care
• Personal power and efficacy
• Social expectations
• Connecting with people
• Personal growth
• Stability
• Coping with relapses
• Expression of spirituality
• Understanding the symptoms of the illness
• Differences between what one hoped for oneself and what one has now

Self-management support
Use of clinical information systems
Delivery system design
Decision support tools
Community resources
Health care organization support
Recent innovations of care for Schizophrenia
• Community-based care
• Providing therapeutic inpatient care
• Supporting people with mental illness into employment
• Improving physical health outcomes
• Creating a recovery-focused workforce
• Transforming the secure care pathway

1. Often feel hurt and frustrated.
2. Family conflicts
3. Difficulty communicating
4. Frightened and confused
5. Socially isolated
6. Withdrawing from their support
7. The lifetime emotional, social, and financial consequences
8. Time consuming or not enough time for other family members

Impact on the person
Impact on the family
• Public misconception of the disease
• Stigma
• Isolation
• Unemployment
• Financial Difficulties
• Medication Adherence
• No access to a psychiatrist or community treatment

Challenges from a patient's perspective
• Medication therapy
• Assertive community treatments (ACT) teams
• Compensated work therapy/supervised job coaching
• Self-help groups

Intervention
Challenges from the family's perspective
OBJECTIVE
• Disruption in family functioning and relationships
• Constraints in social, work and leisure activities
• General health disturbances
• Financial problems

SUBJECTIVE
• Stress
• Care burden
• Feelings of shame & guilt
• Anger
• Depression and anxiety
• Embarrassment in social situations
• Stigma

• Promote public awareness and knowledge.
• Close the gap between the onset of symptoms and treatment.
• Provide welcoming access to treatment and services.
• Provide education and support for caregivers and individuals living with schizophrenia.
• Invest in research
Intervention
Low work security
Lost of productivity
Substance abuse
Poor living conditions
Isolation
Relationship breakdown
Financial & Social Impact
Financial Cost
•The annual cost in Australia is ~20 billion dollars
• Income support payments - 3,219.8 million dollars
•Workforce participation programs - 114.8 million dollars
•Housing and accommodation programs - 115.6 million dollars
•Disability support services - 45.5 million dollars
•War veteran's disability compensation - 192.1 million dollars
•Home and community care - 10.6 million dollars
•Total - 3,698.4 million dollars

Abs 2009, 4102.0 - Australian Social Trends, viewed 23rd Oct 2014, <http: //www.abs.gov.au/.../4102.0Main+Features30March%202009>
Abs 2009, 4102.0 - Australian Social Trends, viewed 23rd Oct 2014, <http://www.abs.gov.au/.../4102.0Main+Features30March%202009>
(NHS, 2013)
According to ABS National Survey, who is most affected of schizophrenia?

a. Men
b. Women
https://respond.cc
Session key: 15900
Question:
defined as "severe, persistent, and dysfunctional" health problem that significantly affects how a person feels, thinks, behaves, and interacts
with other people.
brain disorder that affects the way a person acts, thinks, and sees the world. They have altered perception of reality, often a significant loss of contact with reality. They may see or hear things that don’t exist, speak in strange or confusing ways, believe that others are trying to harm them, or feel like they’re being constantly watched.
(Reference: http://www.asrn.org/journal-nursing/317-nurse-care-for-schizophrenia-patients.html), (http://www.pearsonhighered.com/uploads/PC-Kneisl2e-chapter16.pdf)
Psychological Impact
Positive symptoms:
-Hallucinations
-Delusional thinking
-Severe thought process disturbance
Negative symptoms:
-Poverty of speech and ideas
-Loss of energy
-Loss of drive
-Loss of living skills
-Blunted affect
-Loss of the experience of pleasure
Physical Impact
-Loss of drive
-Personal hygiene
-Nutritional intake
-Physical activity
-Occupation and work
(NHS, 2013)
Davidson, M. & O’Boyle, S. 2010, Improving Access to primary Health care Services for People with serious mental Illness, Final Project Report 2010, viewed on 23rd October 2014
Davidson, M. & O’Boyle, S. 2010, Improving Access to primary Health care Services for People with serious mental Illness, Final Project Report 2010, viewed on 23rd October 2014
Rethink Mental Illnes 2012, The schizophrenia commission innovation network, viewed on 23rd October 2014 http://www.rethink.org/about-us/the-schizophrenia-commission/innovation-network
Rethink Mental Illnes 2012, The schizophrenia commission innovation network, viewed on 23rd October 2014 http://www.rethink.org/about-us/the-schizophrenia-commission/innovation-network
Winton, F. & Robinson, R. 2005, 'The multidisciplinary team and the non-pharmacological treatment of schizophrenia', The Medicine Publishing COmpany, vol 44, no. 1, pp. 43-45
What is the role of nurses in managing patients with schizophrenia as part of the multidisciplinary team?
a. Assessment of functional deficit

b. Consultation, assessment , psychological therapies and formulation on complex cases

c.Medication administration and monitoring, and moment-by-moment management of disturbed patients
Question 2:
https://respond.cc
Session code: 72555
Tungpunkom et al 2012, ‘Caregiving Experiences of Families Living with Patients with Schizophrenia: a Systematic Review’, JBI Library of Systematic Reviews, vol. 10, no. 28, pp. 1 -10
Tungpunkom et al 2012, ‘Caregiving Experiences of Families Living with Patients with Schizophrenia: a Systematic Review’, JBI Library of Systematic Reviews, vol. 10, no. 28, pp. 1 -10
Tungpunkom et al 2012, ‘Caregiving Experiences of Families Living with Patients with Schizophrenia: a Systematic Review’, JBI Library of Systematic Reviews, vol. 10, no. 28, pp. 1 -10
Tungpunkom et al 2012, ‘Caregiving Experiences of Families Living with Patients with Schizophrenia: a Systematic Review’, JBI Library of Systematic Reviews, vol. 10, no. 28, pp. 1 -10
http://www.asrn.org/journal-nursing/317-nurse-care-for-schizophrenia-patients.html), (http://www.pearsonhighered.com/uploads/PC-Kneisl2e-chapter16.pdf)
Abs 2009, 4102.0 - Australian Social Trends, viewed 23rd Oct 2014, <http://www.abs.gov.au/.../4102.0Main+Features30March%202009>
Davidson, M. & O’Boyle, S. 2010, Improving Access to primary Health care Services for People with serious mental Illness, Final Project Report 2010, viewed on 23rd October 2014
Rethink Mental Illnes 2012, The schizophrenia commission innovation network, viewed on 23rd October 2014 http://www.rethink.org/about-us/the-schizophrenia-commission/innovation-network
Winton, F. & Robinson, R. 2005, 'The multidisciplinary team and the non-pharmacological treatment of schizophrenia'
, The Medicine Publishing Company,
vol 44, no. 1, pp. 43-45
Katterl, R. & Kalucy, E. 2009, Chronic disease self-management, Research Roundup, Issue 7, Adeliade: primary health care research & information service http://www.phcris.org.au/publications/researchroundup/issues/7.php
References:
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