Introduction
This assignment aims at exploring the psychosocial interventions for patients with schizophrenia. It achieves this by expounding on a case scenario of a patient named Geoff.
The observed experiences of Geoff by both his parents and teachers clearly reveal that he is suffering from schizophrenia. The term schizophrenia is derived from a Greek word having two splits: schizo, which means split and phrenia means mind. Schizophrenia is a psychiatric disorder /mental illness that interferes with a persons ability to think, relate to others and management of emotions. It impairs the reality expression manifesting as hallucinations, delusions and anxiety (Castle, et al., 1991). He exhibits the symptoms of a person suffering from schizophrenia difficulty in concentration, change of behavior, isolation, lack of sleep and intrusive thoughts of torture and death at night. He is also overactive as evidenced by the breaking of his window glasses at night.
The physiological cause of schizophrenia is increased dopaminergic activity of the mesolimbic part of the brain where the neurotransmitter involved is dopamine. Other causes include biological factors where genetics and heredity are the main factors. Infections of the brain like meningitis may also cause schizophrenia. Stressful events and drug substances such as cannabis are also attributed to schizophrenia (Backrush, 2006). Its diagnoses are founded on self-report experiences of the patient themselves and their observed behavior (American Psychiatric Association, 2004).The successful treatment of this disease is multidisplinary including antipsychotic drug medications, cognitive behavioral therapy (CBT), and family therapy/interventions. In order to achieve the goal which is recovery, early interventions and enlightment of the families involved with sound information is important (Amminger et al., 2006).
The case scenario utilizes care programme approach framework and the KGV assessment tool to solve Geoff’s problems. The mental health nurse can use the psychosocial interventions for patients with schizophrenia to lay down a structure which when followed, it will help the patient. The first thing the mental health professional need to do is to come up with some Problem statements:
- Geoff has difficulty in concentration. The two short-term goals to be achieved under this are Identification of the cause of loss of concentration in the patient during the interview process and recovery of the patient’s concentration power within a period of one month. The long-term goal will be total recovery of concentration within a period of three months without relapse episode.
- Geoff’s change of behavior including isolation. The two short-term goals are identification of the cause of change in behavior and ensuring that the patient stops isolating himself from others. The long-term goal will be ensuring total recovery of the patient’s normal behavior recovery. Then Geoff and his parents will be invited for a schedule where all of them will be involved may be in turns if need be.
The Care Programme Approach
During this interview session, a care plan for Geoff will be prepared. A care plan is a document that is written to put up together information about social care, plan of medical treatment, auxiliary support names of the involved professionals in the action of changing a circumstance.The prepared Geoff’s care plan will entails care management and planning processes and is utilized both at the clinic and community levels. The CPA process will involve assessment of both health and social care needs of Geoff. The mental heath nurse will then identify a mental health service provider who is qualified to coordinate the written care plan. This mental health worker will be allocated to Geoff who will ensure that contact with the service is maintained. There are two levels of CPA namely standard and enhanced. In the preparation of a standard care plan the patient requires intervention and support of one discipline or little support from several agencies.The patients is able to individually manage his mental problems in this level the patients have an informal network support and they pose a danger to themselves and others. The other level of care plan is called enhanced care plan and is different from the standard care plan in that at the preparation point of it the patient already have a severe mental problem.
Geoff will require the enhanced care plan because he already has a severe mental problem. This means he will have multiple care needs to be observed and thus requires inter -agency coordination. The patients involved in the enhanced care plan are in contact with different agencies due to their multiple needs. Geoff requires intensive frequent interventions because he presents a notable risk to himself and others due to the complications of the mental illness. This is evidenced by the fact that he is already being overactive as it is said that he breaks window glasses at night. Geoff is also likely to disengage form service in an unplanned manner as he is experiencing loss of concentration. The mental worker dealing with this case should know that the cares plans may not necessary indicate the genuine severity at the time of making the useful decision and the cases should be considered. After taking all factors into considering each case is dealt with differently since the transformation of needs may result in shifting from one level to the other.
The copies of the prepared care plan distributed to the client care coordinator and all the other participants involved (Sallah D, 2006).
Bearing the fact that Geoff is having social needs, then the health worker will need to incorporate a social services care plan in the care plan.A social services care plan provides services for its clients who have physical, learning disability, or sensory. The latter will provide for the following services to both Geoff and his parents; information on the management of Geoff in their own home, specialist advisory information, dietary advice and information about other organizations that are of help to them.
Benefits associated with the Care Programme Approach
The care program-approach model has several advantages attached to it. The first one is that it ensures the making of clinical decisions, which are explicit. Geoff will benefit from an explicit clinical decision of the mental health worker by recovering faster. Secondly, the model will ensure that Geoff’s observed risks including over activity and intrusive thoughts are recorded.Thirdly; it will make sure that Geoff receives quality treatment due to the liaising of professionals. This is because the psychotherapists are invited to multidisplinary meetings where they interact with one another. Moreover, this model increases the chances of Geoff and his parents of clients keeping in contact with the service providers and serves as a vital administrative tool in the CPA process. Lastly, the model has clearly marked staff roles where one is able to do a thorough work.
Limitations of the Care Programme Approach
Despite the benefits that Geoff will enjoy from this model, there are some limitations of which will affect him. They include spending some time in filling forms, he may not find pleasant. The model is also associated with confidentiality problems due to centralized data storage which he may have. In addition, the assessment questions addressed to the patient in this case Geoff may send a wrong message to him. Some people also have the view that this model conflicts the philosophy of care giving.
KGV assessment tool
During the interviewing process the mental health worker will utilize KGV assessment tool. This is an assessment tool used to support the recovery of people with psychosis. Some questions will be addressed to both Geoff and his parents who may include the following; some of the questions addressed to (Geoff) include:
- What are thoughts that invade his mind about?
- Why does he find it difficult to concentrate? What does he think about?
- Why he does not want to interact with other people? Do they harm him?
- Is there a member of his family who suffers from the same disease?
- Does any thing stress him?
- If so, what is it?
During this interviewing process, the professional would assess the symptoms that Geoff is experiencing to find a comprehensive insight of his experiences and identify the problematic areas. The mental health professional worker will focus on fourteen items that the KGV assessment tool recommends. These include Anxiety, Depression, Suicidal thoughts and behaviour,Elevated mood, Hallucinations, Delusions, Flattened affect ,Incongruous affect, Over activity, Psychomotor retardation, Abnormal speech and Poverty of speech, Abnormal movements and Accuracy of assessment. The first six are ratings of severity and their rating is done on a five rating scale. Out of the six Geoff is experiencing anxiety, hallucinations, over activity and change of behavior. The remaining eight are observational items that the health worker must rate during the interviewing process.
The health worker should attempt to follow the laid down guidelines and make detailed notes of the findings provided by Geoff in his responses. Then completed ratings of severity of the symptoms will be made independently after completing the interview. Care should be taken not to alter ratings that have been entered incorrectly. During the rating process, the researcher should refer to the laid down guidelines in the handbook. When the health worker finds rating difficult because of lack of information, he/she should rate conservatively excluding the suicidal symptom. Properly trained Raters in people with psychosis develop it for utilization. The rate at which reports are noted and recorded. The aims of the assessment include symptom identification and naming the experiences associated with schizophrenia, measuring the severity of the experiences, focusing on certain specific experiences to solve them and using the principals of cognitive behavioral therapy for analysis (Sallah, D, 2006).
Then the Geoff’s parents need to be educated on how to cope and reduce stress in the family setting. This is because stress is one of the aggravating factors of schizophrenia. Education of Geoff’s parents also aids in problem solving since they will be involved in giving care to him at home. Again if one of the factors affecting Geoff lies in the family setup, then it will be addressed by educating them on stress management. The family intervention used as an adjunct treatment in community mental health services has some benefits to Geoff and any other patient involved in this program. First there is marked reduction in the relapse rates of the patient and enhancement of the patient’s quality of life. The social functioning is also improvement of the relationship of the family and the social environment is also achieved. All these factors are essential in recovery of the patient.
After education, Geoff’s parents an antipsychotic medication/ pharmacological intervention will be included. Some drugs will be administered to Geoff by the mental health practitioner.these drugs aim only to reduce the symptoms associated with schizophrenia. They enable a person to function well and carry out his normal duties as normal. Geoff and his parents will be educated on the dosages of the drugs that will be administered to him. The mental health practitioner will make the choice of the drugs since this depends on a particular patient. Some of the effective drugs that the practitioner drugs can offer include clozapine Newer antipsychotic drugs including risperidone, aripiprazole, quetiapine (Seroquel), and olanzapine can also be administered due to their safety regarding when it comes to tardive dyskinesia.Geoff will also be administered with an anti depressive medication as the sleeping problem he is experiencing may be due to depression.
The mental health worker need to explain to Geoff and his parents that even with continued drug taking some patients still experience relapses. However, this should not mean a discontinuity of the dosage as this result in even higher occurrences of relapses. The mental health worker will then draft a treatment plan for Geoff and explain to him the importance of adhering to it. This would mean adhering to the correct dosage and frequency every day.Geoff and his parents will be offered an appointment for follow-up purposes. This is important to review the Geoff’s progress of the after a period. A medication calendar can then be offered to Geoff and his parents to enhance adherence to the medication offered. Lastly, the health worker would give these parents a responsibility of observing that Geoff takes his oral medication every day. The involved Practitioner should not forget to ask the parents how he is progressing from time to time.
Advantages of KGV Assessment Tool
There are several advantages of K.G.V (M) assessment tool include; first, the tool proves to be relatively easy in obtaining good levels of agreement in experienced groups. In addition, Geoff will take a relatively short training period compared to other assessment measures for example, B.P.R.S. Moreover, the patient administration time is also short hence capturing a good percentage of the patients participation.Lastly,the sub scales involved in the KGV(M) tool give references of where the mental health professional should assess further.as such this tool is relatively thorough in its own approach. All these have an overall effect of ensuring Geoff’s quick recovery. It is also sensitive to change over a period of time.
Disadvantages of KGV Assessment Tool
Despite the cited advantages of this assessment tool, KGV is associated with several limitations including: it is a symptomal approach where the presence or absence of a symptom is not helpful in intervention. Again, the presence of a symptom only aids diagnostic classification but not intervention process. This will adversely affect Geoff because it alludes to the fact that the symptoms he is experiencing may not necessarily guide the intervention to be used. The other problem is this assessment process is too broad for provision of information for a formulation. Lastly, it only offers an outline formulation (Barker, 2001).
Role of enhanced engagement skills
The role of enhanced engagement skills cannot be overlooked in schizophrenia management. The mental health nurse must be adequately trained so as to be competent. The engagement skills of the mental health worker will enable ensure that Geoff is actively involved during the interview process and that the required information is uncovered from him. Enhanced skills program for health workers was developed to meet certain educational needs of those mental health professionals. It entails two sections. The first section focuses on engagement skills and necessity of positive attitude in therapeutic work (Gamble & Brennan 2006). Geoff’s case needs a positive minded professional mental health worker who will feed the same virtue into him. The nurses’ training on the utilization of functional approaches for making problem and goal statements when dealing with Geoff. They also also engaged in use of various assessment tools and models. The second section introduces them to the main characteristics of cognitive-behavioral therapy and application of its techniques. The techniques introduced to the nurses are agenda setting, monitoring of behavior of patients and their cognition besides structure of working.
The Multidisciplinary Team (MDT)
The successful intervention of a schizophrenia case requires a multidisplinary approach. It requires a multi disciplinary team (MDT) to achieve the ultimate goal of recovery. MDT is defined as a group of practitioners having a large variety of professional training who oftenly meet to offer a service to clients. In the case of mental health environment MDT comprises psychologists, occupational therapists, nurses, and clinical psychologists. Other therapists such as dieticians, psychotherapist, counselors and social workers are also involved in patient’s care. The members of these team works together with a similar objective to accomplish a positive patient outcome (Barker P, 2008).
The MDT will have to consider Geoff’s current state and if the change he experiences in lifestyle would be of benefit to him in the long-term. The advantage that Geoff will reap from the multidisciplinary team approach is that a complete view of his possible problems will be obtained. This is achieved by collecting information from Geoff by the team of the professionals.this will ensure that a correct range of treatment is offered. (Onyett, 2003). Despite these benefits, one major disadvantages of this approach is that they work personally, thus there is possibility of lack of direction and unclear goals besides poor leader ship (Darby et al, 1999) if good communication is not achieved. This would affect the care that Geoff receives and probably delay his recovery.
The MDT involvement is vital because people with mental health problems have several needs and so require a diverse pool of expertise to meet these needs. Geoff has several requirements which vary from one another and therefore the MDT approach will be of great help to him. These needs range from social needs such as the need for reconnecting to people, pharmacological needs, and nutritional needs. The role of all these members is vital in the recovery of a patient and is outlined below;
Clinical psychologist
The Clinical psychologist discusses with the Geoff his medical problems and the prescription given to him explaining the importance of adhering to it.
Psychotherapist
Psychotherapist-this professional is responsible for coming up with Geoff’s prescription and the correct dosage. He will give him the neuroleptic drugs and explain the correct dosages to him.
Dietician
A well balanced diet is required for the medications of schizophrenia to effectively work. Some foods may also interact adversely with some of these medications and thus the guidance of a dietician may be required.The dietician also explains the risk of poor diet to the patient.
Occupational therapist
The services of an occupational therapist are also vital in the management of schizophrenia. The main role of this professional is to help individuals with daily tasks, promoting and maintaining their independence. This goes a long way in reducing the risk of relapse (Burke, 2006).
Psychiatrist
The role of a psychiatrist is to discuss with the client his experiences and try to provide a better overlook of daily and overall life. This is achieved through an open discussion with the patient.
Social worker
The main role of a social worker is to help the patient to cope with the environmental aspect of life and participate in the community. Apart from this, it is his role to provide supportive information to the patients family members (Barker P, 2004).
Conclusion
In conclusion, when all the approaches discussed above are applied in solving Geoff’s problem, he will definitely recover quickly. It should be noted that the multidisciplinary team approach is key for success. Besides the efforts of the health care professionals, Geoff will also be expected to adhere to advice offered to him during the care plan process. His parents are also not left out since they will be expected to offer any form of help that Geoff may require from them. This ranges from ensuring that he adheres to the prescribed dose to providing balanced meals to him. The successful intervention of a schizophrenia case requires a multidisplinary approach. This ranges from interventions such as antipsychotic medications, cognitive behavioral therapy (CBT), and family management. All these interventions are intertwined to work together for the overall benefit of the patient.
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