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Recovery Care Planning: Person with Psychotic Disorder Complicated By Limited Insight into Behavior

Recovery Care Planning: Person with Psychotic Disorder Complicated By Limited Insight into Behavior


Treating persons with complex psychotic disorders proves to be a great problem to nurses and other medical practitioners particularly if the situation is complicated by a limited insight into the consumer’s behavior and condition. It particularly poses great challenges to place the consumer in a collaborative care plan as they may not accept their condition and in some cases may refuse to comply with the medication or treatment program. Due to this, it may be difficult to establish the correct or accurate condition of the consumer based on their own directions. In this case, the medical practitioners have to probe into the health background of the individual to establish truth in the consumer’s views and place the situation into its rightful intervention category before developing a care and recovery plan.

Research has indicated that many people with serious mental disorders such as schizophrenia can recover fully. In fact, some of them can make relatively greater progress than expected. Mostly, mental health services confine their objectives to alleviating symptoms or looking after people. However, recovery means more than this. It focuses on assisting individuals to improve their general lives rather than just keeping an adequate existence. Recovery goes beyond mere treatment and therapies which address symptoms directly. Even though medication is important particularly for those individuals that have experienced serious illness, the idea of mental health is built on a broader foundation than this. Current developments design recovery care plans basing on the five principles that include: Hope, Active sense of self or Meaning and directions, respect and equality, empowerment, social inclusion (Each, 2012).

Description of the Patient

The case study highlights such a complicated situation in the hands of practitioners. A 38 year old male consumer had voluntarily presented himself to the department of emergency with the hope of treating the burning sensation in his arm that he was experiencing. The consumer had also claimed that he had an electric shock, his unit had wrong tasting water, had a problem with his lungs and panted heavily, strong smell in his unit and that he had been hit by hot air from his shower. The study also indicates that consumer suffers from schizophrenia which he either denies or has little knowledge about.

The consumer has been hospitalized on different occasions with almost similar complains. At the age of 19, the consumer admits to have been diagnosed with schizophrenia but believes he was healed and it doesn’t recur anymore. Despite his claims, several diagnostic results indicate that he suffers from schizophrenia. He admits to have stress and frustrations and believes he is being targeted for no specific reason. In addition the consumer has a history of non-compliance with medication and believes that little could be done to help him. His situation is further complicated by the fact that he has little insight in his own behavior and condition.

Hope is quite vital in the concept of recovery. It involves concentrating on the small strengths rather than weaknesses, celebrating any little improvement and concentrating more on the future rather than recounting loopholes in the past (Shean, 2009). Hope enhances the recovery process by adding beauty to life perceptions, enlarging the sphere of possibilities, and sustaining the individual even during moments of relapse. Hope is perceived to lay a ground work in the process of healing. This implies that any recovery plan should give hope a priority. However, people with mental disorders are affected by the destructive predictions of the future and stereotypes to the extent that they lose hope. The loss then cultivates a belief that nothing can be done to change their condition. For instance, during the interview in the case study, the consumer answered that he responds to nurses only to get them off his back but does not believe anything can be done to improve his condition. This has a negative impact on the consumer’s self worth making risk taking and personal growth impossible. In this case, the individual may allow others to make important decisions for him and design some of the most of the vital goals in his life. These goals would obviously have less meaning if the consumer himself plays a less role in them and could only add to loss of power and hope (Brennaman & Lobo, 2011).

To our specific consumer in the case study, the principle of hope is applied to revive his belief or rather trust in the intervention and treatment. This will help to increase compliance with medication and increase the general co-operation towards promoting a more meaningful life and developing a sense of purpose. The care providers can cultivate hope in the consumer through recounting positive life stories from other individuals who have experienced mental illness. Family members and friends can also help to increase the hopes in the consumer through showing confidence in them and the intervention mechanisms.

Active Sense of Self / Meaning, Purpose and Directions

As the mental health care professionals nurture hope in the consumer, it calls for the next principle of recovery which is finding purpose, meaning, direction and a sense of self-worth in the consumers own life. People with schizophrenia often lose a sense of identity and self worth. It is important to re-orient the consumer’s sense of self regardless of the metal illness and to make him understand that the illness is just a single element not the whole of them. This helps to develop an adaptive and a more positive self-image which is necessary in the general recovery of the consumer (Brennaman & Lobo, 2011). The consumer in the case study seems to have lost a sense of purpose which makes him engage in less safe behaviors. This is also indicated in the fact that he believes nothing can be done to improve his life. This can be developed through encouraging spirituality, positive work relationships, and political actions. Studies for instance, have identified spirituality as a source of solace, hope, social support and peace even though previous intervention mechanisms have ignored it (Forsyth, 2007).

Equality and Respect

Respect for the individuals with mental disorders also greatly promotes recovery. Unfortunately individuals with mental illness are greatly stigmatized and discriminated. They are subjects of stigma, harassment, ridicule, abuse and mostly have to put up with the negative presentation of people with mental illness by the public and the media. They are also stigmatized on the basis that they care less for themselves and that they could cause harm to others. The stigma greatly contributes to the denial of the situation and the individuals give into the negative stereotypes (Eack, 2012). Such actions relatively hinder recovery through eroding opportunities, diminishing self-confidence and limiting community inclusion. The recovery care plan should then challenge discrimination and promote respect through systems that equally treat people with mental disorders as important members of the community. Respect for the consumers guides them to develop a positive culture. This culture is built on the belief that it is possible to recover and incorporates the concepts of tolerance, compassion, trust, safety, cultural diversity and trust. This then adds to the recovery process by shifting the consumers focus from illness to rather important life events and enhance self-worth and healing by making the consumer to concentrate on his strengths rather than weaknesses (Brennaman & Lobo, 2011). Respect also increases compliance with medication by modeling a positive relationship between the consumer and service providers. Working towards respect for people with mental illness corrects the discrimination in the wider community helping them to live a more purposeful life. This can be achieved step by step from service providers to the wider community.

Personal responsibility / Empowerment

The five principles of recovery work in unison as one builds on the other and any reliable recovery plan should treat them as such. Individuals with mental illness should be given a chance through empowerment to make important decisions in their lives and play a role in their recovery process. In mental illness, recovery cannot be achieved through passively receiving services wholesomely facilitated by professionals. Empowerment enables the consumer to make choices, become self-determining persons, exert control over their recovery process and accept consequences (Park & Sung, 2013). The service providers should then allow the consumers to set their goals and shouldn’t measure their success by particular predetermined rules. There should be a chance to make relevant decisions and an opportunity to learn from mistakes after failing. This has been identified by studies as an essential element of reliable service provision (Elder, Evans & Nizette, 2009). This principle also helps to correct the learnt helplessness experienced as a result of interacting for a long time with metal health systems. It also serves to boost the consumers self esteem and self-orientation that encourages a quality living. For our consumer, this principle is applied to assist him formulate his goals in life which would assist the care providers to help him live a more meaningful life. This would help to shift their concentration from the illness and concentrate on other aspects of life, which is a big step in the recovery process. To make empowerment possible, the consumer should be provided with skills relevant in making their interaction with nurses and other service providers meaningful, genuine and effective. It calls for a collaborative relationship between the service providers and the individuals allowing negotiation, joint planning for more reliable decision making.

Connectedness / Social Inclusion

Recovery is enhanced by connectedness and social inclusion. This is achieved through establishing social roles through relationships, activities and occupation. People with mental illness have social networks which could either affect them positively or negatively. Social supports reduce the likelihood of symptoms and promote a feeling acceptance in the consumer. This also increases the likelihood of the individual being accessed during stress and reduces psychological distress (Shean, 2009).

Difference between Anosognosia and Denial

Anosognosia is a deficit or a lack of self-awareness such that a person who suffers from a particular disability seems to be unaware of his/her condition. It is caused by damage in the brain caused by schizophrenial disease process. It is often identified by the way the patients respond to questionnaires concerning their health. Patients may also find excuses for not performing particular tasks but they cannot admit it is because of their disability (Breggin, 2009). In some cases, the patient overestimate their performance particularly if interviewed in a first person formed questions but cannot give the same answers if it is interview from a third person. Denial on the other hand is a situation where the consumer or patients understands their problem or condition but are unable to accept the nature of the situation. In the case, study the consumer is affected by anosognosia as the interview indicates that he does not understands that his actions risk his life. In addition, he believes he is okay and his family members have fewer reasons to worry.

Select appropriate interventions that will address the issues of limited insight in a patient with psychotic disorder?

Patients of schizophrenia are greatly associated with a lack of insight in their state or condition which can greatly hinder the recovery process. Due to this, mental health professionals should lay intervention measures to improve the consumer’s insight before proceeding to address other symptoms of the disease (Forbes, 2010). For instance the consumer in the case study finds it unnecessary to take medication for he feels he is okay. To address this problem and increase the consumer’s insight, the mental health professionals should employ several intervention mechanisms to improve the consumer’s insight. This includes improving self reflection, enhancing capacity to “shift set” and reducing SC with an aim of promoting awareness of illness, need for medication, symptoms’, and also awareness of issues with behavioral functioning (Boyd, 2008).

The care providers should avoid efforts to convince the consumer that they are sick as it is hard for these individuals to comprehend that. They should instead focus on the symptoms rather than illness. This helps in achieving the patient’s compliance with taking medication or getting him to participate in other treatment strategies which he can recognize as helpful in controlling the symptoms (Brennaman & Lobo, 2011). As most patients including the consumer in the case study dislike the diagnostic term “schizophrenia”, it is important that clinicians avoid it and rather engage the patient in conversations about feeling paranoid, hearing voices, having insomnia and other symptoms. This is an attempt to enhance compliance.

The clinicians should also focus on other reasons that the consumer can relate to in regard to seeing the doctor or taking medication. It is important to remind them how medication had helped them in the past to relief symptomatic experiences rather than trying to convince them that their perceptions are not true. If the care giver can discover what would motivate the patients to take the medication, highlight the reasons back to the consumers and reflect on perceived benefits; the consumer is more likely to take medication (Drymalski, & Campbell 2009). This goes along with motivational interviewing to reduce resistance from the patients by eliciting the need for change from the patients themselves. The care providers should carefully explain to the patient the need to take medication and stay with them long to ensure that they swallow the medicine. They should also encourage the consumer to express feelings on having chronic illness and emphasize the continued need for medication. This should go hand in hand with efforts to counter the stigma about the patients being seen taking medication (Costal, 2012).

In addition, it is relevant for the care providers to educate the consumer to understand the connection between non-compliance and the worsening of symptoms. If the consumer can identify the benefits of medication, it is more likely for him to comply. It is necessary to discuss the consumers feelings about dependency and convenient times allowing control on non-essentials and limits on essentials. In case of distressing side effects from medication, the care providers should encourage the consumers to feel free to report. This enhances trust in the recovery plan, which in turn promotes hope that lays a great foundation for recovery. If after all the interventions the consumer still prefer to be non-compliant, the care providers should encourage them to provide honest answers about the reasons for such feelings and give a report on the same. It is also important that family members be educated about the patient’s illness, medication and the treatment plan to assist in the patient’s recovery process.

How do those interventions answered above keep the patient safe and co-operative in their own care planning?

These interventions generally help to improve the general functioning and the quality of life of the consumer. This includes reducing the symptoms and the frustrations and making the consumer to feel more accepted. In addition, the interventions help to restore cognitive functioning to recover insight which in turn promotes compliance with medication. Research indicates that individuals with schizophrenia are capable of living a normal life if they commit and have hope in recovery plans (Donohue, 2006). The interventions aim at restoring the consumer’s hope and understanding which enable them to cooperate in their own care planning. This guides the consumer to avoid risky behaviors such as sleeping on the beach and reduces the risk of relapses, recurring symptoms and involuntary hospitalization.

What is the safe evidence based management of a patient’s clinical symptoms?

Clinical symptoms imply other symptoms apart from those of lack of insight. They include visual hallucinations, delusions, and auditory hallucination. It is vital to treat the symptoms instead of the lack of insight. The purpose of the intervention plan is to reduce the symptoms of the disorder. This is done throughAntipsychotic medication aimed at suppressing the dopamine receptor activity (Donohue, 2006). In addition, social and vocational rehabilitation and psychotherapy is important in controlling the disorder. According to the consumers situation in the case study commitment from either parties is quite essential. The nurses have to be committed to the intervention measures aimed at redeeming the consumer’s situations. In addition, the consumer too should show interest, hope and commitment in the intervention measures.

What does recoveries mean to the consumer – is this unique for this individual?

To the consumer recovery implies gaining control over the frustrations and stress and gaining ability to function normally both at home and at work. The consumer also wants to establish good relationship with his family members and other members of his family and find a better place to stay. However, he feels that the medication does not help him and wants to be left to go away from the hospital.

He also wants to feel more accepted and respected. This seems unique to the consumer, yet most individuals affected by schizophrenia display similar interests according to different studies. This also means maintaining hope engaging in active life, understanding ones strengths and weaknesses including ones abilities and disabilities, purpose and meaning in life, social identity, and a positive sense of oneself (Brennaman & Lobo, 2011).

What is the consumer’s view of, and reaction, to treatment?

Even though proper medication is a vital aspect of any successful treatment it could be limited by refusal to take medication prompted by a lack of insight, delusions, denial of illness, and poor relationship with professionals and side effects of medication. The consumer has a negative view of treatment. He feels there is nothing that could be done to help him and the medication does not improve his condition even though family members think so. He explains that he only answers medical practitioners to get them off his back. This could one of the reasons why he does not comply with medication. He even becomes angry and frustrated when his wish to be discharged from the hospital is not granted. He prefers being treated discharged from the hospital to be allowed to continue with his life even though the doctors and family members feel it is not safe. This conforms to the research indicating that persons with schizophrenia have negative attitude towards treatment particularly if they got less insight in their condition (Cardoso & Galera, 2009).

How do the consumers’ complex psychotic features impact on their attitudes, values and beliefs?

The consumer does not seem to understand his condition which puts him a greater risk. His complex psychotic features prompt a negative attitude to any diagnostic results indicating that he has schizophrenia and neither does he take it from friends or family members. This poses a great challenge on establishing the right relationship between the consumer and the supporters and ensuring the supporters are not overworked (Baby, Gupta, & Sagar, 2009). This calls for insisting on guiding the consumer to understand and accept his condition at the preliminary stage of treatment. It is necessary to refer less to schizophrenia at earlier stages of treatment as the consumer is so sensitive to it

What are the difficulties of developing a consumer led focus?

Developing a consumer led focused intervention plan is hindered by the fact that the consumer has little insight in his own condition. For instance he engages in unsafe behaviors such as sleeping on the beach that is only two hours’ drive from his home and does not consider it unsafe. In addition, the consumer believes he does not have schizophrenia and has a negative attitude to any diagnosis that implies so. Even though he was diagnosed with the disorder at the age of 19, he believes it was totally treated yet the symptoms indicate he suffers from the disorder. Another factor hindering an effective consumer led focus is the fact the previous records indicate that the consumer rarely complies with the medical routine and the prescriptions. In this case, the specialists cannot trust him to medicate himself.


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