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Literature Review: Would the Addition Psycho Education to Medication Management in Q Community Outpatient Setting By a Nurse Practitioner Yield Greater Medication Adherence in Adult Schizophrenic Patients

A new achievement in medical science is the introduction of psycho-education for the people who live with psychological disturbance. This educates and trains patients in regards to various psychological disturbances such as schizophrenia, depression, anxiety, eating disorders, psychotic illness and personality disorders. Psycho-Education also helps in the treatment of physical illness by emphasizing on mental well being and positive thinking. Moreover this education is not only restricted to patient’s but their families as well. As said that mental well-being leads to physical well being as the brain in one’s body controls and operates it. So it is very important to understand and treat the brain and its functions with utmost care.

According to Kelly and Scott (1990) the theory of Psycho-education helps the patient and their families to be well acquainted with the patients’ condition, to understand their illness, strengths, weakness and the short term and long term causes and treatment for a better living. Moreover this theory helps the patient’s and their families to live normal lives, coping up and living with their psychological condition.  One very common Psychological disorder is Schizophrenia. It is a condition of the brain where the patient lacks thought process and is emotionally unresponsive. Patient also suffers from hallucinations, delusions and has disintegrated speech and thinking. People with a condition this way have difficulties coping up with their social and professional life. People suffering from schizophrenia are a danger to them as they often have suicidal feelings submerged within, the society because of their negative yet sudden change in behavior, and barely can sustain basic needs of living.

Dowrick (2000) noted that Schizophrenia in adults is a chronic disorder and the ratio of men suffering from it is more than in women and conditionally more severe in men than women. Individuals suffering from Schizophrenia might see or hear things that don’t have an existence in real life. They speak and express in a confusing manner. Such individuals lose the power of recognition between the real worlds and imagine things that are irrelevant. Such individuals adapt fear and confusion within themselves thus, drawing themselves out from the activities of a daily life and also restrains them to act and behave in a normal way. Hence, according to Hollon, Thase and Markowitz (2003), it becomes difficult for them to move along the norms of the society endangering oneself and the society at large. Their behavior may vary from social withdrawal, hostility, suspiciousness, deterioration of personal hygiene, flat expressionless stare, inability to express sorrow or joy, depression, inappropriate way of laughing or crying, insomnia, hypersomnia, irrational statements, loss of memory, lack of concentration, hyper reaction to criticism etc.

Gutiérrez-Maldonado and Caqueo-Urízar (2007) noted that adding Psycho-education to medication management would yield greater medical adherence in adult schizophrenic patients in a community outpatient setting by a Nurse Practioner as their treatment is very important as Schizophrenia is a very complex psychological disorder that is difficult to diagnose as Psychological experts have not been able to explain the root cause of it.  In such cases Psycho-education helps the patients and their families to be educated about this illness. Moreover addition of Psycho-education to medication management would bring out much better results in regards to a cure for this illness as prescribed medication and its dosages could have side effects on the patient’s emotional responsiveness.

Moreover, according to Larsen (2004), in terms of medication adherence in adult schizophrenic patients most of them have severe memory impairment and cognitive distortions and could even complicate the overall treatment plan as they could require multiple doses a day. The main area of focus of Psycho-education aims at teaching and/or educating the patient to increase his/her knowledge and the proper understanding of his/her illness and treatment respectively. It is proved that a patient with knowledge of his/her illness increases and enables the chances of getting cured faster and also helps in coping up with the medication, therapy and treatment in a much effective way.

Studies Wheeler and Greiner (2003) and Picchioni and Murray (2007) prove that interaction between the patient and the doctor efficiently adds more value to the standard treatment and helps the reduction of possible relapse and hospitalization. Also Psycho-education improves compliances that are followed with medication and non-adherence to medication. It also promotes better social well being with proper functioning of social outcomes. Mostly Psycho-education emphasizes on a group where multiple patients share multiple areas of concern, thus making the schizophrenic platform global and so it can be addressed in a way that becomes more reactive yet informative and helpful for treatment.

According to Hollon, Thase and Markowitz (2003) adult Schizophrenic patients have a very sociodemographic feature that makes their characterization of illness difficult to diagnose, since this is a condition that affects thoughts and behavior and is often termed as a chronic relapsing psychotic illness. These features also include comorbidity and often have side effects of the medicational features. Nearly one out of five patients experiences some of the symptoms. Another 20% experience worse of these symptoms; in the remaining 60%, the symptoms become even more chronic and even leads to hospitalization.

As such, in these cases family administration, support and encouragement is highly recommended. Gutiérrez-Maldonado and Caqueo-Urízar (2007) noted that Psycho-education characterizes treatment with the collaboration of prescribed medication including a systematic study of the relation between the Physician and the patient is intervened by different studies and reinforcement of mental education, skills training, memory enhancement, and anger management. Psychologists encounter Schizophrenic patients quite often and they encourage services that rely less on medicines and more on long-term therapy that includes counseling, advocacy, group discussions, behavioral social skills training, family education, counseling and therapy.

These special trainings come in various forms. According to Larsen (2004) many community based groups conduct informal interactions to help to understand the patient’s unique and specific behavior and implement their skills for overcoming obstacles that interrupt a normal life. Treatment for schizophrenic patients through prescribed medication and therapy only diagnosis and focuses the presence of psychological symptoms and does not necessarily classify the characteristics of social construction of recovery such as hope, faith, belief, self identification, social well being and empowerment.

Over whelming evidence, by Wheeler and Greiner (2003), proves that antipsychotics can be effective for treating certain symptoms of Schizophrenia. This antipsychotic medication needs strict medical adherence as, if not adhered as prescribed; it may increase the risk of a relapse. It is often found that most people suffering from Schizophrenia, medication adherence is often poor and most of them discontinue medication after a short period assuming that it is not required anymore; nonetheless this causes serious consequences. Studies review that approximately one-third of the patients with schizophrenia, suffer from medical non-adherence. These patients also outlook nearly 1-10 days of oral antipsychotic therapy which nearly doubles the risk of hospitalization.

Picchioni and Murray (2007) noted that non-adherence of these medications may increase the risk of hospitalization with a possible relapse due to the gaps in prescribed medication doses. It has also been discovered by researchers that individuals with an education about their illness are less hospitalized than that of individuals who are only on prescribed drugs with non-adherence in regards to it. Another factor that adds to medical non-adherence in regards to schizophrenic patients is that the patients do not attend their appointment with regards to their therapy. Individuals who are not regular and do not keep a track of their outpatient appointments post-hospitalization become non-adherent to prescribed medications and this way it slowly but surely becomes critical in the outcome of Schizophrenia in adults. 

Hollon, Thase and Markowitz (2003) noted that community based outpatient treatment centers offer services to individuals those have issues at adjustment at home, work, society or even more complex psychological disorders such as depression, stress-related conditions, anger, anxiety, loss of memory, diversion of attention etc. Studies have reviewed that the common clinical practice for the treatment of Schizophrenia in Adults were not very effective and Non-adherence to these clinical therapies and prescribed medication increased at an alarming rate. The view of a broader treatment proved successful and an array of support from Community Based Services and Rehabilitation Centers offering a wider and even more effective treatment for the mentally ill started flowing in.

Studies by Larsen (2004), Wheeler and Greiner (2003), and Picchioni and Murray (2007) also reviewed those individuals with the knowledge of their illness yielded greater results in treatment. The demand for more professionals with the knowledge of Psychotic illness increased with Nurse Practioners to broaden their scope of knowledge with Psychiatris Studies.  With a collaboration of Psycho-education and medication management under the supervision of Nurse Practioners proved successful and efficient.

According to Gutiérrez-Maldonado and Caqueo-Urízar (2007), Psycho-education is intervened by the patient’s interaction with their peers and it is proved that this helps individuals and their families to gain a lot of crucial and important information about the illness. This also involves motivation and interpersonal support from peers. Here, a patient is given full opportunity to express thoughts, concerns and raise questions. It is important to make the patient realize that the illness suffered, is worldwide. Psycho-education helps an individual to absorb a lot of information that helps to potentially grow and change and also makes an individual more tolerant in nature.

Psycho-education relates to practical and concrete problem solving issues including social challenges faced everyday that help to develop independent living skills and achieve specific goals. The aim of all of Psychological Disorder treatment and therapeutic intervention lies in the boosting of empowerment of the patient and his/her families. In this intervention an individual is treated with an utmost positive care to encourage and boost one’s confidence in order to face and tackle their Psychological disorder. Psycho-education intends to educated all individuals about their Psychological disorder along with the different other types around.

A comprehension of the background and its available treatment is always very important for an individual. Through this, as per Hollon, Thase and Markowitz (2003), individuals and their families accept the illness and cope with it in a very effective manner. A variety of self-development programs are conducted for the patient and their families such as Behavioral therapy, Problem-Solving training, Communication training and Family therapy etc. There is a huge relation in the collaboration of medicines, Therapy and Psycho education and proven to be effective due to the fact that medicines such as Antipsychotic drugs help to reduce Neuro-functional disorders that results in formation of disciplined orders and understanding and Psycho-educational therapies helps in coping up strategies for a normal living.

According to Picchioni and Murray (2007), Psycho-education as an addition to medication management is a much better way of monitoring a patient’s well being with proper scheduling of medication by avoiding drug interactions and introduction to general prescribed medication. Medication management aims at appropriate use of medicines and drugs that would not cause complications in the longer run. A collaboration of Psycho-education with Medication management would introduce various support and care from individuals, the community, psychiatrists, social workers and experts. A community outpatient uses day centers, hospitals and rehabilitation centers to refer to different Psychological professionals to cure their psychological illness.

Such is a success, Wheeler and Greiner (2003) notes, if Psycho-education is introduced in a community outpatient setting with help from a Nurse Practioner, as a Nurse Practioner can treat physical and mental conditions through various methods of additional education and training through comprehending the patient’s history, by advising physical examination and various tests. The Nurse Practioner can also diagnose and then provide appropriate treatment for the patient which includes prescribing medication. A Nurse Practioner can yield much better results with the help of Psycho-education than of a simple medication adherence as it only monitors the course of therapy with regards to medicines, its prescription, discontinuation and proper dose of the medicine whereas Psycho-education refers to educate and aware the patient and their families about the illness. This helps in a greater understanding of the situation and to deal with it accordingly in alliance with medication. As mentioned that it aims at the psychological well being of a person that builds the ambience of living.

Since a Nurse Practioner also serves as a primary health provider, it would yield in a greater result if Psycho-education is added to medication management. The main focus of this addition is individual care of the condition and effects of the patient’s illness. According to Larsen (2004) educating patients about their health is very important and psycho-education helps and encourages them to make choices for a healthy living and to prioritize well being. There are different aspects of Psycho-educational programs and they have different characteristics depending upon the type of psychological disorder. Most of the individuals who suffer from schizophrenia, also suffer from diversion of attention, lack of concentration and memory loss.

According to Gutiérrez-Maldonado and Caqueo-Urízar (2007) Psycho-education significantly highlights the practice, feedback, presentation and discussion to enhance the strength of these problems. A Nurse Practioner can yield greater medical adherence in regards to a community outpatient setting in adult schizophrenic patients as the Nurse Practioners’ role is broad and deals with different mental health issues at outpatient clinics, primary care units, private therapy practices, community health centers and hospitals. A Nurse Practioner also specializes on focusing on genetic psychiatry to understand the history of illness and to conduct various physical and psychological tests.

Hollon, Thase and Markowitz (2003) noted that a Nurse Practioner has a proven role in the treatment of chronic schizophrenia with anti psychotic medication and remedial approaches such as training, exercise, educating of residual symptoms. There is also evidence about Psychiatric Nurse Practioners in the community and their effectiveness in regards to supervision of schizophrenic patients.  Many Nurse Practioners combine therapy and treatment in an assertive community program that aims to reduce relapse and hospitalization. The techniques include developing trust; normalizing, enhancing the skills to coping with strategy, practical theory and reality testing, work along dysfunctional affective and behavioral attitude towards psychotic illness. This not only helps in an enhanced response to the therapy but also yield results faster.

Langdon (1994) noted that the use of Psycho-education and medication together aims at a higher recovery rate of patients suffering from Adult Schizophrenia with a Nurse Practioner being an active part of the recovery process as Nurse Practioners are highly trained professional in the field of both physical and mental health. Psychiatric Nurse Practioners are well trained in the medication management of Schizophrenic Patients. Many Psycho-educational professionals and groups have proved to bring dynamic effect in behavioral changes in the case of acute and post-acute adult schizophrenic patients. This is one of the major reasons Psycho-education is derived as a modern tool for a useful collaboration of bringing out the potential of independency within the individuals and their families. This also forecasts the future of professional constituency for Psychological disorders as well as it will open up arrays into specific form of Psychotherapy.

Psycho-education, in accordance to Gruber (2002), in the form of an obligatory-exercise program, should be made available to all patients suffering from a schizophrenic disorder and their families. Psycho-education goes deep down into current conceptions, methods and practice. Carefully, under the support, supervision and accompaniment by a Nurse Practioner, the empathic and socially enduring therapeutic attempt must be strong, stable and sustainable, despite altering the ambience around. With such an approach, psychological principles and standardized procedures must be valid while interacting with an adult schizophrenic patient. It is also very important to keep in mind that the patients with Psychological disorder such as Schizophrenia may behave and or react unexpected with an illogical reaction, which could be due to the altered psychological state of mind of the surrounding ambience.

According to Baldo (1993), introduction of Psycho-education does not intend to stop or challenge the continuation of other behavioural therapy when dealing with Psychological Illness and in this case Adult Schizophrenic Patients. It is a subsequent and complementary strategy of treatment where not only the patients, but their families and relatives too which is optimal in respect to their illness. Psycho-education sets general courses that will yield greater and higher success rates in the treatment that will help in long-term coping and adjustments. With the help of Nurse Practioners who are well-established professionals, it is absolutely possible to draw out a successful concept which shelters the different and specific needs of the adult schizophrenic patients and at the same time restoring their resources.

Nathan and Gorman (1998) noted that the addition of Psycho-education to medication management in community outpatient’s settings by a Nurse Practioner and its effectiveness with that of yielding greater medication adherence in adult schizophrenic patients would definitely become a global concept of treatment in many hospitals, rehabilitation centres and clinics. As far as its research goes, there is a huge amount of proven studies done which proves the effectiveness of the concept of Psycho-education with the combination of antipsychotic drugs in the treatment of Schizophrenia in adults.

A greater result was even proved and shown with regards to medical adherence in schizophrenic patients with regular visits under the supervision of Psychiatric Nurse Practioners.  A greater difference can be yielded out if Psycho-education is introduced with regards to the treatment of all Psychological disorders. This also helps to create a mass awareness of the existence of such psychological disorders and the proper attitude to produce towards an individual suffering, moreover giving an effective social boost that helps an individual to cope easily and to carry on with a normal life.

References

Baldo, J. (1993). Selective attention in patients with schizophrenia and non-schizophrenic subjects. Berkeley: University of California.

Dowrick, C. (2000). Problem Solving Treatment And Group Psychoeducation For Depression: Multicentre Randomised Controlled Trial. British Medical Journal, 321(7274), 1450-1454.

Gruber, SA. (2002). Stroop performance in schizophrenic and bipolar patients: an fMRI study. New York: Tufts University.

Gutiérrez-Maldonado, J., and Caqueo-Urízar, A. (2007). Effectiveness of a Psycho-Educational Intervention for Reducing Burden in Latin American Families of Patients with Schizophrenia. Quality of Life Research, 16(5), 739-747.

Hollon, SD., Thase, ME., and Markowitz, JC. (2003). Treatment and Prevention of Depression. Psychological Science in the Public Interest, 3(2), 39-77.

Kelly, G., and Scott, JE. (1990). Medication Compliance and Health Education among Outpatients with Chronic Mental Disorders. Medical Care, 28(12), 1181-1197.

Langdon, R. (1994). Schizophrenic symptoms: dissociable deficits of self/other awareness in the normal cognitive system of consciousness. Boston: Macquarie University.

Larsen, JA. (2004). Finding Meaning in First Episode Psychosis: Experience, Agency, and the Cultural Repertoire. Medical Anthropology Quarterly New Series, 18(4), 447-471.

Nathan, P., and Gorman, J., (1998).  A guide to treatments that work. London: Oxford University Press.

Picchioni, M.M and Murray, R.M. (2007). Schizophrenia. British Medical Journal, 335(7610) 91-95.

Wheeler, K., and Greiner, L. (2003). Integrating Education and Research in an APRN Mental Health Services Program. Journal of Community Health Nursing, 21(3), 141-152.





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