Abstract
Schizophrenia is a serious health problem characterized by cognitive and behavioral defects. Assessing the severity of this disorder is a serious concern for Medical specialists. The care and rehabilitation management of schizophrenic patients is still unclear. The objective of this study was to evaluate the literature accumulated so far and address the issues surrounding the principles and practice of Psychosocial Rehabilitation. An internet search was performed to retrieve the pertinent articles. The key methodologies adopted and the associated findings revealed that schizophrenia management could be made feasible through the identification of problems, motivational interviews to correct the neurocognitive deficits.
Introduction
Health disorders that affect the Central Nervous system place a severe social burden on patients. The magnitude of the severity of such disorders could result in the decline of mental and behavioral functions leading to maladjustment in society. A disorder that falls under this category is Schizophrenia. This condition affects nearly 1% of the population and is widely believed to initiate from biological, psychological, and social causes (Strauss & Carpenter, 1981). Young adult individuals are the first targets. This disorder has financial barriers to overcome and ensure a remedy to the patient. For many years, there has been a controversy about its recovery and management. Hence, the main objective of this essay is to perform a literature review about the influence of neurocognitive and psychosocial factors on readiness to change for the rehabilitation management of schizophrenic patients.
Review of literature
The term psychosocial would mean the relationship between the human interactive behavior and the social factors (Ranjan Roy, 2008). The term Neurocognitive derived from neurocognition would refer to one’s ability to learn, understand, and get aware of the surrounding world with the input of mental abilities like memory perception, attention visuospatial ability, and societal interactions (Roder, 2010). The management of Schizophrenia continues to be a problematic issue. Various strategies have been described by researchers. At a Psychiatric Rehabilitation center, a program on the psychosocial approach was conducted to recognize the objectives of patients (Corrigan, McCracken, and Holmes, 2001). The clients have further mentioned the expenses and benefits of every listed item of their priorities (Corrigan, McCracken, and Holmes, 2001). This program would appear important for Mr. Brayne, as the benefits affect the rationale of meeting his goals and overcoming financial barriers that might interfere (Corrigan, McCracken, and Holmes, 2001). Hence, this program has shed light on the significance of motivational interviews that could serve as initial strategies towards readiness for change (Corrigan, McCracken, and Holmes, 2001). The need for cognitive-behavioral therapies and skills training in the principles of clinical Schizophrenia clinical practice is important (Heinssen, Liberman, and Kopelowicz, 2000). These programs possess implications for hospitalized patients like Mr. Brayne, who could be recommended psychosocial treatment and integration of skills shortly (Heinssen, Liberman, and Kopelowicz, 2000). The present case could be better managed by understanding the important role of neurocognitive deficits (Green et al., 2000). This would require focusing on vigilance, instant memory, secondary verbal memory, and executive functioning as measured by card sorting (Green et al., 2000). The mechanism of the relationship between these defects and schizophrenia is a matter of debate (Green et al., 2000). Mr.Brayne’s problem needs to be addressed keeping in view the variations in cognitive remediation strategies as revealed from different studies. In an intervention program, working memory, planning, and cognitive flexibility have been proven to provide a framework for assessing the client’s cognitive functioning (Wykes, et al., 1999).
Here, reinforcement, principles of learning without mistakes, and procedural learning were recommended for the rehabilitation interventions (Wykes, et al., 1999). Hence, this might ensure the framework on the utility of cognitive remediation strategy that might lessen cognitive deficits and contribute to readiness for change in a short period (Wykes, et al., 1999). Mr.Bryne would require assisted strategies like psychotherapy, vocational rehabilitation, social skills training, and psychosocial interventions as they would better contribute to motivational readiness for change (Twamley, et al., 2003). The effectiveness of these strategies could be assessed through the aid of computers, coaching, and intervention based on environmental adaptation (Twamley, et al., 2003).
These approaches greatly encourage clients to set their own goals by enhancing cognitive functions, symptoms, and daily tasks (Twamley, et al., 2003). This service is recommended for the present case as it has implications for the reliable evaluation of outcomes and their follow- up, and for stressing the significance of enhancing ecological validity in research (Twamley, et al., 2003). It is essential to determine the ethnicity of clients like Mr.Bryne as such factors differ from one country to another country and may influence motivational readiness for change (Higgins, Dey-Ghatak and Davey, 2007). For this purpose, clients need to be assessed through rehabilitation approaches like vocational training, employment guidance, cognitive behavioral therapy, and psychosocial methods (Higgins, Dey-Ghatak and Davey, 2007). Hence, clients could set their goals when issues surrounding gender differences, scarcity of resources, conventional medicine, and importance on the family role were considered (Higgins, Dey-Ghatak and Davey, 2007). Mr.Bryne’s living conditions are not properly known. His psychic problems might improve if there are no predictors. There is a need to understand the significance of rehabilitation services in poor countries (Chatterjee, et al., 2009).
This would in turn exerts influence on disability for individuals with psychotic illnesses which in turn is affected by predictors of social and clinical programs (Chatterjee, et al., 2009). The components of this rehabilitation strategy include psychosocial programs, adherence management, education, and psychotropic drug therapy (Chatterjee, et al., 2009). Through this strategy, large number of clients were beneficial as they had low disabilities with psychotic disorders which included other psychosis, bipolar disorder in addition to schizophrenia (Chatterjee, et al., 2009). Hence, this may indicate that strategeties adopted in poor countries may also need to be implemented in developed countries where there could be diverse ethnic and social group immigrants. Next, in urban settings, the approach of intrinsic motivation was considered to play vita role in mediating the association between the onset of symptoms and functional outcomes (Yamada, et al., 2010). Cases like Mr.Bryne may need a standardized model fore assessing the motivation and the parameters that could indicate an intrapsychic drive (Yamada, et al., 2010). This could be feasible by employing scales like Role Functioning and Scale expanded Brief Psychiatric Rating Scale (Yamada, et al., 2010). Motivation would play a central role as a mediator for the clients with regard to their cognitive functions and positive or negative symptoms, global and random symptoms (Yamada, et al., 2010).This would not only provide the framework for assessing Mr. Bryne’s need and also helps the rehabilitation workers to convert the outcome of study into reliable recovery based approaches for the management of Schizophrenia (Yamada, et al., 2010). Mr.Bryne although lives alone may be in need of a family rehabilitation program. This is because family based strategies have proven to be significant in minimizing the schizophrenia symptoms (Glynn, et al., 2006).
This could also alleviate the client’s psychological distress and might enhance his social functioning (Glynn, et al., 2006).The intervention programs like problem solving, communication and teaching, creating awareness about the disorder, sympathy for the patients (Glynn, et al., 2006), would guarantee a formal assessment of a clients’ cognitive functioning. The interventions could be made to prolong the effectiveness by minimizing the obstacles that block the client’s access to family interventions, recognizing methods to enable consumers comply with the treatment, focusing on systems that ensure the participation of family members in the treatment program (Glynn, et al., 2006). Clients can be encouraged to set their goals by working on the approaches of functional recovery (Kern, et al., 2009). These were based on work, independency in lining mode of life, constancy of symptoms and social functions (Kern, et al., 2009). These could be better made reliable with cognitive training and remediation, behavior guidance and environmental skills (Kern, et al., 2009). These strategies have implications for the health benefits of clients like Mr.Brynes, to meet the goals above the level of symptom constancy (Kern, et al., 2009).
Cognitive rehabilitation has potential to lessen the defects in schizophrenia patients (Matsui, et al, 2009). This program was applied in patients and controls (Matsui, et al, 2009). The tool employed was Script Test measures of social cognition to determine the outcomes (Matsui, et al, 2009). Cognitive rehabilitation could develop social cognitive skills that very important for cases like that of Mr.Bryne (Matsui, et al, 2009).
Hence, it was implicated that the program of cognitive rehabilitation has potential to benefit clients provided there is a follow up of three months, and on combination with atypical antipsychotic drugs (Matsui, et al, 2009).
Mr.Bryne, who is on Clozapine medication, would therefore requires a strong follow up so as to enable a recovery orientation. Longitudinality and intensity of services associated with developments in clinical outcomes and subjective experience could encourage the more active involvement of clients (Brekke and Long, 2000). In addition, these services were also linked to enhancement of self-esteem (Brekke and Long, 2000). This approach known as three-factor model was close to “open-linked” system of Strauss and Carpenter to determine the principles associated with the outcomes (Brekke and Long, 2000). Therefore, community-based rehabilitation plays important role in research and practice for the patients and is largely recommended (Brekke and Long, 2000). The associations connecting psychosocial and neurocognition functions, and intrinsic motivation would also determine schizophrenia management (Nakagami, et al., 2008). There is a strong correlation between neurocognitive functions and psychosocial outcome where intrinsic motivation plays pivotal role in mediating this association (Nakagami, et al., 2008). Hence, paranoid symptoms in clients may be better controlled with this program application. Next, the application of evidence based approaches would help in further effective rehabilitation management of schizophrenia (Roder, et al, 2006). A method of Integrated Psychological Therapy (IPT), was devised keeping in view of social cognitive and neurocognitive strategies (Roder, et al, 2006). The evaluation of this tool in a large group of 1393 schizophrenic patients indicated that IPT affects settings, treatment phases and assessment paradigms in addition to neurocognitive and psychosocial functions (Roder, et al, 2006). This tool when applied may enable functional recovery of clients. There is need of preventing hospitalization of schizophrenic patients by adopting methods like assertive community treatment (Prince, 2006). Mr. Bryne who was hospitalized and lonely may be in great need of this program in order to lessen his hospital stay.
This could enhance the requirement of services that avoid admission (Prince, 2006). Here, this was approach was made applicable by considering various issues like daily structure, social skills, continuation of service, medical and symptom education and family issues(Prince, 2006).Hence, it is reasonable to infer that schizophrenia management approaches should emphasize on interventions in order to prevent rehospitalization of patients (Prince, 2006).Rehabilitation programs should recommend and evaluate the impact of psychosocial and pharmacological interventions that would enable the patients to switch from traditional to new antipsychotic drugs (Szmida and Leff, 2006). This strategy could be made feasible by using Krawiecka Goldberg Vaughn scale (Szmida and Leff, 2006). This would result in lessening of negative symptoms and hallucinations more specific to delusions in patients (Szmida and Leff, 2006). The present case of Mr.Bryne is manageable if the treatment regimen is thoroughly.
Conclusion
Schizophrenia is a severe mental disorder characterized by symptoms that not only affect mental functions but also affect behavioral changes that lead to difficulties in societal interactions in clients. There is need of intensive rehabilitation management strategies for the psychosocial well being of patients. Precise identification of patient needs or goals could be considered as the initial strategy to begin the rehabilitation approach of any kind. Since neurocognitive defects are involved in the episode of schizophrenia, methods associated with vocational training, employment guidance and behavior therapy should be affectively implemented by the nurse care professionals attending long stay inpatients.
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