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Importance of Collaborative Approaches to Care Coordination for Persons with Schizophrenia

Schizophrenia is characterized as a severe mental health disorder in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior that impairs daily functioning, and can be disabling. Schizophrenia is a cyclical disease characterized by multiple psychotic relapses. Unfortunately, schizophrenia is a chronic condition, requiring lifelong treatment.

Clinical Features of Schizophrenia Include:

Positive Symptoms
• Hallucinations (auditory, visual, tactile, olfactory, gustatory)
• Delusions
• Grossly disorganized or catatonic behavior

Negative symptoms
• Flat or blunted affect
• Difficulty speaking or even an inability to speak (alogia)
• Inability to experience pleasure (anhedonia)
• Lack of desire to form relationships (asociality)
• Lack of motivation (avolition)
• Inappropriate social responses to normal social cues
• Lack of interest in most aspects of life
• Inappropriate bodily movement

Functional impairment
• Work Interpersonal relations, difficulty engaging and responding to others
• Self-care (maintenance of appropriate ADL’s)
• Apathy

Cognitive impairment
• Episodic memory
• Executive function
• Working memory

Mental health decompensation or relapse can be extremely difficult for the sufferer as well as the people that love them. Although, a return of mental health symptoms can appear “out of the blue”, most relapses have warning signs, signaling symptom re-emergence. Friends and loved ones that recognize the signs and symptoms of schizophrenia can help to prevent relapse. Loved ones that are aware of the risk factors associated with mental health decompensation can greatly reduce the likelihood of relapse. Preventing a relapse is important as it can create problems and interferences with work, school, and relationships. In most cases, you can treat a relapse and get the disease back under control. However, each relapse makes the disease harder to treat. That’s why it’s important to recognize and prevent a relapse whenever you can.

Risk Factors Associated with Relapse Include:
• Failure to adhere to medication regimen, discontinuance, or change in medication
• Increase in physical or emotional stress
• Abuse of alcohol or drugs

Prodromal (or early stage) signs, which often precede a psychotic episode by 2 or more days, include sudden onset of:
• Interruptions in sleeping or eating patterns
• Restlessness or irritability
• Tension
• Anxiety
• Memory or cognition issues
• Depression

Risk Factors Associated with Disengagement from Mental Health Services Include:
• Lack of established outpatient clinician
• Lack of prior outpatient mental health care
• Short inpatient stay
• Ethnicity
• Involuntary patient admission/hospitalization
• Poverty
• Discharge against medical advice
• Substance/alcohol abuse
• Lack of involvement in treatment decisions
• Transportation difficulties

Adherence Barriers to Overcome

Patient Related
• Lack of or poor insight
• Cultural and religious beliefs
• Language skills
• Lack of social and familial support
• Comorbidities
• Cognitive limitations or deficits
• Stigma

Medication Related
• Poor or inconsistent medication adherence
• Efficacy
• Side effects–actual or fears
• Complex medication regimen
• Lack of perceived benefits
• Poor therapeutic alliance

Treatment of mental illness and decompensation should include a collaborative approach between mental health professionals, hospital staff, the patient, family members, and the community aftercare agencies. Persons struggling with schizophrenia benefit from a solid support system and consistency. By involving all pertinent people and health care providers the likelihood of decompensation and symptom re-emergence can be avoided or greatly reduced.

Persons struggling with schizophrenia possess unique challenges that need to be addressed by the treatment teams that work with them. By utilizing a collaborative approach to treatment stabilization of symptoms is more likely to occur, allowing those with schizophrenia to remain actively engaged with their community and access to appropriate services.