CAREGIVERS KNOWLEDGE AND INVOLVEMENT IN THE PREVENTION AND MANAGEMENT OF RELAPSE IN SCHIZOPHRENIC PATIENTS AT FEDERAL NEUROPSYCHIATRIC HOSPITAL NEW HAVEN ENUGU STATE
CHAPTER ONE
INTRODUCTION
Background of the Study
Schizophrenia the most common type of mental illness is a chronic and disabling psychiatric illness that affects approximately 1% of the world’s population. It is often accompanied by relapse even while on treatment. Relapse rates vary from 50% to 92% and are similar in developed and developing countries, despite the former having well-established mental health services (Davis, 2014; Hogarty & Ulrich, 2013). Unfortunately, psychotic relapse is so common, with up to 60% of all patients having a relapse within the year of being hospitalized (Davis, 2014; Hogarty & Ulrich, 2013).
With the total cost of hospital care for patients with schizophrenia exceeding two billion dollars annually (Weiden & Olfson, 2014) relapse represents a significant public health problem. The personal costs associated with relapse-including impaired role functioning, disrupted interpersonal relationships and demoralization is also considerable. Though new medications have improved the course of illness for many patients, relapses are still common. (Tanveer & Rukhsaner, 2009). Although antipsychotic medication is effective in reducing relapse rates, 30% to 40% of patients relapse within one year after hospital discharge even if they are receiving maintenance medication (Sena, 2003, Sariah 2013).
Schizophrenic symptoms affects patient as well as caregivers in multiple and complex ways. It is obvious that psychiatric and or physical illnesses have great impact on caregivers. Caregivers of schizophrenic patients can be the first source of support and stability or it can become part of the problem that leads to ineffective coping (Kreyenbuhl, Buchanan, Dickerson & Dixon, 2009). The recognition of the importance of the caregiver patient’s care necessitated the incorporation of the caregiver as a unit into healthcare modules in recent time (Bormar & McNeely, 2014).
A caregiver of schizophrenic patient struggles throughout the person’s illness with the change it brings and their own feelings about the illness. In the past, caregivers were blamed for many of the problems that mentally ill people experienced and although this perception of fault has changed, caregivers still experience a catastrophic event when mental illness occurs (Finkelman, 2002). The caregiver which is a unit of mental health care is highly involved in the prevention and management of relapse when the client with mental ill-health especially schizophrenia lives with caregiver. A lot of the day-to-day help and rehabilitation is carried out by the caregiver if the caregiver has knowledge of the prevention and management. Thus, if they are to effectively help the client, caregivers must have help in managing their stress and coping with difficult situations to avoid relapse.
The image of isolated people with serious mental illness, especially schizophrenia, who return to communities, other than their caregiver, has been widely publicized. However, most people with mental illness are involved with their families and have frequent contact with family members who are always the caregivers while they are within the larger community. The mental illness impact on the entire family is so heavy that it is often called family burden (Doornbos, 1997). Mental illness can have a negative impact on the caregiver as well. Problems identified by caregivers/family include the following (Doornbos, 1997):
Increased stress and conflict.
Blaming each other for the illness.
Difficulty understanding or accepting the illness.
Tension during family gatherings.
Disproportionate amount of family time, energy, or money given to the ill member.
Family members may feel guilty about their relative’s illness. It is also common for those who are close to a person with any serious illness to wonder whether they could have done something to prevent regression of the illness (Miller, 2002).
Caregivers who provide care for schizophrenics often feel isolated and alone in dealing with the challenges of care-giving. Sometimes they may be embarrassed about the illness or fear that the person with psychological disorder will behave inappropriately in the presence of others. The caregiver in no doubt has a lot of challenges to face in the prevention and management of relapse of family member that is mentally recuperating or adjusting to the societal dynamics. The services of a mental health nurse may be quite necessary as a support person. The mental health nurse can play an important role in offering caregiver opportunities to discuss their concerns and taking action to meet their needs whenever possible.
Statement of the problem
Schizophrenia is a disabling group of brain disorders characterized by symptoms such as hallucinations, delusions, disorganized communication, poor planning, reduced motivation, and blunted affect (McGrath, Saha, Welham, Saadi, MacCauley & Chant, 2014). In the Global Burden of Disease 2010 study, psychiatric disorders accounted for 3.4% of the total Disease Adjusted Life Years (DALYs) in the African region; of these, schizophrenia accounted for 0.5% of total DALYs (WHO, 2011).
Schizophrenia is often accompanied by relapse even while on treatment (Gelder, Lopez-Ibor & Andreasen, 2014). Relapse has been defined as a worsening of psychopathological symptoms or rehospitalization in the year after hospital discharge (Schennach, Obermeier, Meyer, Jäger, Schmauss & Laux, 2012). Schizophrenia follows a variable course, with complete symptomatic and social recovery in about 1/3 of cases. Schizophrenia can however follow a chronic or recurrent course, with residual symptoms and incomplete social recovery. Individuals with chronic schizophrenia constituted a large proportion of all residents of mental institutions in the past and still do where these institutions continue to exist (WHO report, 2011).
An international survey was done to shed light on experiences and insights of caregivers of individuals with schizophrenic disorder. Relapse was seen to have been a major concern for care givers because of its devastating consequences for family members of people living with the mental illness. A few studies regarding relapse and schizophrenia have been done in Africa. Studies done in South Africa have found that presence of a co-morbid depressed mood, poor adherence due to a lack of patient insight, and medication side-effects appear to be the factors most likely to increase the risk of a relapse (Kazadi, Moosa & Jeenah, 2013). Other factors that have been identified include: lack of social support, grief following the loss of a close family member, and lack of employment. The discussions above revealed that most of the researches on schizophrenic relapse centered more on the causes. In addition effort to control the menace centered more on drug management with little or no attention on the role of caregivers. Since studies have identified the importance of non drug therapy in prevention and management of schizophrenic relapse, roles of care giver cannot be over looked
A visit to the Outpatient Clinic and the Medical records of Psychiatric Hospital Enugu shows some reported cases of relapse most of which were schizophrenic patients who had earlier been mentally stable and discharged home. Hence this study as investigated the knowledge of care givers in prevention and management schizophrenic relapse
Aim of the study
The main purpose of this study was to examine caregivers’ knowledge and involvement in the prevention and management of relapse in schizophrenic patients at Federal Neuropsychiatric Hospital Enugu.
Objectives of the study were to:
- Determine caregivers’ knowledge of relapse among schizophrenic patients.
- Determine caregivers’ knowledge of prevention of relapse among schizophrenic patients.
- Assess caregivers’ knowledge of management of relapse among schizophrenic patients.
- Ascertain caregivers’ involvement in prevention of relapse among schizophrenic patients.
- Determine caregivers’ involvement in the management of relapse among schizophrenic patients.
Research Questions
- What is the caregivers’ knowledge of relapse among schizophrenic patients?
- What is the caregivers’ knowledge of prevention of relapse among schizophrenic patients?
- What is the caregivers’ knowledge of management of relapse among schizophrenic patients?
- What is the caregivers’ involvement in prevention of relapse among schizophrenic patients?
- What is the caregivers’ involvement in the management of relapse among schizophrenic patients?
Hypotheses
- There will be no significant difference in the knowledge of relapse prevention among male & female caregivers’ of schizophrenic patients.
- There will be no significant difference in the knowledge of relapse management between male and female caregivers’ of schizophrenic patients.
- There will be no significant association between knowledge of relapse prevention and preventive measures adopted by caregivers of schizophrenic patients.
- There will be no significant association between knowledge of relapse management and management measures adopted by caregivers of schizophrenic patients.
- There will be no significant association between some demographic variables of the caregivers and the prevention/ management of relapse in schizophrenic patients.
Significance of the study
It is generally acknowledged that mental illness especially schizophrenia creates burdens for the family care givers. Since the 1950s, medical literature has identified the type and extent of those burdens, especially for families of patients with schizophrenia. It is therefore an imperative to provide empirically evidence-based research to proactively engage family members in the prevention and management of relapse among schizophrenic patients.
This study will provide mental health policy makers with information on the outcomes of existing psycho-educational initiatives for families of schizophrenic patients, their level of effectiveness and plausible improvements to be adopted where necessary.
For the clinical healthcare personnel, findings from this study will provide insight into the need to expand existing approaches in order to proactively engage families of schizophrenic patients in their management. The study will also bring to the fore the challenges inhibiting the incorporation of requisite family support-based approaches in management of schizophrenic patients in psychiatric hospitals with a view to providing ameliorative measures.
The generality of the public, especially families which have schizophrenic patients as members, will benefit from the findings of this research as it will adequately highlight the existing challenges as well as the integral role which the immediate family as well as the larger community needs to play to prevent the relapse of schizophrenic patients. The fear and powerlessness often reported by affected families will be adequately addressed by intervention approaches which will be sequel to the findings of this study.
Moreover the outcome of this study will in no doubt proffer solutions to the various challenges being experienced by families caring and living with the schizophrenic family member, and the outcome of this study will finally add to the existing body of knowledge.
Operational definitions
Schizophrenia patients: These are patients that have been diagnosed as schizophrenics, characterized by breakdown of thought processes and poor emotional responsiveness, which have been discharged from the Psychiatric Hospital.
Caregiver: A person who must have spent a minimum of one year caring for a schizophrenic patient. This does not include health workers.
Knowledge of schizophrenic relapse: This means an understanding of signs and symptoms of schizophrenic relapse by the caregiver.
Caregiver management of relapse in schizophrenic patients: This means the roles caregiver plays in the management of schizophrenic relapse.
Knowledge of Relapse: This means understanding of signs and symptoms associated with relapse by the caregiver who may be a blood relation or paid caregiver. This excludes health workers.
Caregiver Prevention of schizophrenic relapse: This means the roles caregiver play in the prevention of relapse among a schizophrenic patient.
Caregiver knowledge of Schizophrenic relapse: This means the understanding of Schizophrenic relapse among those who take care of them.
Caregiver Involvement: This means the participation of caregivers in the management and prevention of Schizophrenic relapse
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