Supporting patients

Building trust

People with schizophrenia may be mistrustful of HCPs, as their symptoms can affect their judgement. Also, if patients are not given adequate information about their condition and their medication, they may fail to see the real value in adhering to their treatment. Poor adherence to therapy may lead to suboptimal outcomes.

  • Only 4 in 10 (41%) schizophrenia patients feel adequately involved in decisions regarding their drug prescriptions1

  • Only 4 in 10 (39%) schizophrenia patients are given information about their medication in a form they can easily understand1

Giving patients more information about their schizophrenia and their drug prescriptions in an accessible form can help to build trust between the patient and the HCP.

Greater trust in the doctor/patient relationship may improve adherence to therapy and hence outcomes.

Developing a care plan

Following the detailed assessment of the schizophrenia patient, a care plan should be written in collaboration with the patient. This will help provide timely, structured treatment based on their psychiatric condition and their physical health. The care plan should be shared with the patient and their GP.2

Mental Health Services should also offer carers an assessment of their needs, and these should be addressed in a care plan, which should be shared with their GP and reviewed annually.2

Lifestyle interventions and physical health

Patients with schizophrenia often make poor lifestyle choices which can impact their general physical health. NICE recommends that people with schizophrenia, especially those taking antipsychotics, are offered a combined healthy eating and physical activity programme by their mental healthcare provider.2

After being prescribed an antipsychotic, patients should be monitored regularly. If a person has rapid or excessive weight gain, or abnormal blood lipid or glucose levels, appropriate interventions should be offered in line with relevant NICE guidance.2

Some lifestyle choices may actually interfere with the effectiveness of the pharmacological therapy they are receiving, so use of the following substances should be discussed with the patient with encouragement to stop:2

  • Alcohol

  • Tobacco

  • Non-prescription medication

  • Recreational drugs

Employment and occupational activities

Some of your patients with schizophrenia may wish to find or return to work or college, and may need assistance and support to achieve this.

For people who are unable to work or have not been able to find employment, they should be encouraged to undertake other occupational or educational activities, including pre-vocational training.2

  • Mental health services should work in partnership with local stakeholders to enable people with mental health problems, including those with schizophrenia, to stay in work or education and to access new employment (including self-employment), volunteering and educational opportunities.

  • Occupational outcomes should be included in patients’ care plans.

References

  1. National Audit of Schizophrenia (NAS). Second National Audit of Schizophrenia: What you need to know. The Royal College of Psychiatrists, 2014.
  2. National Institute for Health and Care Excellence (NICE). Psychosis and schizophrenia in adults: prevention and management. Clinical guideline CG178. February 2014. Available at: https://www.nice.org.uk/guidance/cg178/chapter/1-Recommendations#first-episode-psychosis-2 (accessed March 2018).

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