A registered nurse who works in an acute inpatient mental healthcare facility.
The Assessment folder on NSG3MHI HMS has a patient handover resource. You will need to select a patient.
Please carefully review the information that has been given to you about your patient. Address the following concerns.
These are the most pressing issues that concern their care.
Please provide a summary about the person’s diagnosis.
Identify the symptoms and signs of mental illness in your patients.
Your patient’s legal status should be highlighted and explained to you.
Highlight any relevant issues.
Discuss the medication that was prescribed to you.
Discuss side effects, dosage, and use.
Provide information about your patient’s physical well-being.
Highlight any future or current concerns.
Discuss with your patient the risk assessment.
Identify any problems.
You should consider any possible stigma and discrimination that might impact the patient’s recovery.
Your patients’ social welfare.
Any potential problems should be highlighted.
Discuss how you can support your patients’ family members and/or caregivers.
Signs and symptoms of the patient’s diagnosed illness
Dennis Thompson, a researcher describes Schizophrenia in terms of a “chronic but treatable disease.” Thompson writes in the Web Med Journal that Schizophrenia is often manifested in ‘delusions and grandeur. This refers to a patient’s false beliefs about their personal importance.
For instance, he may believe that he’s “a famous political leader” and no amount reasoning would convince him otherwise. (Lieberman, Murray, 2012).
The writer cited the US National Institute of Mental Heath and stated that some patients have delusions of persecution.
Some of these symptoms were seen in Carolyne Smith (Killackey (2014).
She was paranoid, restless, and aggressive towards others.
It was the medical staff who suffered most. She didn’t cooperate or follow instructions.
Killackey, 2014: She was extremely irritable and disorganized in thought and action.
Her bed was not made and her personal items were scattered.
The patient was clearly deluded. She repeatedly shouted, claiming that “the water on top” would flood the room.
The Mayo Clinic journal, ‘Patient Care and Health Information’, describes the symptoms of schizophrenia in adolescents.
It stated that the most affected teenagers tend not to stay close to their families and friends.
This is often followed by a drop in performance in school.
Many children suffer from depression, irritability, insomnia and other mood disorders (Andreasen 2010).
Children in such advanced situations may exhibit suicidal or suicidal behavior.
Carolyne displayed most of these symptoms even though she wasn’t a child.
The Health Line Newsletter has more information about this topic in an issue.
Timothy J. Legg (PhD) describes schizophrenia symptoms including disorientation and confusion, general dysfunctionality, less desire to socialize, less self-care, dressing and grooming problems, difficulty in remembering and thinking, and episodes of stupor.
It was remarkable that Carolyne showed almost all the symptoms of psychosis.
Some symptoms of schizophrenia can also be associated with certain factors.
One Mayo Clinic journal lists a few symptoms that can occur in patients who misuse drugs and alcohol like Carolyne.
These symptoms include paranoia and hallucinations as well as muscle problems, reduced inhibitions, chills and sweating, and muscle problems.
The 1995 journal Behave Net, which was updated in 2017, lists other symptoms that can be recognized in patients with schizophrenia.
These symptoms may include speech incoherence and derailment due to disturbed thought patterns, social or occupational dysfunction, and mood disorders.
Carolyne shared her concerns and suggested that at least ninety-percent could have been present in her case. “Mental Fitness Tips- Canadian Mental Health Association”, 2017.
The journal recommended that diagnostic physicians ensure that the majority of these symptoms occurred over a period of six months or more.
This will help to rule out other disorders.
Carolyne’s positive symptoms, such as delusion and hallucinations, were able to be overcome (Kelly (2008).
The Journal states that although positive symptoms may not always be true, they are a sign of positive brain activity and encourage treatment.
The Patient’s Legal Status and Implications on Provision of Health Care
According to Victoria Legal Aid (Lawyers and Legal Services), patients’ rights are vital and must be respected by medical personnel when they provide care.
The following are the fundamental rights of patients as outlined by the self-help guide to Mental Health Act, first published in 1989, and then updated in 2010.
No patient should be treated differently.
All persons are equal before the law.
No one should be denied the right of life.
All people should not be subjected to inhumane or cruel treatment.
Patient has freedom of movement
Protection of reputation and privacy
Freedom of religion and thought.
You can enjoy liberty and security.
The right of fair hearing
Except for exceptional circumstances, patients should not be kept in detention longer than three month (Nelson (2009)).
This might be because the patient is threatening peace or social order, or the symptoms of the illness are not stopping.
It should also be obvious that the facility can meet the patient’s needs.
These restrictions have an obvious impact on the delivery and quality care provided to patients.
Although health care workers may feel that patients require more time to be treated in a facility, they also have to comply with legal restrictions.
Prescribed Medication: Use, Dosage, Side Effects
Information was provided by the ‘Oregon Am Farm Physician’ journal, which was published in 2010.
John Muen (assistant professor of Family Medicine) wrote about side effects of antipsychotic medication in this publication (“Mental Fitness Tips, Canadian Mental Health Association”, 2017,).
Common side effects include: seizures, hypotension, sedation and dry mouth.
The following medication was prescribed for the patient and was administered: Olanzapine. It was prescribed to address the patient’s drinking problems (Boer Westenberg & Praag 2010, 2010).
The recommended dosage was increased from 10Mg to 10Mg.
For anxiety attacks, Diazepam PRN was recommended.
Olanzapine: Adults were prescribed 10mg of Olanzapine two times daily.
This was despite expected side-effects such as increased appetite and weight gain.
The aim of diazepam administration was to reduce anxiety symptoms.
You could take 10mg twice daily orally for adults.
Expected side effects included confusion, muscle twitching or tremor, loss bladder control, drowsiness, tiredness, and muscle twitching.
The Patient’s physical and mental well-being; Current, Future and Potential Concerns
The journal Oxford Academic (2014) stated that schizophrenia sufferers were at higher risk of dying from heart disease or succumbing prematurely to other diseases than the general population.
Patients should join support groups to improve their well-being.
They lived a unhealthy lifestyle.
They had an unhealthy lifestyle. It was found that more physical activity led to lower mortality rates and had a positive impact upon mental health as well as the quality of their lives.
Patients were encouraged to exercise by their doctors.
Carolyne struggled with her physical fitness.
The patient had issues with her physical condition.
A plan was needed to help the patient.
These additional reasons included chronic fatigue, fear of social activities and common conditions such as lung disease.
The Centre for Addiction and Mental Health Journal provides timely counseling for schizophrenic patients.
The journal stated that medical and technical advancements have made it possible to provide better care and improved outcomes for patients with schizophrenia.
The Journal stated that schizophrenia patients may respond well to treatment. Some are able to return to their normal jobs or study, while others cannot.
They should consider vocational rehabilitation to regain their skills and confidence (Dickerson Sommerville Origoni Ringel & Parente (2012)).
They will also be able to find alternative occupations that best suit their needs.
Health Central, a journal that examines the effects of schizophrenia treatment on patients, stated that many sufferers have to face challenges every day (“NIMH >> Schizophrenia”, 2017.
These problems include unusual eating patterns and sleep patterns which, in turn, can lead to obesity and issues with physical fitness.
The report also highlighted other problems that patients may face.
Others may have difficulty with slowing down or strange posturing.
According to the publication many victims must deal with conditions such as depression, anxiety and moodiness.
The victim may also be affected by their natural senses and thought patterns, as well as their overall physical behaviour.
Patients with schizophrenia should take care of their mental health.
The case of Carolyne Smith was helped by the information gathered from this source (“DSM-5”, 2017.
The patient shared some childhood memories that suggested she may be predisposed to her current schizophrenic disorder.
Carolyne described a motor impairment and intermittent verbal memory deficits in childhood.
Risk Assessment of the Patient’s Health and Other Vital Issues
The Cochrane Review, which is a journal of The Cochrane Library defines risk assessment to be “the process by identifying people at greatest risk of perpetrating violence and aggression (Chung (2008)).”
After sampling some of the most aggressive patients admitted to hospitals, the study showed that many were schizophrenic.
According to the Mulidharan 2006 study, this situation put medical staff at great risk.
In order to keep violent patients under control, it was sometimes necessary to take extreme measures (Lawrie (2014)
While some of these actions are illegal, they are necessary.
A similar study was conducted in 2001 by Philip J. Candilis MD.
The scholar discovered that 10 to 33 percent had been attacked by violent patients.
The scholar found that 90 percent of violent patients showed suicidal tendencies.
Both the age at which the illness began and the upbringing of the patient were key factors.
The Impact of Stigma and Discrimination on Patient Recovery
The British Journal of Psychiatry (2007) published a study of stigmatization in psychotic patients.
It was carried out in Tanzania.
It defined stigma as “problems in knowledge, ignorance or behaviour and attitudes” (Weinberger & Harrison 2010).
Perceived public shame (stigma originating in the patient herself or others)
Personal stigma (individual attitudes toward stigmatised groups).
Self-stigma (that which is endorsed personally by the patient).
Attitudes towards helping others (affecting patients’ likelihood of seeking help).
Carolyne experienced stigma at work, in her family and in her community (“DSM-5”, 2017).
It was especially difficult to feel empathy and understanding among family members.
She felt discriminated against by workers who were offered a pay raise.
A piece on this topic was published by ‘The Schizophrenia Bulletin’ (2010).
Faith B. Dickerson, the author of the article, wrote that there were common situations in which patients experience stigma. These included: Denial of treatment because of lack of insurance coverage; Exclusion from volunteer or social activities; Unsupportive coworkers and supervisors; and Turn-down for health insurance.
Social Welfare of the Patient and Related Significant Issues
According to The Journal, (2016) ‘The Conversation-Africa Pilot’, Schizophrenia’s impact is enormous.
Finding a job is the top priority for patients suffering from psychotic disorders like schizophrenia, according to the journal.
Kevin Andrews, a Minister in Social Welfare, said that ‘work the best form of welfare’.
This paper showed that patients must be able to achieve both economic independence as well as social functionality.
Similar findings were reported by ‘The Psychiatric Service’ Journal Volume 51 No.2 in 2000.
It called government support for patients a ‘good safety network’ and noted that half the patients were socially isolated while a third had lost their jobs (Mueser, Jeste, 2011).
It concluded that many psychiatric sufferers could be integrated into society if given the right support.
Carolyne was self-sufficient but would require assistance to deal with job dynamics.
Samantha Gluck (2016) offered suggestions to help families that are afflicted.
These suggestions will be helpful to Carolyne and her family as they cope with her illness.
Ms. Gluck explained that caregivers must allow the patient some independence in daily life.
The caregiver will cease to perform all tasks for the patient.
She suggested that the patient’s dignity would increase if there was some freedom (Crane, McDonough, 2014).
According to the researcher (Tsuang Faraone & Glatt 2011, 2011), caregivers should not attempt to explain away paranoias, hallucinations and delusions.
Instead, caregivers should be able to offer support and guidance to the patient.
Caregivers should forgive themselves when they make mistakes. This will help them to stop blaming the patient (Nodgvist 2017).
They need to learn to forgive others, and not just themselves, when they make mistakes.
This is important because it will allow caregivers to love and care for the patient, even if the symptoms are not pleasant (Ando Clement Barley, Thornicroft, & Barley, 2011).
They would not only hate the disease, but they would also love the patient.
Ms. Gluck said that it was harmful to feel shame for having a schizophrenic person at home.
Instead, caregivers should accept and view the illness as any other disease.
A similar publication, “Self-Help Tools and Tips to Patients”, also contains practical suggestions (Mahoney (2011)).
It urges patients to actively participate in the treatment program as laid out by doctors (Nodgvist 2017,).
Patients are encouraged to obtain self-education about their illness, treatment and warning signs.
She should develop a relationship of trust with her doctor/therapist (Ando Clement Barley, Thornicroft, 2011).
The patient is advised not to exceed the prescribed dosage.
In order to be successful in turbulent times, it is recommended that the patient create reminder lists on their medication schedule (Szasz 2010).
This can be either a digital reminder, or a computer-based one.
Patients who have a history of drug or alcohol addiction should seek professional help.
Walsh (2011) suggests that caregivers recognize specific warning signs of danger in schizophrenic patients. This could include suicidal tendencies or behaviours, self injury, increased anxiety disorders and financial problems directly related to such habits.
Finally, the journal schizophrenia.
Com provides caregivers with more information.
It encourages caregivers to take better care of their patients.
It cautions against self neglect (Alanen 2010).
The Journal suggests that caregivers and patients’ needs may not always be the most important.
Care providers should ensure that the patient’s safety is protected in cases of violent episodes.
It is important that caregivers remember to use humor as a natural remedy for difficult situations such as caring for the chronically ill.
Schizophrenia. Its history and treatment.
London: Karnac Books.
A systematic review on the simulation of hallucinations to lower schizophrenia stigma.
Retrieved on 18 April 2017.
Schizophrenia: Positive symptoms and syndromes.
Neurobiology of schizophrenia: New advances
Stories for children.
New York, NY : iUniverse.
Oxford: OUP Oxford.
Living with Schizophrenia – Coping, Resilience and Purpose.
Oral History Review.
Coping with schizophrenia.
Welfare to Work: A Different Approach for People with Mental Illness.
Schizophrenia: Neuroimaging and neuroscience.
Comprehensive treatment of schizophrenia: A textbook on clinical management.
Oxford: Oxford University Press.
Clinical handbook for schizophrenia.
Bottom of the Form
Schizophrenia – The bearded lady illness.
Mental Fitness Tips – Canadian Mental Health Association.
Canadian Mental Health Association.
Cognitive behavioural therapy for schizophrenia: The practice manual.
Schizophrenia: Symptoms. Causes. And Treatments.
Medical News Today.
Schizophrenia and Other Psychotic Disorders – Behavenet.
Schizophrenia is the sacred symbol of psychiatry.
Syracuse University Press. Syracuse N.Y.
Oxford University Press.
Schizophrenia: Clear talk for family members and friends.
New York: Morrow.
New York, NY – John Wiley & Sons.