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 person's sense
of self. It changes a person's 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, 1996a, 1996b, Fontaine
& Fletcher, 1999). A psychiatrist's 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, 1996a). 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 client's
assessment is an ever-changing evaluation of how treatments are working
(Anonymous, 1996b). 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 it's 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, (1996b). 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 nurse's 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, 1996a).BibliographySchizophrenia: knowledge for practice. Nursing Times, 92(30), 1-4. Anonymous
(1996b). 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 (4th ed., pp. 281-309). Redwood City, CA: Addison-Wesley.