Tag Archives: rehabilitation centre for schizophrenia

Prevalence of self-stigma and its association with self-esteem among patients in mental hospitals

psychiatric hospital delhi ncr

Stigma against mental disorders cuts across all age, religion, ethnic origin or socio-economic strata. In the same way, self-stigma among psychiatric patients admit in mental hospitals or in other IPD settings is also prevalent worldwide. The consequences of self-stigma are low self-confidence, increased severity of symptoms, low adherence to prescribed medication & treatment, increased suicide rate and an overall decreased quality of life.

Mental disorders are accompanied by reactions from the societies and communities of the suffering persons, that adds a dimension of suffering to the existent condition of the sufferer, which is called “second illness” or “stigma”.

Most studies highlight the existence of two dimensions of stigma namely, public stigma and self-stigma or internalized stigma. Public stigma is comprised of the negative attitudes held by members of the public about devalued people. On the other hand, self-stigma occurs when people internalize those public attitudes and suffer numerous negative consequences as a result.

Negative attitudes of people in general (hospital staffs, other people in society) towards them, during the process of admission into a mental hospital, may be an underlying cause for them to internalize such negative attitudes leading to self-stigma.

According to a study, prevalence of self- stigma among psychiatric patients is high: ranging from 22.5 to 97.4% in different countries: it is 36% in USA, 97.4% in Ethiopia, 22.5% in Nigeria, 49.5% in China and 50–66% in India.

In addition to this, self-stigma among psychiatric patients is associated with poor quality of life, low treatment adherence, decreased esteem, increased severity of symptoms, low self-efficacy and poor recovery. In extreme circumstances, self-stigma is associated with a higher rate of suicidality.

Self-stigma is strongly linked with low self-esteem that is directly related to the prognosis and impediment of the disease condition. On the other hand, positive self-esteem is basic characteristic of mental health that protects the people’s mental health from the impact of negative influences of mental illness. Furthermore, it promotes and facilitates effective coping with stressful situations, thus acting as a protective factor in mental health. This imperative element of mental health is vulnerable to self-stigma among psychiatric patients.

Implementation of awareness programs could help in reduction of self-stigma.

Furthermore, self-stigma and self-esteem have a strong negative relationship, which implies that as self-stigma increases, self-esteem decreases.

So in order to protect the self-esteem of psychiatric patients residing in mental hospitals or other such IPD settings, self-stigma must be reduced.

Different interventions and therapies being practiced at mental hospitals, which are focused on reduction and elimination of self-stigma like healthy self-concept, self-stigma reduction program, ending self-stigma, and cognitive therapy might help in reducing self-stigma. Self-esteem enhancement programs can also decrease self-stigma. A reduction in public stigma is also suggested here.

KEEP CALM AND TREAT SCHIZOPHRENIA: #RECOVERY

schizophrenia treatment in delhiSo in the last article we came to know that Schizophrenia is treatable and the best option would be admitting the patient in Psychiatric Hospital where they can be rehabilitated. Rehabilitation is “a set of measures that assist individuals who experience, or are likely to experience disability, to achieve and maintain optimal functioning in interaction with their environment” (World Health Organisation, 2011)

There has been stigma around Schizophrenia since decades because it was misperceived as a degenerative and disabling disease. The Psycho-Social rehabilitation has been proved to be successful with the Schizophrenia patient in achieving ‘recovery’.

Recovery is a process of change through which individuals improve their health and wellness, live a self- directed life, and strive to reach their full potential. (SAMHSA)

Goals of rehabilitation-

The functions of Psychiatric hospital are to enable with the best practices of Schizophrenia management and psychosocial functioning. Below are the principles on which Psychiatric Hospital thrives-

  1. Enabling the patient with Schizophrenia to live a normal life in the community. The goal is to bring focus away from the disease model towards a functional model.
  2. Re-instigating the interest of individuals again in social activities like meeting people, friends, and relatives. Going for outings and participating activities which bring pleasure.
  3. Restructuring the environment of home to suit the needs of the individual.
  4. Reducing the burden of the family by improving the quality of life for both patient and caregiver.

Types of best evidence-based treatment provided for patients of Schizophrenia in a Psychiatric Hospital-

  1. Individual-Centered Strategy- It aims in developing the patient’s skill in interacting with a stressful event and patient learns a vocation which will suit their current capabilities and help them to become independent.
  2. Ecological Strategy- It is directed towards developing the environmental resources to reduce stressors. It focuses on psycho-educating the family about the illness. It also focuses on expanding and reaching out to the support group networks which also facilitates recovery among the peer by self-help groups.
  3. Pharmacological Treatment- Anti-psychotic is the primary step in the treatment of Schizophrenia, because psychosis can be disturbing for the patient, these medicines are to reduce the acute symptoms in which the patient can harm self or others.
  4. Behaviour Therapy- Since the patient has learnt maladaptive behavior during the course of illness, behavior therapy aims to change it.
  5. Cognitive Rehabilitation- Engaging the person in such activities which involves their cognitive abilities like memory, decision making and problem solving.
  6. Vocational Rehabilitation- The major role in this is to identify the skills which are still present in the present in the patient. This therapy later can help individual to earn money himself/herself and become independent.

The aim of Psychiatric Hospital is totally different than of acute care hospitals because it attempts to provide social support to the patients in a way to make them a part of the society again.

 

Tips to relearn social skills while in a Psychiatric Hospital

tulasi psychiatric hospital in delhi ncr

Learning Social skills consists of learning activities utilizing behavioral techniques that enable persons with disabling mental disorders to acquire interpersonal disease management and independent living skills for improved functioning in their respective communities & societies. A large and growing body of research supports the efficacy and effectiveness of social skills training for mental illnesses & disorders. When the type and frequency of training is linked to the phase of the disorder, patients in psychiatric hospitals can learn and retain a wide variety of social and independent living skills. Generalization of the skills for use in everyday life occurs when patients at psychiatric hospitals are provided with opportunities, encouragement, and reinforcement for practicing the skills in relevant situations. Recent advances in skills training include special adaptations and applications for improved generalization of training into the community, short-term stays in psychiatric inpatient units, dually diagnosed substance abusing mentally ill, minority groups, amplifying supported employment, treatment refractory schizophrenia, older adults, overcoming cognitive deficits, and negative symptoms as well as the inclusion of social skills training as part of multidimensional treatment and rehabilitation programs being undertaken at psychiatric hospitals.

Given the key role of effective communication in obtaining one’s needs for normal community functioning, social competence is essential for a satisfactory quality of life. “Social competence” can be defined as the “ability to achieve legitimate, personally relevant goals” through interacting with others in all situations: work, school, home and neighborhood, recreation, shopping and consumer services, medical and mental care. In contrast, “social skills” represent the “constituent behaviors” which, when combined in appropriate sequences and used with others in appropriate ways and places, enable an individual to have the success in daily living reflected by social competence.

Skills are the raw material of social competence and comprise the full range of human social performance: verbal, nonverbal, and paralinguistic behaviors; accurate social perception; effective processing of social information to make decisions and responses that conform to the normative, reasonable expectations of situations, and rules of society; assertiveness; conversational skills; skills related to management and stabilization of one’s mental disorder and expressions of empathy, affection, sadness, and other emotions that are appropriate to the context and expectations of other patients at the psychiatric hospital. In summary, social skills represent the topography of social interaction, whereas social competence reflects the accumulation of self-efficacy and real-world success through experiencing the favorable consequences of interactions within the psychiatric hospital.

The term “skills”—in contrast to the term “abilities”—implies that they are predominantly based on learning experiences. Thus, social skills training utilizes behavior therapy principles and techniques for teaching individuals to communicate their emotions and requests so that they are more likely to achieve their goals and meet their needs for affinitive relationships and roles required for independent living. This modality of treatment at psychiatric hospitals and rehabilitation centers has been empirically validated for a broad range of mental disorders and other psychological problems. Because of its protean and generic applications to such disparate functions as family psycho-education, behavioral marital therapy, and dialectical behavior therapy, social skills training can be best defined by its operational components inside psychiatric hospitals, rehabilitation centres and psychiatric nursing homes, such as the ones being successfully run by Tulasi’s Group of Psychiatric Hospitals.

SHARING INSANITY

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Mr Dayal is a 55year, senior government official; he is admitted to a general hospital for treatment of head injury. He was attacked by his wife and son 2 days back .Mrs. Dayal is a 50year woman was brought to Tulasi Rehab Centre by her brother. She was very disturbed, agitated, and restless. Her looks were disheveled and she made no eye contact. When she was questioned by the psychiatrist about her problems, she blamed her husband of having an affair and she also thought that he was trying to kill her. She was convinced that he wanted her dead so that he could continue with his affair .She has a son 18 year old boy, who on interviewing also shared a similar view about his father. He also believed that his father was having an affair and was targeting him and his mother. Mrs.Dayal brother was also interviewed; he informed the doctor that she was a patient of paranoid schizophrenia since last 15 years. She did not take medicine regularly and was violent with her husband from time to time.

Family had tried to get her treated but all their efforts had been fruitless. Since last 5years there was deterioration in the son’s behavior towards the father and he was also aggressive towards him .Mrs Dayal was admitted for treatment of paranoid schizophrenia. She was started on anti psychotic medicines. The son was separated from the mother and underwent counseling sessions. He was able to recognize the false belief system he had developed. He was sent out of Delhi for higher studies and was soon overcame his delusion and was able to restore relationship with his father.

Mrs Dayal and her son were diagnosed to have Shared Psychotic Disorder .This is a condition where a healthy person shares the delusion of a psychotic person. The first case is called the secondary case and the second is the primary case. The delusions are induced in the secondary cases which usually disappear when both are separated. This disorder is seen in long term relationships in which one person is dominant and other is passive. Generally the people involved are isolated and have a close emotional link. The cause of shared psychotic disorder is unknown but social isolation and stress plays a role in its development.

Basically 3 important symptoms are required to make the diagnosis

  • An otherwise healthy person is in a close relationship with someone who already has an established delusion and develops a delusion himself/herself.
  • The content of the shared delusion follows exactly or closely resembles that of the established delusion.
  • Psychotic disorder, such as schizophrenia not found in the secondary case

The treatment recommended is to separate the secondary partner from the source of the delusion. The primary case has to be started on anti psychotic medicines. If the secondary case symptoms do not disappear, anti psychotic medication may be considered. Prognosis is good if the partners are separated and do not reunite. Psychotherapy for the secondary partner is most important for him or her to realize the existence of delusions.