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Schizophrenia is a severe mental illness characterized by a variety of symptoms, including loss of contact with reality, bizarre behavior, disorganized thinking and speech, decreased emotional expressiveness, and social withdrawal. This illness affects those parts of the mind that are fundamental to a persons sense of self. It changes a persons perception of reality, through hallucinations and delusions. This mental illness is diagnosed in about one person in every 100. Schizophrenia has been categorized into two specific classes and has possible causes for each class. We will also focus on the roles of the nurse and the family and the importance of medication. (Anonymous, 1996 a, 1996 b, Fontaine & Fletcher, 1999).
A psychiatrists classical categories of schizophrenia once included undifferentiated, catatonic, paranoid, and disorganized subtypes. A new classifying system which is widely used has replaced the former categories. This system includes two categories which are positive characteristics and negative characteristics. There are five sub-characteristics which can be described as positive and negative. These are behavioral, affective, perceptual, cognitive and social (Fontaine & Fletcher, 1999). Positive characteristics are additional behaviors which are not usually found in normal adults.
These patients experience delusions, hear voices, and have inappropriate emotional responses. These clients feel as if people are harassing them and they cannot do anything about it. They experience feelings of guilt and try to punish themselves and others with aggression (Fontaine & Fletcher, 1999). Negative characteristics can be described as the lack of behaviors, or " flat effect. " Symptoms include anhedonia and attention deficits. Most of these clients forget about self-care and their appearance can be a signal of negative Schizophrenia. These patients often have feelings of worthlessness and some eventually commit suicide.
Negative characteristics have been found more difficult to treat (Fontaine & Fletcher, 1999). There is a wide range of causes of Schizophrenia. Research has yet to come to a conclusive overall cause of Schizophrenia. There are a number of possible causes to this disorder.
One determining factor is that the disorder may be a genetic problem that runs in the family. Another factor may be an imbalance in the brain that results in the client obtaining jumbled thought processes. Other factors may include birth complications, many stresses in life, and family structure. Any of these factors and many more can have a trigger action that leads to insane behavior (Anonymous, 1996 a). The role of the nurse in treating someone diagnosed with Schizophrenia has to start with a trusting relationship. The nurse must first spend time with the patient to discover the problems the patient finds the most stressful and what the patient does to alleviate his or her symptoms.
The nurse can set specific goals and preferred expectations with the client that will help build a one-to-one relationship with the client and will also help the client cope with regressive behaviors. Nurses should pay specific attention to all of the clients actions, verbal and nonverbal. Furthermore the clients are very aware and sensitive to our verbal and nonverbal actions. For example, a patient that is at high risk for violence, directed at others, related to suspiciousness, may be a result of a misunderstanding in communication.
Therefore, these particular clients should never be underestimated. The clients assessment is an ever-changing evaluation of how treatments are working (Anonymous, 1996 b). Antipsychotic medications are used to control the symptoms of Schizophrenia. Examples of these Antipsychotic medications include phenothiazines, thioxanthenes, butyrophenones, dibenzoxazepine, dihydroindolone, and diphenylbatylperidine. These medications are the most useful in helping intervention with these clients suffering from Schizophrenia. For the drug to be most effective it has to be taken consistently as a relapse of symptoms is common when medication is discontinued.
It is usually prescribed on a long term basis and has serious side effects. Because of these side effects, the patient may discontinue the use of these drugs. This is when the nurse has a major role to educate these clients about the medication and its importance. The clients should fully understand the effects of the drug. Also the nurse and the client should freely discuss what particular effects the drug has on the client and if necessary to help negotiate a change in medication with the client. The family should also help in dispensing doses to the patient therefore the nurse needs to educate the family about the drug as well (Fontaine & Fletcher, 1999, Anonymous, (1996 b).
Nurses need to focus on the importance of family members along with the individual with Schizophrenia. Not only do the clients suffer, but the family is involved also. The nurse should show equal compassion to the family as well as the patient. Nurses should encourage family relationships with the patient, this can be a positive treatment for the individual with Schizophrenia. A nurses greatest contribution to mental disorders is the development of clinical interventions that target in on families and system needs. Statistics show that family intervention has helped reduce the rate of a relapse, reduce hospital admissions, and improve medication compliance ( Fontaine & Fletcher, 1999, Droogan & Bannigan, 1997).
Nurses who go into the field of Schizophrenia need to be very sociable and have plenty of patience. Two thirds of the patients diagnosed with the illness will never fully recover, so long term care is inevitable. Many of these patients will only get worse and for others it will lead to suicide. It takes a special kind of person to establish a working relationship with clients diagnosed with Schizophrenia. A nurse must dedicate herself to this specific field and have excellent talent in observing patients and promoting support with the families. Nurses should always remember that these are real " people" and deserve a chance to cope with their disorders to the best of their abilities (Anonymous, 1996 a).
Schizophrenia: knowledge for practice. Nursing Times, 92 (30), 1 - 4. Anonymous (1996 b). Schizophrenia: the role of the nurse. Nursing Times, 92 (31), 5 - 8.
Droogan, J. & Bannigan, K. (1997). A review of psychosocial family interventions for schizophrenia. Nursing Times, 93 (26), 46 - 47. Fontaine, K.
L. & Fletcher, J. S. (1999). Schizophrenic disorders. Essentials of mental health nursing (4 th ed. , pp. 281 - 309). Redwood City, CA: Addison-Wesley.
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