SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
Mr.JOBIN NINNAN
I YEAR M .Sc NURSING
MENTAL HEALTH NURSING
2012-2014
THE ADITYA COLLEGE OF NURSING
#12, KOGILU MAIN ROAD, YELAHANKA,
BANGALORE – 560064
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PERFORMA FOR REGISTRATION OF SUBJECTSFOR DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS / JOBIN NINNAN,1ST YEAR MSc NURSING
THE ADITYA COLLEGE OF NURSING #12, KOGILU MAIN ROAD, YELAHANKA,BANGALORE – 560064
2 / NAME OF THE INSTITUTION / THE ADITYA COLLEGE OF NURSING #12, KOGILU MAIN ROAD, YELAHANKA,BANGALORE – 560064
3 / COURSE OF STUDY AND SUBJECT / DEGREE OF MASTER OF SCIENCE IN MENTAL HEALTH NURSING.
4 / DATE OF ADMISSION TO COURSE / 15-06-2012
5 / TITLE OF THE TOPIC / “A STUDY TO ASSESS THE SELF CARE ABILITY AND MENTAL STATUS AMONG SCHIZOPHRENIC PATIENTS UNDERGOING OCCUPATIONAL THERAPY IN PSYCHIATRIC DEPARTMENTS OF SELECTED HOSPITALS IN BANGALORE.
6.0 BRIEF RESUME OF THE INTENDED WORK
6.1INTRODUCTION
A mental disorder or mental illness is a psychological or behavioral pattern that occurs in an individual and is thought to cause distress or disability that is not expected as part of normal development or culture. Mental disorders have been found to be common, with over a third of people in most countries reporting sufficient criteria for Mental illness at some point in their life.1
Schizophrenia is a mental disorder that makes ithard to Tell the difference between what is real and not real, Think clearly, Have normal emotional responses, Actnormally in social situations. Schizophrenia is a complex illness. Mental health experts are not sure what causes it. 2
Schizophrenia affects both men and women equally. It usually begins in the teen years or young adulthood, but it may begin later in life. It tends to begin later in women, and is more mild. Childhood-onset schizophrenia begins after age 5. Childhood schizophrenia is rare and can behard to tell apart from other developmental problems in childhood, such as autism.3
Schizophrenia is a major cause ofdisability, with active psychosis ranked as the third-most-disabling condition afterquadriplegiaanddementiaand ahead ofparaplegiaandblindness.4Approximately three-fourths of people with schizophrenia have ongoing disability with relapses5and 16.7million people globally are deemed to have moderate or severe disability from the condition.6Some people do recover completely and others function well in society.7Most people with schizophrenia live independently with community support.8In people with a first episode of psychosis a good long-term outcome occurs in 42%, an intermediate outcome in 35% and a poor outcome in 27%.9 Outcomes for schizophrenia appear better in thedevelopingthan thedeveloped world.10These conclusions, however, have been questioned.11,12
Schizophrenia affects around 0.3–0.7% of people at some point in their life,8or 24million people worldwide as of 2011.13It occurs 1.4times more frequently in males than females and typically appears earlier in men14—the peak ages of onset are 20–28 years for males and 26–32 years for females10Onset in childhoodis much rarer,11as is onset in middle- or old age.12Despite the received wisdom that schizophrenia occurs at similar rates worldwide, its prevalence varies across the world,15within countries,16and at the local and neighborhood level.17It causes approximately 1% of worldwidedisability adjusted life years.The rate of schizophrenia varies up to threefold depending on how it is defined.8
Personal health depends partially on the active, passive, and assisted cues people observe and adopt about their own health. These include personal actions for preventing or minimizing the effects of a disease, usually a chronic condition, throughintegrative care.18Personal health also depends partially on the social structure of a person's life. The maintenance of strongsocial relationships,volunteering, and other social activities have been linked to positive mental health and even increased longevity. One American study amongseniorsover age 70 found that frequent volunteering was associated with reduced risk of dying compared with older persons who did not volunteer, regardless of physical health status.19
Occupational therapy(also abbreviated as OT) is the use of treatments to develop, recover, or maintain the daily living and work skills of patients with a physical, mental or developmental condition.20 Occupational therapy is a client-centered practice in which the client has an integral part in the therapeutic process. The occupational therapy process includes an individualized evaluation during which the client/family and occupational therapist determine the individual’s goals; a customized intervention to improve the person’s ability to perform daily activities and reach his/her goals; and an outcomes evaluation to monitor progression towards meeting the client’s goals.21Occupational therapy interventions focus on adapting the environment, modifying the task, teaching the skill, and educating the client/family in order to increase participation in and performance of daily activities.
Occupational therapists help individuals with mental illness acquire the skills to care for themselves or others including the following: 22
- schedule maintenance
- routine building
- coping skills
- medication management
- employment
- education
- community access and participation
- social skills development
- leisure pursuits
- money management
- childcare
6.2NEED FOR THE STUDY
Schizophrenia is a chronic, severe, debilitating mental illness that affects about 1% of the population, more than 2 million people in the United States alone. The incidence of schizophrenia (and other similar disorders where hallucinations and delusions are the dominant feature) still showed variation between neighborhoods after taking into account age, sex, ethnicity and social class. Three environmental factors predicted risk of schizophrenia -- increased deprivation (which includes employment, income, education and crime) increased population density, and an increase in inequality (the gap between the rich and poor).
The study suggested that a percentage point increase in either neighborhood inequality or deprivation was associated with an increase in the incidence of schizophrenia and other similar disorders of around 4%.
The study also found that risk of schizophrenia in somemigrant groups might depend on the ethnic composition of their neighborhood. For black African people, the study found that rates tended to be lower in neighborhoods where there were a greater proportion of other people of the same background. By contrast, rates of schizophrenia were lower for the black Caribbean group when they lived in more ethnically-integrated neighborhoods. These findings support the possibility that the socio-cultural composition of our environment could positively or negatively influence risk of schizophrenia and other similar disorders.
In the International Pilot Study of Schizophrenia 23 and the Determinants of Outcome of Severe Mental Disorders study 24, catatonia (a form of schizophrenia characterized by a tendency to remain in a fixed stuporous state for long periods) was diagnosed in 10% of cases in developing countries compared with less than 1% in developed countries. Hebephrenia (a form of schizophrenia characterized by severe disintegration of personality) was present in 13% of cases in developed countries and 4% in developing countries. These differences in the disease in developed versus developing countries indicate that there is more to the prevalence of schizophrenia than simple epidemiological data. Better prognosis in developing countries may indicate different sets of aetiological and perpetuating factors .25
In India, where about 1.1 billion people reside, the prevalence of schizophrenia is about 3/1000 individuals.26 It is more common in men, and in terms of age of onset, men tend to be younger by an average of about five years than women when they develop schizophrenia. In terms of symptomatology, overall men with schizophrenia tend to have more negative symptoms, whereas women exhibit more affective symptoms. 27
A cohort study was conducted in Thirthahalli taluk of Shimoga District,Karnataka with the help of IDEAS (Indian Disability Evaluation and Assessment Scale). The point prevalence of schizophrenia in this study was 1.6 per thousand.28
6.3REVIEW OF LITERATURE
Review of literature is a systemic identification and summary of written materials that contain information on research problems. It is key step in research . It refers to an extensive, exhaustive and systemic examination of publications relevant to research project.
- Studies related to self care abilities among schizophrenia patients.
- Studies related to occupational therapy among schizophrenia patients.
Studies related to self care abilities among schizophrenia patients.
Hamidreza Khankeh etal 2011 A quasi-experimental study, using a hospital based accessible sampling method. Participants included 60 schizophrenic patients who were randomly divided into two groups of intervention and control (30 patients in each group). There was a significant difference between the self-care abilities after intervention (from month 1 to month 6) in the intervention group compared with the controls. It means that conducting a discharge plan, education and follow-up increased the self-care abilities of the participants in the intervention group compared with themselves and control group members.29
Madhumitha Balaji etal 2012 The study aimed to develop a lay health worker delivered community based intervention in three sites in India. This paper describes how the intervention was developed systematically, following the MRC framework for the development of complex interventions. They reviewed the lierature on the burden of schizophrenia and the treatment gap in low and middle income countries and the evidence for community based treatments, and identified intervention components. Then evaluated the acceptability and feasibility of this package of care through formative case studies with individuals with schizophrenia and their primary caregivers and piloted its delivery with 30 families.30
Chatterjee S etal 2012 The trial is a multi-site, parallel group randomized controlled trial design in India.The trial will be conducted concurrently at three sites in India where persons with schizophrenia will be screened for eligibility and recruited after providing informed consent. Trial participants will be randomly allocated in a 2:1 ratio to the CCBC+FBC and FBC arms respectively using an allocation sequence pre-prepared through the use of permuted blocks, stratified within site. The structured CCBC intervention will be delivered by trained lay community health workers (CHWs) working together with the treating Psychiatrist. We aim to recruit 282 persons with schizophrenia. The primary outcomes are reduction in severity of symptoms of schizophrenia and disability at 12 months. The study will be conducted according to good ethical practice, data analysis and reporting guidelines.31
Patterson TL,Klapow JC etal 1998studieshave directly assessed functional capacity in psychiatricpatients, especially older ones who may be at an increased risk for disability. Subjects were 102 middle-aged and elderly outpatients with DSM-III-R or DSM-IV diagnosis ofschizophreniaor schizoaffective disorder, and 66 normal comparison subjects, ranging in age from 45 to 86. The Direct Assessment of Functional Status (DAFS), a standardized measure of behavior during simulated daily activity tasks (i.e. time orientation, communication, transportation, finance, shopping, grooming and eating) was used to quantify levels of disability. Schizophrenicpatientsdemonstrated significantly greater disability than normal subjects. An evaluation of specific behaviors indicated that thepatientswere significantly more limited than comparison subjects across all subscales of the DAFS except for grooming and eating. The DAFS is a useful instrument for characterizing functionalabilitiesin olderpatientswithschizophrenia. Our findings of significant functional disability in older schizophrenicpatientshave implications for treatment as well as allocation of health-careresources.32
Pan YJ, etal 2009The study to associate patterns between affect recognition and basic neurocognitiveabilitiesin 40 acute and 33 stablepatientswithschizophrenia were compared to explore whether their interrelationships changed across clinical stages. The independent contribution of affect recognition deficits to social dysfunction was explored by multivariate models controlling for general intellectual ability, basic neurocognition, and clinical symptoms.Affect recognition deficits were associated with social role performances,self-care, and contributed independently to global social functioning in stablepatientsbut not in acutepatients. Conversely, affect recognition deficits were associated with impaired basic neurocognition in acutepatientsbut not in stablepatients.33
Sawicka M etal 1997To assess the level of knowledge and skills onself-careabilitieshas been examined among the group of 30 long-termpatientssuffering fromschizophrenia. The research has been made four times during the period of 18 months after the training session had been completed. The final results show that three months duration of the training session exerts influence on the progress in learning and change of the view point. However, little change is observed as regards the daily functioning ofpatients.34
Studies related to occupational therapy among schizophrenia patients
Mohamed S, etal 2008 the study to evaluate the association of neurocognition and symptoms with measures of social andoccupationalfunctioning in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE). Symptoms of 1,386patientswere measured with the positive syndrome scale of the Positive and Negative Syndrome Scale (PANSS) and a PANSS negative symptom scale that eliminated items that most overlap with measures of community functioning or neurocognition.The result was symptoms and neurocognition were associated with quality of life in bivariate correlation analyses. Symptoms contributed more to the incremental explained variance in quality of life than did neurocognitive functioning, but both kinds of measures was significantlyrelatedto quality of life. In an analysis including only the positive syndrome scale, the increased explained variance in quality of life was about equal to that associated with neurocognition. Both psychotic symptoms and neurocognitive deficits appear to contribute independently to decreased quality of life in schizophrenia.35
Lewandowski L, etal 1992 conducted a Study evaluates the concept ofoccupational therapyfor schizophrenic outpatients. Preliminary results from 18patientssuggest thatoccupational therapyfor outpatients might contribute to an improvement in cognitive-adaptive functions and open up ways for further integration on the job market. The prognosis was favorable when the outset ofoccupational therapywas not equated with a rise in the level of professional adaptation and a certain approachability and flexibility were to be observed in cognitive, affective and intentional aspects among the chronic schizophrenicpatients. With regard to cognitive functions and to professional adaptation, it proved more favourable foroccupational therapyto be carried out within the framework of regular service enterprises (externaloccupational therapy, n = 9) and not within training areas of the psychiatric institution itself (internaloccupational therapy, n = 9).Patientstaking part in internaloccupational therapyfelt more heavily burdened by workplace conditions, and greater family-relatedstrain seemed to develop in the therapeutic centre than was the case amongpatientstaking in externaloccupational therapy.36
Liberman RP etal 1998 reported that The community functioning of outpatients with persistent forms of schizophrenia after treatment with psychosocial occupational therapy or social skills training, with the latter conducted by paraprofessionals. Eighty outpatients with persistent forms of schizophrenia were randomly assigned to receive either psychosocial occupational therapy or skills training for 12 hours weekly for 6 months, followed by 18 months of follow-up with case management in the community. Antipsychotic medication was prescribed through "doctor's choice" by psychiatrists who were blind to the psychosocial treatment assignments. Patients who received skills training showed significantly greater independent living skills during a 2-year follow-up of everyday community functioning.37
Reker T,Eikelmann B. 1998 The framework of a study on vocational rehabilitation of the mentally ill, we examined 83 schizophrenic outpatients enrolled in a work therapy program. The course of illness and rehabilitation was documented over a 3-year period by means of annual follow-up examinations. The sample comprised 44 men and 39 women with an average age of 35 years (SD +/- 8.5). The majority were chronically ill patients with a history of frequent and long psychiatric hospitalization. After 3 years, 22% of the patients were integrated into the general labor market, 26% had sheltered employment, 23% were still in work therapy, and 29% were unemployed. Besides the patients' subjective expectations, early introduction of rehabilitative measures and a favourable course of illness were found to be predictors of a successful rehabilitation leading to vocational integration. Outpatient work therapy is a contemporary, effective organizational form of sociotherapy. It may contribute to improved vocational competence and integration, reduced psychiatric hospitalization and stabilized psychopathology. 38
Bayer W etal 2008 study of the German Research Network on Schizophrenia the long-term effects of four-week vocational and ergotherapeutic measures on in-patients were investigated. The target criteria were the vocational integration, level of general functioning (Global Assessment of Functioning Scale) and psychopathology (Positive and Negative Syndrome Scale). 227 patients were randomized and assigned either to a work-oriented vocational therapy group or to a creativity-oriented ergo therapy group; 163 patients completed the study. Data was available for 89 patients at the last catamnesis point after two years. The results was No differences were seen between the effects of the two forms of therapy on the development of vocational integration or on general functioning level and psychopathology after two years. The number of patients in regular work declined over this period.39
Längle G etal 2006Occupational therapy approaches have been an integral part of inpatient psychiatric treatment of patients with schizophrenia. Like most sociotherapeutic measures, they are largely hypothesis-based. So far, their effectiveness has been subjected to very little scientific scrutiny. The results of a multicenter study in which five vocational therapy models were compared with creativity-oriented ergo therapy in a prospective, randomized control group design are presented. Target criteria were job-relevant skills, psychopathology, general level of functioning, quality of life, self-efficacy, and speed of cognitive performance. 227 patients were enrolled in the study, which was carried out within the framework of the German Research Network on Schizophrenia funded by the German Federal Ministry for Education and Research (BMBF). Multicenter analyses in a pre-post comparison revealed only minimum differences between the experimental and the control group over a four-week intervention period. Job-oriented approaches cannot currently be assumed to be superior to creativity-oriented ergo therapy.40
6.4STATEMENT OF THE PROBLEM
A Study to Assess the Self Care Ability and Mental Status among Schizophrenic Patients Undergoing Occupational Therapy in Psychiatric department of selected hospitals in Bangalore.
6.5 OBJECTIVES OF STUDY
1. To identify level of self care abilities of the schizophrenic patients undergoing occupational therapy.