The adult-gerontology acute care nurse practitioner (AG-ACNP) must handle various tasks in inpatient and outpatient settings. In the inpatient and acute care setting, the AG-ACNP often interacts with patients suffering from acute anxiety and psychoses. One of the instances where such an issue is prevalent is schizophrenia-spectrum disorders, which will be discussed in this post. The lack of definitive measure scales or uniform direction indicates a need for more inpatient research on the psychosocial treatment of schizophrenia.
The question of schizophrenia diagnostics must be addressed prior to the treatment plan recommendations. Patients with schizophrenia often need acute care treatment during periods of exacerbation to manage the crisis and stabilize their condition (Gaudiano et al., 2017). In addition to the core symptoms of hallucinations, delusions, or persistent disorganized speech, schizophrenia may be manifested through psychosis, which accounts for the majority of acute admissions to the inpatient setting (Jacobsen et al., 2018). An incredibly wide range of outcomes and assessment tools makes it challenging to diagnose or treat patients with schizophrenia-induced psychosis (Harris & Panozzo, 2019; Jacobsen et al., 2018). Therefore, any recommendations for this treatment plan may be subject to change depending on individual circumstances.
The cornerstone of helping schizophrenic patients across different settings is pharmacological treatment. The American Psychiatric Association (APA) (2021) recommends that the schizophrenia treatment plan includes a continuous administration of antipsychotic medication, which should be monitored for effectiveness and side effects. Moreover, for patients with a history of poor or unreliable adherence to the treatment rules, a long-acting injectable antipsychotic medication is recommended (American Psychiatric Association, 2021). However, psychoeducation and several psychosocial interventions are discussed in addition to pharmacotherapy.
Currently, there is no clear direction for evidence-based inpatient psychological therapy for schizophrenic psychosis manifestations. Nonetheless, Harris and Panozzo (2019) strongly assert that AG-ACNPs need to establish a therapeutic relationship with the patient and not rely solely on pharmacology to achieve optimal care. If a patient experiences the first episode of psychosis, APA (2021) recommends placing them in a coordinated specialty care program. Next, Jacobsen et al. (2018) and APA (2021) guidelines recommend cognitive behavioral therapy (CBT) specifically for psychosis and supportive psychotherapy in general. Gaudiano et al. (2017) endorse acceptance and commitment therapy (ACT), which uses mindfulness-based strategies that have shown initial efficacy in improving psychotic patients’ acute and post-discharge outcomes in psychiatric care settings. These psychotherapy tactics can be useful for schizophrenic patients in acute care, but picking the best fit may take some time.
In addition to pharmacotherapy and psychotherapy, many other interventions are also advised. For instance, patients with schizophrenia should be aided in integration into society as much as possible. APA (2021) recommends that such patients receive psychoeducation, supported employment services, and assertive community treatment when needed. Psychoeducation can be considered for the patient and family members to educate them about the disorder (Grover et al., 2017). AG-ACNP can offer simple and brief explanations about the nature of the patient’s condition, treatment methods, possible side effects, and likely duration of treatment. Further, APA (2021) suggests providing some training on social skills, self-management skills, and person-oriented recovery for the patients. Moreover, according to APA (2021) and Grover et al. (2017), cognitive remediation and a family intervention may be suggested if a patient keeps in touch with their family. However, it is important to consider that many of these recommendations aim for long-term improvement rather than addressing acute psychosis issues.
The schizophrenia patients’ treatment process requires a combination of approaches, including pharmacological, psychosocial, and other interventions. There is still much work left to establish traditional psychotherapy approaches for treating psychosis in the setting of acute care. The predominant recommendations for acute treatment include the administration of appropriate medication in the inpatient setting. However, counting on medication alone to address all aspects of schizophrenic disorders is not advised. In the long-term, various forms of therapy, like CBT and ACT, training, psychoeducation, family interventions, and cognitive remediation are suggested for the treatment plan.
References
American Psychiatric Association (Ed.). (2021). The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia (3rd ed.). American Psychiatric Association.
Gaudiano, B. A., Davis, C. H., Epstein-Lubow, G., Johnson, J. E., Mueser, K. T., & Miller, I. W. (2017). Acceptance and commitment therapy for inpatients with psychosis (the REACH Study): Protocol for treatment development and pilot testing. Healthcare, 5(2), 1-17. Web.
Grover, S., Chakrabarti, S., Kulhara, P., & Avasthi, A. (2017). Clinical practice guidelines for the management of schizophrenia. Indian Journal of Psychiatry, 59(1), 19–33. Web.
Harris, B. A., & Panozzo, G. (2019). Therapeutic alliance, relationship building, and communication strategies for the schizophrenia population: An integrative review.Archives of Psychiatric Nursing, 33(1), 104–111. Web.
Jacobsen, P., Hodkinson, K., Peters, E., & Chadwick, P. (2018). A systematic scoping review of psychological therapies for psychosis within acute psychiatric inpatient settings. The British Journal of Psychiatry, 213(2), 490–497. Web.