Weighing Of The Value Of Medical Functional Subjective And Societal Factors
Concerning the broad range of views of even the most educated of persons in recovery from schizophrenia, it is not surprising that there exists considerable variation concerning the question of relative weighting of the several approaches to recovery addressed in this article. Medical/biological approaches to psychiatric disabilities include the traditional focus on symptom reducing but increasingly are encompassing other, related health issues, such as obesity, cardiovascular illness, hyperlipidemia, diabetes, and other conditions that may be associated with medication side effects, and other issues affecting morbidity and mortality that may accompany serious mental illnesses.,
The measurable functional, psychosocial factors, ie, the degree to which individuals can care for themselves and can find a satisfactory role and quality of life in society, continue to be vitally important, but questions concerning the degree these matters as viewed by professionals are weighted, as opposed to the more subjective and societal factors embodied in the recovery model, is a matter that can be approached in a variety of ways by different consumer/survivor advocates. For example, the 3 authors of this article address this question very differently.
E.L.K. addresses the question concerning the weighing of these various factors with comments from a global perspective as well as from his personal experience. He comments:
Course And Recovery In Schizophreniform Disorders
The schizophreniform patients showed better global outcome than the schizophrenia patients at each follow-up, with 1 comparison being significant . Similarly, a larger percentage of patients with schizophreniform disorders than patients with schizophrenia were in recovery at each of the 5 follow-ups, although these differences are not significant. The schizophreniform patients showed somewhat better courses over time than the patients with schizophrenia, but many experienced difficulties. Seventy-five percent of the schizophreniform patients experienced subsequent psychotic activity at some point, although it was usually at 1 or 2 follow-ups rather than continuously. Eleven of the 12 schizophreniform patients had complete data on outcome at either 4 or 5 of the 5 follow-ups over 15 years. Only 1 of these 11 schizophreniform patients showed psychotic activity at all follow-ups. On the positive side, unlike the schizophrenia patients, at some point over the 15-year period, 7 of the 12 schizophreniform patients were working full-time during a follow-up year, most of these at more than 1 follow-up. While none of the 11 schizophreniform patients was in recovery at each of the follow-ups, 3 of the 11 schizophreniform patients were in recovery for almost all of the follow-ups and thus could be viewed as showing a very favorable course over the 15 years.
What Are The Treatments For Schizophrenia
Ninety-nine percent of patients with schizophrenia need lifelong treatment with antipsychotic drugs, counseling and social rehabilitation, says Dr. Bowers.
This will reduce their symptoms and help them get to a place of stability in their lives, she says.
Antipsychotics are given orally or by injection. Depending on the type of schizophrenia, other medications may be needed as well:
- People with paranoid schizophrenia usually respond well to antipsychotics, which decrease paranoid thinking and help them readjust to their environment.
- People with catatonic schizophrenia require benzodiazepines to relax their muscles, allowing them to become more active and to react to the environment.
- People with undifferentiated schizophrenia are slower to respond to antipsychotics because thinking is disturbed across the board. The medication makes them more alert and able to care for themselves, but it doesnt always clear their thinking, she says.
- People with schizoaffective disorder require a combination of antipsychotics and antidepressants or mood stabilizers.
Despite significant side effects, its important to keep taking these medications.
When people go on and off their meds, their symptoms return, and they often end up back in the hospital, says Dr. Bowers. Also, the more episodes you have, the further you get from your healthy baseline.
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Your Attitude Towards Schizophrenia Treatment Matters
Accept your diagnosis. As upsetting as a diagnosis of schizophrenia can be, resolving to take a proactive role in treatment and self-help is crucial to your recovery. That means making healthy lifestyle changes, taking prescribed medications, and attending medical and therapy appointments.
Dont buy into the stigma of schizophrenia.;Many fears about schizophrenia are not based on reality. Take your illness seriously but dont buy into the myth that you cant improve. Associate with people who see beyond your diagnosis, to the person you really are.
Communicate with your doctor.;Help your doctor ensure youre getting the right type and dose of medication. Be honest and upfront about side effects, concerns, and other treatment issues.
Pursue self-help and therapy that helps you manage symptoms.;Dont rely on medication alone. Self-help strategies can help you to manage symptoms and regain a sense of control over your health and well-being. Supportive therapy can teach you how to challenge delusional beliefs, ignore voices in your head, protect against relapse, and motivate yourself to persevere with treatment and self-help.
Set and work toward life goals.; Having schizophrenia doesnt mean you cant work, have relationships, or experience a fulfilling life. Set meaningful life goals for yourself beyond your illness.
Getting a diagnosis
Because of these issues, it is best to see a psychiatrist with experience identifying and treating schizophrenia, rather than a family doctor.
Implications For And Involvement Of Schizophrenia Professionals
Reflecting on the impact of the recovery concept, and considering how important the consumer perspective has been in its development, what are some major messages for those referred to by Jacobson as the elite professionals, working in the area of schizophrenia? How does one accommodate the predominantly subjective and politically oriented recovery model into the objective, scientific approach of professionals working in the field of schizophrenia? One avenue to explore in answering this question could be the realization that some of these so-called professional elites are themselves persons who have been diagnosed with and treated for schizophrenia. Because of the obvious downside consequences of revealing that one has a personal history with schizophrenia, it is likely that most professionals in this category are unlikely to publicly identify themselves, particularly those younger professionals, for whom such revelations could be career damaging. However, during the past few decades, there have been a number of highly trained professionals who, for various reasons, have been willing to be open and even publish materials related to their conditions and the process of their recoveries.
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Tip 6: Understand The Role Of Medication
If youve been diagnosed with schizophrenia, you will almost certainly be offered antipsychotic medication. The two main groups of medications used for the treatment of schizophrenia are the older or typical antipsychotic medications and the newer atypical antipsychotic medications. Its important to understand that medication is just one component of schizophrenia treatment.
Medication is not a cure for schizophrenia and only treats some of the symptoms.;Antipsychotic medication reduces psychotic symptoms such as hallucinations, delusions, paranoia, and disordered thinking. But is much less helpful for treating symptoms of schizophrenia such as social withdrawal, lack of motivation, and lack of emotional expressiveness.
You should not have to put up with disabling side effects.;Schizophrenia medication can have very unpleasanteven disablingside effects such as drowsiness, lack of energy, uncontrollable movements, weight gain, and sexual dysfunction. Your quality of life is important, so talk to your doctor if youre bothered by side effects.
Never reduce or stop medication on your own.
Sudden or unsupervised dosage changes are dangerous, and can trigger a schizophrenia relapse or other complications. If youre having trouble with your medication or feel like you dont need to take it, talk to your doctor or someone else that you trust.
New Study Challenges Our Understanding Of Schizophrenia As A Chronic Disease That Requires Lifelong Treatment
A new study shows that 30 per cent of patients with schizophrenia manage without antipsychotic medicine after ten years of the disease, without falling back into a psychosis.
The results go against conventional treatment of psychosis and schizophrenia.
Patients are usually prescribed medication for an unlimited length of time after it has been established which medicine works best without too many side effects.
But perhaps doctors should think about helping people to transition off their medication, suggests the authors behind the new study.
It shows that theres actually a large group, though still a minority of patients, who can function without medicine and without developing psychosis. So as a doctor, you shouldnt rule out that patients could give up their medicine, says co-author Merete Nordentoft, a professor in psychiatry at the University of Copenhagen, Denmark.
The study is .
Women who do not use drugs cope best
In the study, scientists collected observations from 496 patients who were diagnosed with schizophrenia ten years ago and started on a treatment with antipsychotic medicine for ten years.
A decade on, the doctors invited the patients in for a follow up interview to find out how they were doing. The patients were previously interviewed at the first, second, and fifth year after their initial diagnosis.;
The most well-functioning schizophrenics cope best
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How Is Schizophrenia Treated
There are different types of treatment available. Medical professionals should work with you to find the right treatment for you. The National Institute for Health and Care Excellence recommends that you should be offered a combination of medication and talking therapies.
People who live with schizophrenia can respond to treatment differently.
For many treatment helps to reduce symptoms to help make daily life easier. You may find that you need to continue with treatment to keep well. For every 5 people with schizophrenia:
- 1 will get better within 5 years of their first obvious symptoms.
- 3 will get better but will have times when they get worse again.
- 1 will have troublesome symptoms for long periods of time.
What medication should I be offered?
Your doctor may offer you medication known as an antipsychotic. These reduce the symptoms of schizophrenia, but dont cure the illness. Your healthcare professionals should work with you to help choose a medication. If you want, your carer can also help you make the decision. Doctors should explain the benefits and side effects of each drug.
In the past, some antipsychotics had negative side effects. Some people find that the side effects of newer antipsychotic drugs are easier to manage.
Your medication should be reviewed at least once a year.
What type of psychosocial treatment will I be offered?
Family intervention is where you and your family work with mental health professionals to help to manage relationships.
Helping Someone With Schizophrenia Tip 1: Encourage Treatment And Self
Encouraging treatment and self-help is a cornerstone of helping a loved one with schizophrenia. While medication is an important element of schizophrenia treatment, your loved ones recovery depends on other factors as well. Self-help strategies such as changing to a healthy diet, managing stress, exercising, and seeking social support can have a profound effect on your loved ones symptoms, feelings, and self-esteem. And the more someone does for themselves, the less hopeless and helpless theyll feel, and the more likely their doctor will be able to reduce their medication. Your encouragement and support can be crucial to your loved one starting and continuing a program of self-help.
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What If I Am A Carer Friend Or Relative
It can be distressing if you are a carer, friend or relative of someone who has schizophrenia. You can get support.
How can I get support for myself?
You can do the following.
- Speak to your GP about medication and talking therapies for yourself.
- Speak to your relatives care team about family intervention. For more information about family intervention see the further up this page.
- Speak to your relatives care team about a carers assessment.
- Ask for a carers assessment.
- Join a carers service. They are free and available in most areas.
- Join a carers support group for emotional and practical support. Or set up your own.
What is a carers assessment?NICE guidelines state that you should be given your own assessment through the community mental health team to work out what effect your caring role is having on your health. And what support you need. Such as practical support and emergency support.
The CMHT should tell you about your right to have a carers assessment through your local authority. To get a carers assessment you need to contact your local authority.
How do I get support from my peers?You can get peer support through carer support services or carers groups. You can search for local groups in your area by using a search engine such as Google. Or you can call our advice service on 0808 801 0525. They will search for you.
How can I support the person I care for?
You can do the following.
There is no definition for what high risk means. It could include:
What Are The Symptoms
Mental health professionals classify most schizophrenia symptoms as either positive or negative. Other symptoms involve cognition and inappropriate motor behaviors.
- Positive symptoms include hallucinations and delusions, both of which can often be managed with medications. They arent considered positive because they are helpful or healthy, but rather because they appear because certain regions of the brain are activated.
- Negative symptoms appear to stem from diminished activation of certain parts of the brain, and dont usually respond as well to medical therapy as positive symptoms. Negative symptoms include those that interfere with normal, healthy functioning. They include problems interacting with other people and little desire to form social connections, as well as the inability to show emotions and feel pleasure and rewards.
- Cognition challenges associated with schizophrenia include confusion and disorganized speech. Thinking and verbal skills can become impaired, so, for example, an answer to a question may not make sense to the person asking the question.
- Abnormal behaviors and motor skills problems can range from agitation and impatience to silliness and other childlike traits. A persons body language may not match their words, while in other situations, someone with schizophrenia may not be able to formulate an answer or may be moving excessively, so communication and focus become even greater challenges.
From The Medical Model To The Rehabilitation Models
The increasing presence of seriously mentally ill persons in the community gave rise to the recognition that although some persons with schizophrenia and similar disorders could function, to varying degrees, in society despite their conditions, it quickly became clear that there were difficulties reintegrating serious mentally ill persons into society. Initially, this problem was addressed by caretakers focusing on social as opposed to medical aspects of the disorder. The primary goal of care became to increase former patients ability to function in society, as opposed to the traditional focus on attempting to diminish or eliminate the symptoms of the disorder. Interestingly, the term, function, began to include the resources, as well as the skills needed, to succeed in an environment. The term psychosocial rehabilitation started to be used to describe this approach, which stressed the rehabilitation of those with the disability, as opposed to medical treatment of the disease. Importantly, stated principles of PSR included emphasis on client choice,strengths, and empowerment of consumers.
Learn To Recognise Your Early Warning Signs
These might include:
- everyday things like going off your food, feeling anxious or not sleeping
- not changing your clothes, cleaning your flat or cooking for yourself
- feeling a bit suspicious or fearful or starting to worry about peoples motives
- starting to hear voices quietly or occasionally
- finding it difficult to concentrate.;
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Prospects Are Not As Hopeless As Previously Thought According To The Researcher Behind The Study
Until recently, medical professionals believed that only a minority of patients could recover from schizophrenia. But now, new Norwegian research suggests that more than half of the study participants are doing well.
After four years of treatment, 55 per cent of the young people were partially or fully recovered, and fully ten per cent of those who are fully recovered no longer use medication.
“Having such a high proportion be well-functioning shows that schizophrenic patients have a greater potential to get well than previous research has shown,” says Professor Anne-Kari Torgalsbøen at the University of Oslos Department of Psychology.
She believes too much pessimism has been associated with this diagnosis.
“The results of this study give hope not only to patients and their relatives, but also provide inspiration for everyone who treats young people with psychotic disorders,” she says.
Hallucinations and delusions
Torgalsbøen specializes in clinical psychology and is following close to 30 young adults for ten years. This study shows how the participants are doing after four years, and was recently published in the European Psychiatry journal.
All the study participants were recruited within five months of being hospitalized or starting outpatient treatment for first-episode mental disorders.
The study required the first episode of psychosis to be on the schizophrenia spectrum, she says.
Prejudices are an additional burden
Close follow-up using several treatment methods
When A Loved One Has Schizophrenia
The love and support of family and friends plays an important role in schizophrenia treatment and recovery. If you have a loved one with schizophrenia, you may be struggling with any number of difficult emotions, including fear, guilt, anger, and frustration. You may feel helpless in the face of your loved ones symptoms, worried about the stigma of schizophrenia, or confused and embarrassed by their strange behaviors. You may even be tempted to hide your loved ones illness from others.
But its important to remember that a diagnosis of schizophrenia is not a life-sentence. Recovery is possible, especially with your love and support. To help someone with schizophrenia, its crucial you:
- Accept the illness and its difficulties.
- Not buy into the myth that someone with schizophrenia cant get better or live a full and meaningful life.
- Do your best to help your loved one feel better and enjoy life.
- Pay attention to your own needs.
- Maintain your sense of humor and remain hopeful.
While dealing with a loved ones schizophrenia can be challenging, the following strategies can help you guide your loved one on the road to recovery without losing sight of your own hopes and dreams.
Tips for helping a loved one with schizophrenia
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