Neuroleptics and chronic schizophrenia

Mental Health Nursing,  Jul/Aug 2001  by Jackson-Koku, Gordon

• E-mail
• Print
• Link

Care study

The use of depot neuroleptics to treat a young man suffering from schizophrenia is examined in this care study. Gordon Jackson-Koku also looks at the role of the community mental health nurse in helping clients to be more positive about medication

Mental Health Nursing Vol 21 No 4 pp 10-14

The treatment of schizophrenia remains one of the most difficult challenges in psychiatric mental health nursing not only because of the complexity of the disorder but because it frequently strikes individuals during young adulthood leading to significant residual disability (Kane 1990). Since the introduction of Chlorpromazine and Haloperidol in the 1960s, neuroleptic drugs have been successfully established as the mainstay in the treatment of schizophrenia (Turner 1998). However, over the last two decades, there has also been an increase in the use of other forms of clinical intervention in the treatment of schizophrenia such as cognitive behavioural psychotherapy and the use of family therapy (Dickerson 2000, Drury et al 2000, Mohit 2000).

In this care study, the long-term use of depot neuroleptic therapy as the main intervention strategy in the management of Joe', a 22-year-old man suffering from schizophrenia and living in the community will be critically examined. In addition, the role of the mental health nurse as a facilitator who helps clients develop positive attitudes to medication-taking is also critically examined. Other factors such as the quality of nurse-- patient relationship, patient's medication knowledge and schedule, side effects of medication, and the quality of therapeutic alliance between the patient, his family and health care professionals will also be discussed. In addition to pseudonyms, significant client details have been changed in order to protect client identity.

Background

Joe was a third year university student. During that year, he presented as very anxious and agitated and over time felt that he could not cope anymore. He felt inordinate pressure from his academic work and complained on a regular basis about his tutors. This pattern of immense anxiety and agitation continued until it resulted in physical aggression against his personal tutor. He was referred for counselling on campus but he failed to attend and instead returned home two weeks prior to his final exams. He was seen by his general practitioner who in turn referred him to a psychiatrist.

At his consultation with the psychiatrist, Joe claimed that acts of physical aggression against his personal tutor resulted from the tutor sending messages about him by telepathy to other tutors. He said there was a conspiracy within the faculty to prevent him from getting his degree because he was too brilliant. In his opinion, all tutors in the faculty were evil and their evilness provoked his aggression. Joe also believed that he heard people laughing at him through the wall of his bedroom and felt that one of these was his personal tutor.

The psychiatrist recommended voluntary admission to a psychiatric unit for psychiatric assessment. Joe refused, so he had to be admitted under section 3 of the Mental Health Act 1983. On admission he exhibited quite florid psychotic symptoms. While in hospital it became apparent that Joe had been experimenting with drugs, particularly LSD, amphetamines and cannabis. His drug use was reported to have escalated while in the final year of university.

This admission was the first in a series of other admissions in and out of his local psychiatric hospital. At the time of carrying out this care study, Joe was being discharged from hospital following another psychotic episode. He was being discharged under Section 117 of the Mental Health Act 1983. He was also being treated on what is now the standard level of the Care Programme Approach. A study of his medicine cards revealed that he had been previously treated on Sulphide, Chlorpromazine, Procyclidine, Haloperidol and Diazepam.

Joe's perception of his illness and the perception of relevant others

Joe's earlier admission onto a psychiatric ward and subsequent discharge into the community was a direct result of his prominent paranoid delusions, increasing chaotic behaviour and unprovoked physical aggression against others.

The community psychiatric nurse (CPN) and the author first came into contact with Joe during an initial assessment after a referral came through from the discharging medical officer. Asked whether he knew what was wrong with him, Joe stated emphatically that there was nothing wrong with him, but it was us (nursing and medical staff) who felt that he was ill. As far as he was concerned, there was nothing wrong with him but if we were interested in labelling him with a psychiatric condition that was fine by him. At that point the CPN and the author felt slightly puzzled. We were not quite sure if Joe had full insight into his illness or not. Nevertheless, precise notes about the level of insight he expressed were made for further discussion at the next CPA meeting.