Just like many other diseases, mental illnesses are rather debilitating to the affected individuals. In particular, schizophrenia is one of the mental diseases that are associated with a range of other physical conditions, increased mortality, and comorbidities (Correll et al., 2017). The primary characteristics of schizophrenia include behavioral dysfunction, cognitive impairment, and psychosis; this disease affects approximately 1% of the population of the United States (Correll et al. 2017).
Effective management and treatment strategies are required for the patients with schizophrenia in order to reduce their readmission rates (Kripalani, Theobald, Anctil, & Vasilevskis, 2014). This literature review is focused on the exploration of self-management programs for patients with schizophrenia and their effectiveness in terms of the reduction readmission rates and the overall management of the condition.
The severity of schizophrenia is recognized not only in the United States. For instance, in China, schizophrenia is linked to a wide range of impactful disabilities and, in this regard, is acknowledged to be far more dangerous than other mental conditions (Zhou, Zhang, & Gu, 2014). There exist different self-management and rehabilitation strategies aiming at the minimization of symptoms and burdens associated with the prevalence of schizophrenia, as well as at the improvement of the overall quality of life of the affected individuals.
However, it is important to note that one of the major factors contributing to the success of these strategies is the patients’ adherence to the necessary measures, activities, and medications. According to the data of Zhou et al. (2014), among the entire population segment of people affected by schizophrenia in China, only about 2% adhere to their management and rehabilitation strategies.
Moreover, when it comes to the results worldwide, the review by Barkhof, Meijer, de Sonneville, Linszen, and de Haan (2012) covering the past decade revealed that the general rates of nonadherence could vary in range from 20 to 89% in different studies. In that way, it is possible to make a conclusion that the situation in China is quite demonstrative of the adherence to dynamics of schizophrenia treatment and intervention strategies occurring on the global scale.
In addition, the authors found that, on average, the rate of adherence to treatments in schizophrenic patients could be approximated to 50%; also, the findings of this review showed that if within two years after the first psychotic episode the patients demonstrated 50 or 55% rate of nonadherence, their likeliness of being readmitted within the next year grew significantly (Barkhof et al., 2012). In that way, adherence can be recognized as a very important issue to discuss in regard to readmission and self-management among schizophrenic patients.
All in all, as mentioned earlier, low adherence to antipsychotic medication and self-management strategies is highly prevalent among patients suffering from schizophrenia due to a variety of determinants and factors associated with this phenomenon (Barkhof et al., 2012). In particular, as one of the health behaviors, adherence can be studied from the perspective of Health Belief Model that states that a patient’s desire, intention, and readiness to comply with their doctor’s prescriptions is majorly dictated by the perceived effects of the medication outweigh its costs, and, most importantly, when the patient can observe noticeable health risks and threats (Barkhof et al., 2012).
In turn, as a mental condition characterized by cognitive impairment, paranoid delusions, and other psychotic symptoms, schizophrenia may be accompanied by low illness awareness in the patients; and as a result, such individuals are likely to have reduced rated of adherence to treatments and interventions based on both medication and self-management (Barkhof et al., 2012).
In that way, the set of main factors contributing to nonadherence to treatments causing readmissions involves low illness awareness and the perceived lack of efficiency of the medication; the additional factors are substance abuse that has a strong negative impact on adherence rates, therapeutic alliance, and environmental factors (the creation of nourishing and stress-free conditions for the patients by their doctor, family, and community) (Barkhof et al., 2012).
The latter factor (the participation of families and communities in the management and treatment programs for people with schizophrenia) is a rather important aspect of the contemporary interventions that work based on a patient-centered model and approach mental illness holistically. The study by Armijo et al. (2013) targeting management programs involving communities in Chile was carried out in the form of a qualitative review of the literature covering the period from 1999 to 2012 and showed that the involvement of holistic approach helped address many challenges associated with management of schizophrenia. In particular, in addition to the significant reduction of psychotic and other negative symptoms of this mental condition, the researchers found that the community-based management of the illness helped improve the patients’ rates of adherence to their treatment (Armijo et al., 2013).
In that way, taking into consideration the findings of Barkhof et al., (2012) showing that low or even 55% rate of nonadherence often results in a significant increase in readmission chance, it is possible to note that the improvement of adherence achieved by the management programs involving the patients’ communities and families actually helped address readmission rates. Another positive effect that can be linked to potential readmission rate is the reduction of psychotic symptoms in schizophrenic outpatients. Alongside with these outcomes, the other effects of the discussed interventions were the minimization of terms of hospitalization and the reduction of comorbidities linked to schizophrenia (Armijo et al., 2013).
Also, it is important to point out that the management programs involved patients, as well as their families and other community members and worked through the delivery of psychoeducation and the improvement of the communities’ and individuals literacy in regard to schizophrenia (Armijo et al., 2013). Some of the additional results of this management program were the improved understanding of the disease from the side of both patients and their family members leading to the minimization of self-stigmatization, isolation, and alienation due to involuntary ableism and similar attitudes directed at people with mental health conditions.
Another study researching self-management programs based on psychoeducation for people affected by schizophrenia was conducted in China and focused on educational intervention focused on the application of mindfulness (Chien & Thompson, 2014). The authors noted that psychoeducation is at the core of many self-management programs for patients with schizophrenia; however, even though this intervention is known to increase the patients’ awareness of the illness and insights into their condition and treatment, its practical effect on such factors as psychotic symptoms and readmission rates remains under-researched or is reported to be low.
In fact, as reported by Chien and Thompson (2014), psychoeducational self-management programs based on mindfulness can be characterized as particularly effective compared to the standard treatments for schizophrenia as they produce a noticeable positive impact on the patient’s knowledge of the illness, awareness of the condition, insight, and the readiness to manage schizophrenia; moreover, another visible positive effect of this type of treatment is the reduction of negative psychotic symptoms. In addition, even though readmissions occurred in the research sample, the findings showed a significant decrease in their length (Chien & Thompson, 2014).
Another study researching educational self-management programs was carried out by Zou et al. (2012); the findings of this research showed that self-management education for patients with schizophrenia is strongly associated with the events of re-hospitalization and relapse. Similarly to the results reported in the previously discussed studies, the authors mentioned that self-management education was also linked to the improvement in adherence to medication and the prevalence of psychotic symptoms in comparison with the results of the patients who did not enroll in educational self-management programs (Zou et al., 2012; (Armijo et al., 2013; Chien & Thompson, 2014).
In addition to the confirmed benefits of self-management programs powered by mud fullness and education, there exists a theory that peer-led self-management programs could be highly advantageous (Chan et al., 2014).
All in all, schizophrenia is a mental condition that is rather debilitating to the affected individuals. Due to cognitive impairments and delusions associated with its development, low illness awareness and the consequent adherence to medication are seen as some of the main causes of readmissions. Education and mindfulness-based self-management programs are known to help reduce symptoms of schizophrenia and improve the illness insight and readiness to comply with the medication, thus producing a positive effect on the rate of readmissions, as well as their length.
References
Armijo, J., MĂ©ndez, E., Morales, R., Schilling, S., Castro, A., Alvarado, R., & Rojas, G. (2013). Efficacy of Community Treatments for Schizophrenia and Other Psychotic Disorders: A Literature Review. Frontiers in Psychiatry, 4. Web.
Barkhof, E., Meijer, C., de Sonneville, L., Linszen, D., & de Haan, L. (2012). Interventions to improve adherence to antipsychotic medication in patients with schizophrenia–A review of the past decade. European Psychiatry, 27(1), 9-18. Web.
Chan, S., Li, Z., Klainin-Yobas, P., Ting, S., Chan, M., & Eu, P. (2013). Effectiveness of a peer-led self-management programme for people with schizophrenia: Protocol for a randomized controlled trial. Journal of Advanced Nursing, 70(6), 1425-1435. Web.
Chien, W., & Thompson, D. (2014). Effects of a mindfulness-based psychoeducation programme for Chinese patients with schizophrenia: 2-year follow-up. The British Journal of Psychiatry, 205(1), 52-59. Web.
Correll, C., Ng-Mak, D., Stafkey-Mailey, D., Farrelly, E., Rajagopalan, K., & Loebel, A. (2017). Cardiometabolic comorbidities, readmission, and costs in schizophrenia and bipolar disorder: a real-world analysis. Annals of General Psychiatry, 16(1). Web.
Kripalani, S., Theobald, C., Anctil, B., & Vasilevskis, E. (2014). Reducing hospital readmission rates: Current strategies and future directions. Annual Review of Medicine, 65(1), 471-485. Web.
Zhou, B., Zhang, P., & Gu, Y. Effectiveness of self-management training in community residents with chronic schizophrenia: A single blind randomized-controlled trial in Shanghai, China. Shanghai Archives of Psychiatry, 26(2), 81-87. Web.
Zou, H., Li, Z., Nolan, M., Arthur, D., Wang, H., & Hu, L. (2012). Self-management education interventions for persons with schizophrenia: A meta-analysis. International Journal of Mental Health Nursing, 22(3), 256-271. Web.