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UNIT 3 ■ Care of Patients With Psychiatric Disorders
The recovery model has been used primarily in car- ing for individuals with serious mental illness, such as schizophrenia and bipolar disorder. However, con- cepts of the model are amenable to use with all indi- viduals experiencing emotional conditions with which they require assistance and who have a desire to take control and manage their lives more independently. Weiden (2010) identifies two types of recovery with schizophrenia: functional and process. Func- tional recovery focuses on the individual’s level of functioning in such areas as relationships, work, independent living, and other kinds of life function- ing. The individual may or may not be experiencing active symptoms of schizophrenia. Weiden (2010) suggests that recovery can also be considered as a process. With process recovery , there is no defined end point, but recovery is viewed as a process that continues throughout the individual’s life and involves collaboration between client and clinician. The individual identifies goals based on personal values or what they define as giving mean- ing and purpose to life. The clinician and client work together to develop a treatment plan that is in align- ment with the goals set forth by the client. In the process recovery model, the individual may still be experiencing symptoms. Weiden states: Patients do not have to be in remission, nor does remission automatically have to be a desired (or likely) goal when embarking on a recovery-oriented treatment plan. As long as the patient (and family) understands that a process recovery treatment plan is not to be confused with a promise of “cure” or even “remission,” then one does not overpromise. The concept of recovery in schizophrenia remains controversial among clinicians, and many challenges lie ahead for continued study. Recovery models have similarities with ACT in that they both necessarily engage the support of multiple resources, but recov- ery models also highlight the dimension of active engagement and empowerment of the client in deci- sion making. Some argue that this approach is dif- ficult to implement when clients lack insight about their illness or the need for treatment. Furthermore, there is a lack of consistency in what constitutes “recovery,” and many concepts exist. One of the identified QSEN competencies is patient-centered care and despite the controver- sies about the recovery model approach, the hope is that as these models become better studied and more clearly defined, they will provide a treatment approach that is comprehensive, protective, and supportive of patient-centered care.
RAISE (Recovery After an Initial Schizophrenia Episode) The RAISE approach to treatment for schizophrenia is based on a large National Institute of Mental Health (NIMH) initiative that began in 2008. Research find- ings published in 2015 have demonstrated several benefits of this approach. Kane and associates (2015, p. 2) describe the RAISE approach as follows: The premise of the NIMH RAISE-ETP (Early Treat- ment Program) is to combine state-of-the-art phar- macologic and psychosocial treatments delivered by a well-trained, multidisciplinary team, in order to significantly improve the functional outcome and quality of life for first episode psychosis patients. The RAISE approach incorporates many elements from other treatment approaches, including com- munity treatment, recovery model approaches, fam- ily approaches, and comprehensive care models. It adds the dimension of early intervention at the first episode of psychosis. The research findings after 5 years of studying this approach look very prom- ising for improving care to this population when intervention begins at the earliest onset of psychotic symptoms. Positive outcomes have included greater adherence to treatment programs; greater improve- ment in symptoms, interpersonal relationships, and quality of life; more involvement in employment or educational pursuits; and less frequent hospitaliza- tions than are seen for clients involved in more tradi- tional treatment approaches (Kane et al., 2015). The hope for this approach to treatment is that, through early and comprehensive intervention, the long-term, debilitating consequences of schizophre- nia can be averted or minimized. Psychopharmacological Treatment Chlorpromazine (Thorazine) was first introduced in the United States in 1952. At that time, it was used in conjunction with barbiturates in surgical anesthe- sia. With increased use, the drug’s psychic properties were recognized, and by 1954 it was marketed as an antipsychotic medication in the United States. The manufacture and sale of other antipsychotic drugs followed in rapid succession. Antipsychotic medications are also called neuro- leptics and historically were referred to as major tran- quilizers. They are effective in the treatment of acute and chronic manifestations of schizophrenia and in maintenance therapy to prevent exacerbation of schizophrenic symptoms. A meta-analysis of studies (Takeuchi et al., 2017) evaluating the benefits of maintenance antipsychotic medication found that
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