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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:
1. Determine caregivers’ knowledge of relapse among schizophrenic patients.
2. Determine caregivers’ knowledge of prevention of relapse among schizophrenic patients.
3. Assess caregivers’ knowledge of management of relapse among schizophrenic patients.
4. Ascertain caregivers’ involvement in prevention of relapse among schizophrenic patients.
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