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Schizophrenia

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Schizophrenia is the most common form of psychotic illness with a markedly consistent prevalence rate throughout the world of just under one per cent. This serious mental disease needs a suitable treatment and human understanding. The nurse must be tolerant and accurate in order not to hurt a patient.

For a diagnosis of schizophrenia to be made, the individual must have continuous signs of profound break with the reality and evidence of the fragmentation (disorganization) of personality for at least six months during some time in his or her life. This six-month period must include at least one phase when there are symptoms of hallucinations, delusions or marked thought disorders.

Schizophrenia may happen underhand, when a person becomes gradually more self-contained and introverted, loses his or her inspiration and drive. The changes could not be detected for months or years, until they become apparent and obvious that the person suffers from delusions (fake ideas which cannot meet the reasoned argument) or hallucinations (a sensory experience in the unavailability of external stimulus). In some other instances the disease comes on more unexpectedly, mostly as reaction to external stress.

Delusions may take a variety of forms, ranging from single ideas, such as the belief that one is Jesus Christ or Napoleon, to elaborating delusional systems in which special significance is attached to everyday objects or events. In paranoid schizophrenia, the disease is suppressed by mania of persecution, grandeur or jealousy.

Hallucinations are frequently experienced as voices that comment on behavior or thoughts, occasionally in the form of conversations in which the sufferer is referred to as he or she. This kind of aural third person hallucination takes place exceptionally in schizophrenia. The true visual hallucinations are rare in Western cultures, but distortions of visual perception do occur; faces or objects may look sharper or change their shape. Bodily sensations, such as tingling, are common.

Disordered thinking is reflected in the muddled and disjointed speech. The disturbance of association results in the schizophrenic jumping from one subject to another, seemingly unrelated one.

The inability to think in abstractions often leads to bizarre responses to questions. In the rare form of schizophrenia catatonia may occur. Sufferers of catatonic schizophrenia adopt the prolonged rigid postures and engage in the outbursts of repeated movement. Symptoms of manic-depressive illness may accompany schizophrenia, especially in the early stages. However, as the illness progresses, emotions usually become severely blunted, there is increasing detachment from other people and a loss of interest in hobbies or occupations. Behavior becomes more eccentric and self-neglect is common.

Schizophrenia may be caused by different factors. It may have the hereditary component. The inherited genes make a person vulnerable to the disease. Often there may be several members of the family suffering from it. Therefore, not every person is genetically predisposed to schizophrenia has the disease developed during his or her life. A variety of environmental factors are involved in the illness course. They may be: physical or sexual abuse in the childhood; early parental loss or separation; low level of oxygen during the birth; antenatal susceptibility to a viral infection; exposure to a virus during infancy. If symptoms of the disease are not treated well or are simply ignored, the effects of schizophrenia may be dangerous not only for patients but also for their families and surrounding. This condition affects social relationships because ill people prefer isolation to communication. A person may also be suspicious of his friends and parents as a result of paranoia. Schizophrenia also has great effect on the daily activities: it becomes difficult to maintain everyday tasks and overcome other social difficulties. Disorganized thoughts don’t allow a person doing such things as eating, bathing and shopping. Schizophrenics frequently become alcohol or drug addicted because a lot of medicine used for their treatment have damaging effects.

The main form of treatment embraces antipsychotic drugs, like haloperidol, which reduces the symptoms and makes the person more amenable to psychotherapy. Some antipsychotic drugs can be given as long-acting depot injections. Drug treatment is effective in suppressing more obvious symptoms of schizophrenia, such as tremor and hallucinations (abnormal muscular movements), but may have side-effects, particularly dyskinesia.

Schizophrenics may be treated initially in the hospital environment. Once major symptoms are controlled, most sufferers return to the community. Adequate provision of the day centers, suitable housing and vocational opportunities can help to control symptoms to improve the sufferer's self-reliance, to prevent relapses and reduce the stigma attached to the mental illness. If the patient is to live at home, the family needs to be provided with support and guidance, since some schizophrenics may be difficult to live with. A certain number of them suffer a relapse, especially if they do not take their medicines on a regular basis.

The first step in the way of nursing management of schizophrenia is assessment of the client’s mood and cognitive state. The signs typical for this disease are the following: insomnia or oversleeping, absence of expression of feelings, controversial speech and thoughts, referential and odd ideas, the attacks of hallucinations, disorganized speech, apathy, delusions and emotional flatness. Medical workers should keep a patient away from stress for avoiding relapse. This state can cause resistance, withdrawal, psychotic symptoms and preoccupation of the client.

The next phase in nursing is assessing the potential for violence by providing a range of therapies. They may include: ultimate social isolation, paranoia, experience of committing suicide, a kind of hallucinations telling a patient to act in the violent way, noncompliance of medication, attacks of uncontrolled anger, suspiciousness.

The kind of help on the next step is providing social support. Network and social support are critical parts of the nursing management of schizophrenia. The nurse's responsibility includes assessing the knowledge of treatment, relapses, biological basis of the disease.

Brain disorders like schizophrenia can be a challenge not only for a patient or medics but also for a family. It is very important to have an opportunity to share your problem with other people. Social resources allow cooperating and finding better treatment strategies. National Mental Health offices are inclined to help individuals in achieving the government services.

Different organizations, like National Alliance for Mentally Ill, provide family training programs for those who suffer from schizophrenia and other mental diseases. There are also non-profit societies whose trained volunteers help adults and children receive proper mental health treatment. There are over 100 programs such as Compeer in different countries: the USA, Australia, Canada, etc. These network resources maintain various educational methods and treatment support, publish information about update researches and progressive approaches to mental diseases management.

Although medicaments have improved the perspective for most schizophrenics, insufficient community care often results in the recurrence, negligence, vagabondage or even imprisonment. Often appropriate nursing management and available social help can cope with the disease even more effectively than traditional treatment.

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