Schizophrenia and type 2 diabetes: Perceptions and understandings of illness management in everyday life

People with schizophrenia and type 2 diabetes face complex challenges in daily life and the management of both illnesses is burdensome. This qualitative interview study aimed to explore perceptions and understandings of the day-to-day management of schizophrenia and type 2 diabetes. Fourteen semi-structured interviews were conducted between January 2020 and October 2021 in the participants' respective mental health clinics, in their homes or by phone. Thematic analysis led to four themes representing participants' self-management strategies and perceived challenges. The first theme showed that participants use self-learned strategies for managing schizophrenia. In contrast, they perceived type 2 diabetes self-management as governed by a set of rules and guidelines given by health professionals. The second theme showed that both psychotic and negative symptoms present challenges to diabetes management. Theme 3 illustrated that participants consider their type 2 diabetes to be a very serious illness. They worried about potential long-term consequences and expressed wishes and motivation to improve their lifestyle. The final theme showed that participants discuss challenges related to their schizophrenia with family and friends but not type 2 diabetes. In conclusion, this study highlights the importance of considering individual challenges and everyday routines when supporting this population. It underlines the need for future research to further explore the complexity of managing the illnesses and to understand the needs for treatment and support.     

“Moving forward despite adversity”: The lives of Korean older adults with schizophrenia

IntroductionOlder adults with schizophrenia experience aging-related challenges and chronic psychiatric difficulties. However, their uniqueness is understudied.AimThis study explored three life stories to illuminate schizophrenia's trajectory.MethodA narrative inquiry method was used to elicit rich narratives in chronic patients' lives. Two men and one woman suffering from chronic schizophrenia for more than 20 years were engaged in conversation three times.ResultsThe analysis revealed one main theme expressing their fundamental perspective on their lives: “moving forward despite adversity.” Three subthemes emerged: living with the mental disorder, giving and receiving support, and adaptation to old age. They reflected on their interpersonal relationships, failures, and successes in the context of the challenges of schizophrenia. They indicated adapting to schizophrenia, exchanging social support with loved ones, and meeting aging-related challenges with confidence. They were hopeful about brighter personal futures than their pasts.DiscussionFamily and community supports were very important; self-acceptance positively influenced their successful community living.Implications for practiceFor effective long-term treatment of older adults with schizophrenia, mental health policies should focus on meeting the social needs of patients and families and reorient programs away from the medical model limited to symptom reduction.     

Narrative enrichment in the psychotherapy for persons with schizophrenia: a single case study

Recovery from schizophrenia may involve persons developing a renewed sense of their illness, identity, agency, and worth within their life stories. To explore the requirements and challenges of psychotherapy that could facilitate this, we present a case study of a person with schizophrenia enrolled in treatment for over 19 months. Observed challenges to this process include the therapist's inclinations to "fix" the client, the client's own deficits and symptoms, and discomfort within the therapeutic relationship. Techniques to address these difficulties are presented, along with an objective means of assessing the treatment outcomes in terms of changes in narrative processes.     

Meaning of resilience as described by people with schizophrenia

The aim of the present study was to understand the meaning of resilience, as described by people with schizophrenia. Building resilience is a component of recovery‐oriented mental health care, and yet almost no research has been conducted into the resilience of people who live with schizophrenia and who are routinely considered vulnerable. Establishing the meaning of resilience in the context of schizophrenia is an important first step in building understanding. van Kaam's psychophenomenological method was used to interpret 14 interviews with people with schizophrenia who are currently well and living in the community. Resilience is invoked in the tension between opposing forces of challenge and support and in the act of ‘striving’ to take control of schizophrenia. Striving includes repeated, seemingly backwards steps, and during this, the person takes risks and seeks out and uses supportive people and resources. Those same supportive people and resources can also be challenging. Resilience is an energy embedded in the process of recovery from schizophrenia, and is manifest in an attitude of striving. Taking on challenges and engaging in risk is important within treatment and recovery from schizophrenia.     

African American Males Diagnosed with Schizophrenia: A Phenomenological Study

Little is known about how African American men with schizophrenia experience their every day existence. Through applying interpretive phenomenology and using a methodological structure designed by van Manen (1990, 1997), this research aimed to enrich the current understanding of what it is like for these African American males to live with schizophrenia. In this study, five men ranging in age from 21 to 57 described their lives within the context of existing with the diagnosis of schizophrenia. The lived experiences across the interviews revealed four overarching themes: They know that they are mentally ill; they make a special effort to test reality; they assert their autonomy and; they experience reality differently, which they see as a gift. To provide appropriate treatment support to African American males diagnosed with schizophrenia, it is important to recognize the clients’ ability to assert their autonomy and appreciate each man's view of himself as unique and special. Moreover, in terms of symptom management, it is pivotal to understand that although the client may not be free of hallucinations and delusions, he nevertheless may be at his optimum state of wellness. The realization that these men have transcended their diagnosis of schizophrenia rather than being crushed by their condition is evident in their stories.     

COVID-19 coping experiences of individuals with schizophrenia: A grounded theory approach in Korea

Humankind has responded to the profound medical, economic, social, and cultural consequences of coronavirus disease 2019 (COVID-19) by employing various strategies. However, although individuals with mental disorders, including schizophrenia, have suffered more challenges from the infectious disease spread, they have received inadequate attention and care. Hence, this study aimed to explore the experiences of individuals with schizophrenia coping with COVID-19; one-to-one interviews were conducted with 17 individuals diagnosed with schizophrenia in Korea. The data were analysed using grounded theory methodology. The results showed that individuals with schizophrenia became distanced from the routine care they received before COVID-19, faced a dual threat from their mental illness and the emerging infectious disease, and experienced inequity and paradoxical situations. Nevertheless, they strived to live their daily lives by utilizing non-face-to-face access, seeking support from mental health professionals, and devising self-help measures. Moreover, reflecting on their lives throughout the pandemic after returning to their regular daily lives provided an opportunity for healing and growth. This study's results can provide evidence for treating individuals with schizophrenia and other mental disorders during subsequent infectious disease spread. Practical policies and interventions tailored to their vulnerabilities are required.     

EMBODIMENT OF SEVERE AND ENDURING MENTAL ILLNESS: FINDING MEANING IN SCHIZOPHRENIA

For many individuals, schizophrenia is a severe and enduring illness. While nurses need to understand the symptomatology of the illness in order to provide specific care and treatment, it also is important to find out how people with schizophrenia embody the illness. Capturing this knowledge will help nurses to provide more appropriate care to these individuals. This paper, which is taken from a larger qualitative study, reports the lived experience of young adults with schizophrenia. Three main themes emerged from the data, which highlighted how these individuals found meaning in schizophrenia. The first theme, “embodied temporality: illness as a catastrophic experience,” portrayed how schizophrenia affected participants' temporality or lived time. The second theme, “embodied relationality: illness as a mediator of social relationships,” reflected how the illness affected their relationships with others. The third theme, “embodied treatment: medications side effects as burdensome,” illustrated how the side effects of antipsychotic medications distorted the individual's perception of his or her body and how it compromised the ability to establish and maintain sexual relationships. The findings are important to mental health nurses because they highlight the need to be sensitive to how people with schizophrenia find meaning in their illness experience and to incorporate this knowledge into the care that they provide.     

Home‐visit nurses' attitudes for providing effective assistance to clients with schizophrenia

There were two objectives of this study. The first was to identify the attitudes of home‐visit nurses towards clients with schizophrenia that lead to the provisions of effective care and positive client outcomes for clients with schizophrenia. The second was to develop a framework to understand how nurses acquire nursing attitudes that lead to such provisions. Seven expert home‐visit nurses who had successfully prevented rehospitalization of clients with schizophrenia for more than 2 years were interviewed. In the semistructured interviews, the nurses described their experiences in assisting one or two clients. Data were analyzed qualitatively. The central theme was having equal footing with the client. An effective nursing attitude was acquired through recognizing one's own preconceptions of clients with schizophrenia through two steps: encountering unexpected client behaviours and becoming aware of one's problematic care. For these clients, it was essential that the nurses reflect on their preconceptions towards clients with schizophrenia and alter these preconceptions by working with the clients and believing in their innate ability to live in the community. The findings suggest that the field of mental health home‐visit nursing might benefit from adding these educational components in order to cultivate effective nursing attitudes for assisting clients with schizophrenia.     

Medical illnesses in people with schizophrenia

The physical health of people with schizophrenia is poor, and the challenges in finding effective treatment and optimizing health outcomes are significant. However, it is likely that people diagnosed with schizophrenia can be partners in the treatment of their physical health problems. Research suggests that many people with schizophrenia value physical health and will participate in health-related behaviors when they are provided with the opportunity to do so.     

Effectiveness of family interventions for patients with schizophrenia: A systematic review and meta-analysis

The family is the primary caregiver for most patients with schizophrenia, and their roles are essential in patients' illness trajectories and outcomes. Due to this, various family interventions for schizophrenia have been developed and applied to the relatives who take care of their family members with schizophrenia. This study examined the effectiveness of existing family interventions for schizophrenia in achieving their target outcomes at both the family and patient levels by utilizing a systematic review and meta-analysis. Combinations of terms were used to search for relevant studies from the databases. Thirty-seven randomized controlled trials that met the inclusion criteria were included in the analysis. Based on the pooled result of the included studies, the programmes significantly improved the targeted outcomes with large effect size. The programmes' impacts on family-related outcomes were higher than those on patients. Among the targeted outcomes, patients' treatment satisfaction and adherence and family caregivers' mental health were the most remarkable outcomes that had improved from the included programmes. Conversely, outcomes related to family relationships, caregiving experiences, perceived social support of family caregivers, and patients' medication use did not see significant improvements. The programmes delivered to individual family units and only to the family caregivers were more effective than those delivered to groups of caregivers and caregivers and patients together, respectively. Programme-focused interventions were more effective than emotion-focused ones. Based on these findings, an in-home visiting nurse programme or advanced technology is suggested when applying family interventions for schizophrenia in practice.     

From the Editor—Inadequate Treatment of Adolescent Mental Disorders

Relationships are critical to a woman's growth and development, yet when living with serious mental illness, developing and nurturing connections can be challenging. This qualitative study explored the nature and quality of support provided within relationships for 14 women with schizophrenia. Families were key supporters. Female friends with mental illness often provided a meaningful source of connection for participants. Problematic relationships, losses over time, and living in poverty were among the barriers to receiving needed support. Participants conveyed a sense of wanting relational reciprocity as they talked about their relationships and place within the community.     

精神分裂症恢复期患者对复发经历的真实感受

目的：了解精神分裂症恢复期患者对复发经历的真实感受及对复发影响因素的认识。方法：采用现象学研究方法,结合个人访谈及观察法,对赤峰市10名精神分裂症恢复期患者进行研究,应用Colaizzi分析法分析资料。结果：深入挖掘精神分裂症恢复期患者对复发的感受及认识,持续分析并提炼出3个主题：对复发及影响因素的认识、疾病复发后压力的感知、不良感受的调节。结论：研究结果可为预防精神分裂症的复发提供参考,为精神科护士针对精神分裂症患者实施个性化的管理和干预提供科学依据。     

Tool Development for Profiling the Attitude of Clients with Schizophrenia Toward Their Medication,Using Fishbein's Expectancy-Value Model

Many treatment-evaluation studies have demonstrated the value of psychotropic medication in controlling symptoms of schizophrenia. However, the presence of an effective treatment has not solved the treatment problem. Clients with schizophrenia are unusually resistant to participation in a treatment regimen. Fishbein (1963) and Fishbein and Ajzen (1975) present an expectancy-value model that provides a method for profiling a person's attitude toward any object (an object can be a person, place, idea, etc.). This study describes the model and considers dynamics of schizophrenia that must be considered in data collection. Implications of the model for data collection with the client with schizophrenia are discussed, and tools for measuring the attitude of inpatients toward taking medication are presented.     

Unlocking the Doors: How Fundamental Changes in Residential Care Can Improve the Ways We Help Children and Families

This article describes the organizational change effort that took place in a residential treatment facility for teenagers with serious emotional and behavioral challenges. The new service-delivery model is based on a nationwide effort to transform residentially-based services, which includes (1) short-term, intensive residential treatment with parallel community-based services to promote the youth's fastest possible return to a less restrictive setting, as well as to help parents or other primary caregivers to maintain or develop a connection with the child and prepare for the child's return; (2) aftercare services to support the stability of the child and family following reunification or transition to family-based care; (3) improvements in the service delivery decision-making pathway; and (4) better integration of residentially based services within a county's continuum of care. This new model requires programmatic changes, as well as an organizational systems and culture change, for agencies providing services to youth and families. The article documents the stages of preparing for change, the processes used to implement change and the organizational conditions that supported the change process, along with initial outcomes for the clients and their families, one year later.     

The experience of South American mothers who have a child being treated for malignancy in the United States

This phenomenological study examined the experience of South American mothers who brought their children to the United States for cancer treatment. Five mothers were interviewed twice about their subjective experiences. Data were analyzed using Colaizzi's method of phenomenology. Thirty-two significant statements were grouped into eight themes. The South American mothers brought their children to the United States in hopes of finding effective treatment, illustrating the major theme of our findings that no effort or sacrifice was too great to save their children's lives. The diagnosis of cancer had an over-whelming impact on the child and the family. This was made worse by the uncertainty of treatment outcome. Although the decision to come disrupted family life and caused economic and cultural hardship, it was uniformly believed to have been the right decision. The greatest challenges experienced by the mothers were language difficulties and the constant preoccupation with the child's illness. Through faith and a variety of coping strategies, these South American mothers succeeded in adapting. They transcended life disruption and focused on the critical goal of restoring their child's health. Central to their experience is that everything humanly possible be done to preserve the life of their child.     

Vesicular monoamine transporters: Structure‐function,pharmacology, and medicinal chemistry

Vesicular monoamine transporters (VMAT) are responsible for the uptake of cytosolic monoamines into synaptic vesicles in monoaminergic neurons. Two closely related VMATs with distinct pharmacological properties and tissue distributions have been characterized. VMAT1 is preferentially expressed in neuroendocrine cells and VMAT2 is primarily expressed in the CNS. The neurotoxicity and addictive properties of various psychostimulants have been attributed, at least partly, to their interference with VMAT2 functions. The quantitative assessment of the VMAT2 density by PET scanning has been clinically useful for early diagnosis and monitoring of the progression of Parkinson's and Alzheimer's diseases and drug addiction. The classical VMAT2 inhibitor, tetrabenazine, has long been used for the treatment of chorea associated with Huntington's disease in the United Kingdom, Canada, and Australia, and recently approved in the United States. The VMAT2 imaging may also be useful for exploiting the onset of diabetes mellitus, as VMAT2 is also expressed in the β‐cells of the pancreas. VMAT1 gene SLC18A1 is a locus with strong evidence of linkage with schizophrenia and, thus, the polymorphic forms of the VMAT1 gene may confer susceptibility to schizophrenia. This review summarizes the current understanding of the structure–function relationships of VMAT2, and the role of VMAT2 on addiction and psychostimulant‐induced neurotoxicity, and the therapeutic and diagnostic applications of specific VMAT2 ligands. The evidence for the linkage of VMAT1 gene with schizophrenia and bipolar disorder I is also discussed. © 2010 Wiley Periodicals, Inc. Med Res Rev 31: 483‐519, 2011     

Personalised Medicine and Medical Imaging: Opportunities and Challenges for Contemporary Health Care

This commentary offers a contemporary perspective on personalised medicine (PM) within diagnostic radiography. PM refers to the use of a person's genetic information in tailoring strategies for the detection, treatment, or prevention of disease. Some key issues are raised in light of this new specialty and how it may affect diagnostic imaging. First, technological and commercial drivers are outlined, supported with ethical considerations. The authors then offer some future challenges that remain evident within the literature. The aim of this article is to begin to acknowledge the importance of PM, but most importantly, identify aspects where diagnostic imaging plays a pivotal role.     

Shared decision making: A dual‐layer model to tackling multimorbidity in primary care

It is common for primary care providers (PCPs) to manage complex multimorbidity. When caring for patients with multimorbidity, PCPs face challenges to tackle several issues within a short consultation in order to address patients' complex needs. Furthermore, some PCPs may lack access to a multidisciplinary team and need to manage multimorbidity within the confine of a PCP‐patient partnership only. Instead of attempting to address multiple health issues within a single consultation, it would be more feasible and time effective for PCPs and patients to jointly prioritize the health issue to focus on. Using the Malaysian primary care setting as a case study, a dual‐layer‐shared decision‐making approach is proposed whereby PCPs and patients make decisions on which disease(s) (layer 1) and treatment(s) (layer 2) to prioritize. This dual‐layer model aims to address the challenges of short consultation time and limited healthcare resources by encouraging PCPs and patients to discuss, negotiate, and agree on the decision during the consultation to ensure patients' health needs are addressed.     

Agency and Addiction in a Harm Reduction Paradigm: French Nurses' Perspectives

French psychiatric nurses' perspectives on individuals addicted to drugs and their treatments are influenced by French socio-cultural norms. In this study, steps of the ethnographic method were used to elicit the intertwining of French professional and cultural perspectives on drug addiction. Emergent themes from nurses' interviews and cultural participant-observations suggest that drug addiction management in France's harm reduction paradigm challenges nurses' beliefs about addicted individuals' agency and conformity to treatment goals, and is influenced by European Union membership, changes in health care, drugs and demographics. Novel nursing strategies emergent from these themes might be applicable in other cultural contexts.     

THE ETHICAL DIMENSIONS OF DELIVERING CULTURALLY CONGRUENT NURSING AND HEALTH CARE

This study investigated patients' expectations prior to participation in an education program about coping with schizophrenia, and their evaluations of the program upon its completion. Adult inpatients diagnosed with schizophrenic disorders (N = 123) responded anonymously to a preintervention expectation measure, and a postintervention evaluation questionnaire. Results point to high expectations of this illness self-management education program, and a high level of satisfaction upon its completion, with a self-fulfilling prophecy effect, in which those with high expectations later reported greater satisfaction. Patients perceived, however, a differential level of helpfulness of the program's nine content areas, and rated learning about diagnosis and medication management as most helpful. Content areas that were rated less helpful included prevalence of schizophrenia, its psychosocial rehabilitation, and use of community resources. Implications for clinical practice in patient education are identified and discussed.