Paranoid schizophrenia as termed by the doctors as a mental illness. Schizophrenia can be called a sort of psychosis which states that mind is not ready to conform with the reality. This disease affects a person and the ways through which he believes and thinks. This tendency shows up in the same person in the same way but through different times. This illness shows up in the young adulthood or in late adolescence. The people that suffer from the schizophrenia experience paranoid delusions and without a valid reason are suspicious of others. These tendencies make it hard for the affected person to perform job, do tasks quickly, make friendships with others and even finds it difficult to consult a doctor. Even though the disease is considered to be a life long illness, a person can take medication to reduce the incidence of the symptoms and make life a lot easier to live. Treatment and care for the paranoid schizophrenia patients involve both the psychological and physical care setting (Faget-Agius et al. 2012). This assignment is based on the role of the mental health nurse and it also provides an insight into the care delivered to a patient named Mr. Smith and his family.
Mr. Smith is a patient exhibiting paranoid schizophrenia with a case history which showed that he is disengaging, which means that he is unable to connect and communicate properly with the friends, family and society. Mr. Smith was also found to be verbally aggressive and with increased tendencies of threatening his wife and children. Mr. Smith was also diabetic and thus was poorly complying with the medication.
Range of Health needs- The health care needs of a paranoid schizophrenia patient involves both the physical and mental health care needs.
The physical healthcare needs can be attributed to the several diseases that the paranoid schizophrenia patients suffer from and the right guidance and care to prevent such occurrences. The paranoid schizophrenia patients suffer from heart diseases, heart attack and strokes due to the build-up of high cholesterol, high rates of smoking, obesity and untreated hypertension. To prevent such diseases from occurring, the physical health of Mr. Smith must be checked annually by the general physicians and also by the primary health care professionals like the mental health nurse. Another major concern is the antipsychotic drug which is administered for the treatment of the disease leads to a high risk of cardiomyopathy, myocarditis and even sudden cardia arrest (Smith et al. 2013).
The mental health needs of Mr. Smith exhibiting paranoid schizophrenia are as: 1) due to the persistent symptoms even after treatment with relevant antipsychotic drug, a functional impairment occurs; 2) abuse of the central stimulant and co-morbid cannabis; 3) several difficulties and issues that arise during stable maintenance and establishment of contact along with the services that provide mental health care; 4) alcohol abuse is also a major mental health care need with people exhibiting mental disorders (Vancampfort et al. 2012).
Impact on patient and the family- Mr. Smith first of all will go through the lack of motivation and emotion. He will lose the ability to enjoy life, express, speak and even to make plans. Experiences like social withdrawal and apathy and lack to ability to show expression and become emotionally flat. Mr. Smith will even hallucinate and hears inner voices and even feels that others might harm him and are able to read his thoughts. The worst impact is the affected person hallucinates which causes the patient to smell, see, feel and hear things even if they are not present. In the later stages Mr. Smith may experience discrimination and stigma (Gerlinger et al. 2013).
The family of Mr. Smith on the other hand experiences frustration and feels hurt because he feels paranoid, exhibits distrust and false ideas regarding the members of the family. Mr. Smith’s tenacity may lead to rise in conflicts among the family members, and the conflicts are frightening and confusing for the family members. Due to persistent hallucinations experienced by Mr. Smith, the family members find it difficult to effectively communicate with him. This is a frightening and disheartening experience when loved ones of the family suddenly starts to talk and respond to the unseen happenings. The unclear speech and the odd behaviours makes the family members to feel frustrated and confused. Thus, due to this odd behaviour of Mr. Smith, the family members often feels embarrassed and becomes isolated in the society. Financial stress arises as the affected person loses the job and the spouse may feel resentment and overwhelmed with the burden of responsibility. While, the children may lose their childhood and assume the responsibility of the family. The affected individual becomes emotionally unavailable due to deteriorating mental health, which results in the members of the family to feel rejected. Lastly, although the family thinks that the medications will help the patient to overcome the disease, but the medications turned out to be less effective (Pitschel-Walz et al. 2015).
Range of services accessed by the service user- the type of services that are available for Mr. Smith are coordinated speciality care (CSC), psychotherapy, talking therapy.
Coordinated speciality care is a multidisciplinary approach service that integrates psychosocial therapies, supported education, medication, family involvement, case management, and employment services. All these benefits target to reduce the paranoid schizophrenia symptoms and improve the quality of life.
Psychotherapy is another service that can be availed by the both Mr. Smith and his family members. Psychotherapy assists and guides Mr. Smith to know about the disease. This therapy is conducted in a group or one to one setting (Rogers 2012).
Talking therapy is an effective service for the treatment of mental illness. However, it is lengthy process and Mr. Smith have to wait for year to receive the service (Corrigall, Payne and Wilkinson 2014).
Professional team building for care delivery- Teamwork is necessary to manage and treat paranoid schizophrenia successfully. Thus, working along with the right team is necessary for the effective delivery of the health care needs. The team to be built depends on the person affected with schizophrenia. However, the configuration of the team includes a mental health nurse, psychologist, vocational counsellor, social worker, psychiatrist, primary care doctor and pharmacist. The roles of the team include the following: psychiatrist- diagnosis, treatment and prevention are the three basic functions of a psychiatrist for the treatment of schizophrenia. Psychiatrist can frame the treatment plan and can prescribe the medication; psychologist- the role of the psychologist is similar to that of the psychiatrist, however a psychiatrist can help Mr. Smith to manage the conditions in a better way (Barch and Ceaser 2012). One of the effective therapy provided by a psychologist is psychotherapy or talk therapy. Social worker- are the professionals that can help Mr. Smith to effectively manage the everyday stress and also assists in connecting the resources with the everyday usage. Pharmacist- this professional can effectively disseminate knowledge about the harmful side effects of the schizophrenia medications and at the same time prevent the harmful side effects of the drug interactions. Mental health nurse- this professional work as care coordinators for Mr. Smith and they provide access to interventions. Specialists even provide one to one care to Mr. Smith (Videbeck 2013). Primary care doctor- people affected with schizophrenia are vulnerable to other diseases like stroke, heart disease and malaspina. Thus, early and effective intervention is necessary for the prevention of the diseases that occur due to the incidence of obesity, diabetes and other risks. Dentist- visiting a dentist is necessary for the effective management of schizophrenia, because dental care is essential as it is closely related with the physical health (?or?evi? et al. 2016).
Person centred care- person centred care is care provided to the aggrieved person who is suffering from mental illness. The service is framed according to the needs of Mr. Smith and his family members of the patient keeping in mind the response, preference, values and needs of him. Person centred care includes several types of models and guiding theories which are described in both the unpublished and published literature over the world. The models even are designed to provide care in the special environments which includes both the hospital environment and residential care areas (Gask and Coventry 2012). Whereas other models lay emphasis on the care provided by the different types of professional groups. The key principles upon which the person centred care is based are as follows: 1) Autonomy- respect for the choices made and the and the option to choose from different options. Balancing the responsibilities, rights and risks. The option to control a person’s choice through decision making and power share. Promoting independence through building on the abilities, strengths and interest. 2) valuing people- listening and working in order to deliver services effectively, and treating every people with respect and dignity through increased awareness and support of the preferences, beliefs, values and personal perspectives (Stanghellini, Bolton and Fulford 2013).
Promoting effective communication- promoting effective communication with Mr. Smith and his family involves knowing of when to communicate, how to communicate and what to communicate. Firstly, to promote effective communication in a schizophrenia patient it must kept in mind that when the patient is upset or angry. It is best not to convey any important information Mr. Smith. Secondly, the family members must wait for the person to become stable (Chan and Mak 2012). Since, schizophrenia is a serious disease, thus it is best not to communicate too much information in one go. The best way to communicate is to choose one certain problem which is important and then discuss about it. How to communicate effectively involves two different levels, non-verbal and verbal. Verbal communication means what a person actually wants to say in a brief and simple way. The non-verbal communication involves the facial expression, tone of the voice, eye contact, posture and physical distance in between the speakers. However, more than the verbal message it is the non-verbal message that is more important (Corcoran 2013).
Recovery model of care- from the perspective of Mr. Smith who is suffering from mental illness, regaining the recovering from the illness is a great relief for Mr. Smith, family as well as the care providing team. The main aim of the recovery model of care is to ensure that the mental health care is delivered in such a way which supports and promotes the recovery from the mental illness of the service taker (Jacob 2015). The six principles are as follows-
Communication and partnership- acknowledges every individual is responsible and expert of their life and recovery can be ensured only if effective partnership with theIt values the vitality in sharing information and effective communication is necessary for better engagement.
Personal reflection- From this experience I can in future will be able to work effectively in a team as a mental health nurse. I being a mental health nurse will be able to communicate effectively both with Mr. Smith and his family members. Also the role of mine as a coordinator of the service rendered should be able to increase my knowledge. This knowledge infusion will further guide me to become a specialist mental health nurse with the enhanced ability to provide one to one care to patients.
Therefore, from the above disclosure it can be concluded that paranoid schizophrenia is a special category of schizophrenia which demand specialised care delivery for the effective treatment and recovery. Although, there are range of services available for both the patient and the carers, care must be taken when choosing the right service. The recovery model on the other hand suggests that effective communication and person to person centred care effectively acts for the recovery of the patient.
References
Barch, D.M. and Ceaser, A., 2012. Cognition in schizophrenia: core psychological and neural mechanisms. Trends in cognitive sciences, 16(1), pp.27-34.
Chan, K.K. and Mak, W.W., 2012. Shared decision making in the recovery of people with schizophrenia: The role of metacognitive capacities in insight and pragmatic language use. Clinical psychology review, 32(6), pp.535-544.
Corcoran, N. ed., 2013. Communicating health: strategies for health promotion. Sage.
Corrigall, J., Payne, H. and Wilkinson, H. eds., 2014. About a body: Working with the embodied mind in psychotherapy. Routledge.
?or?evi?, V., ?uki?-Dejanovi?, S., Jankovi?, L. and Todorovi?, L., 2016. Schizophrenia and oral health: Review of the literature. Balkan Journal of Dental Medicine, 20(1), pp.15-21.
Faget-Agius, C., Boyer, L., Padovani, R., Richieri, R., Mundler, O., Lançon, C. and Guedj, E., 2012. Schizophrenia with preserved insight is associated with increased perfusion of the precuneus. Journal of psychiatry & neuroscience: JPN, 37(5), p.297.
Gask, L. and Coventry, P., 2012. Person-centred mental health care: the challenge of implementation. Epidemiology and psychiatric sciences, 21(2), pp.139-144.
Gerlinger, G., Hauser, M., Hert, M., Lacluyse, K., Wampers, M. and Correll, C.U., 2013. Personal stigma in schizophrenia spectrum disorders: a systematic review of prevalence rates, correlates, impact and interventions. World Psychiatry, 12(2), pp.155-164.
Jacob, K.S., 2015. Recovery model of mental illness: a complementary approach to psychiatric care. Indian journal of psychological medicine, 37(2), p.117.
Pitschel-Walz, G., Leucht, S., Bäuml, J., Kissling, W. and Engel, R.R., 2015. The effect of family interventions on relapse and rehospitalization in schizophrenia: a meta-analysis. Focus.
Rogers, C., 2012. On becoming a person: A therapist’s view of psychotherapy. Houghton Mifflin Harcourt.
Smith, D.J., Langan, J., McLean, G., Guthrie, B. and Mercer, S.W., 2013. Schizophrenia is associated with excess multiple physical-health comorbidities but low levels of recorded cardiovascular disease in primary care: cross-sectional study. BMJ open, 3(4), p.e002808.
Stanghellini, G., Bolton, D. and Fulford, W.K., 2013. Person-centered psychopathology of schizophrenia: building on Karl Jaspers’ understanding of patient’s attitude toward his illness. Schizophrenia bulletin, 39(2), pp.287-294.
Vancampfort, D., De Hert, M., Skjerven, L.H., Gyllensten, A.L., Parker, A., Mulders, N., Nyboe, L., Spencer, F. and Probst, M., 2012. International Organization of Physical Therapy in Mental Health consensus on physical activity within multidisciplinary rehabilitation programmes for minimising cardio-metabolic risk in patients with schizophrenia. Disability and rehabilitation, 34(1), pp.1-12.
Videbeck, S., 2013. Psychiatric-mental health nursing. Lippincott Williams & Wilkins.
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