Psychiatric rehabilitation

Definition

Psychiatric rehabilitation involves helping people with mental illness gain or improve skills while obtaining the necessary resources and support to reach their goals.

Purpose

The purposes of psychiatric rehabilitation include helping individuals cope more effectively with the symptoms of their disorders; preventing or delaying the reemergence of symptoms; assisting the individual in managing or reducing secondary symptoms not relieved by medication, e.g., social withdrawal or apathy; teaching or restoring social and living skills that may never have been learned or that have atrophied during periods of illness or hospitalization; and enhancing support while lessening stress in the individual's environment.

Therefore, the goals of rehabilitation professionals are to sustain symptomatic relief, establish or reestablish interpersonal and independent living skills, and help individuals reach a satisfactory quality of life.

Description

The concepts of mental health and mental illness are culturally determined. In the United States mental illness is generally viewed as a maladaptive response to stress, evidenced by thoughts, feelings, and behaviors that interfere with social, occupational, or physical functioning.

Of the estimated 40 million people in the United States who have psychiatric disabilities, approximately five million are considered seriously mentally ill. People with psychiatric disabilities often have limited daily functioning that includes difficulties in relating, problems coping with stress, difficulty concentrating, and a lack of energy or initiative.

Psychiatric rehabilitation takes place in a variety of settings, including mental health centers, hospitals, sheltered workshops, halfway houses, correctional facilities, places of employment, and the individual's home. It most often involves assessment, training, and modification of personal and community environments. Because rehabilitation focuses on adjustment to everyday life, it is important for the individual to participate as much as possible in choosing the objectives.

Complications

Medications prescribed for severe mental illnesses, called neuroleptic drugs, have a number of side effects. Standard drugs prescribed for schizophrenia , one of the most debilitating mental illnesses, include Haldol, Thorazine, Trilafon, Mellaril, Serentil, Stelazine, and Prolixin. Side effects include agitation, sleepiness and lethargy, dry mouth, eye problems, allergic reactions, weight gain, menstrual irregularities, and sexual dysfunction . Malignant neuroleptic syndrome, a less common but more serious side effect, causes very high body temperatures that can be fatal in some cases if not treated promptly. Hyperprolactinemia or high levels of the female hormone prolactin are common among those taking neuroleptics. This side effect causes menstrual abnormalities while increasing the risk for osteoporosis and breast cancer .

The most disturbing and common of the side effects are known as extrapyramidal symptoms, which cause movement and coordination difficulties. Women are at higher risk for these symptoms, and the risk increases with the length of time the drug is taken and age. Nearly every neuroleptic drug can cause extrapyramidal side effects, which occur in up to 70% of patients taking these medications. A condition known as acute dystonia can develop shortly after taking antipsychotic drugs , resulting in abnormal muscle spasms, particularly of the neck, jaw, trunk, and eye muscles. The most serious effect of antipsychotic therapy is tardive dyskinesia, which causes repetitive and involuntary movements or tics—most often of the mouth, lips, legs, arms, or trunk.

Results

The effectiveness of medication is determined by the degree to which it helps the individual manage the symptoms of their illness. Effectiveness of treatments that help develop an individual's coping skills are assessed on the basis of how well the individual is able to develop these skills.

Health care team roles

Professionals involved in psychiatric rehabilitation vary according to setting and may include nurses, psychiatric social workers, rehabilitation counselors, clinical psychologists, psychiatrists, recreation therapists, and paraprofessionals.

A psychiatric nurse's responsibilities may include case management, client advocacy, managing medications, facilitating therapy (individual, family, or group), clinical supervision, serving as a liaison, and consulting.

Psychiatric social workers are skilled in assessing family, social, and environmental factors that contribute to dysfunctional behavior in the individual or the family. They are also primary contributors to the planning and implementation of follow-up care.

Rehabilitation counselors most often are involved in case management and in assisting individuals with employment, housing, coping skills, and academic preparation.

Psychologists most directly involved in the diagnosis and treatment of mental illness are called clinical psychologists. Clinical psychologists are concerned with the diagnosis of mental illness and have expertise in diagnosing and assessing treatment effects by using personality inventories and tests, including intelligence tests.

The role of the psychiatrist involves making medical diagnoses, prescribing medications, and administering such additional treatments as electroconvulsive therapy (ECT), commonly known as shock treatment.

Recreation or activity therapists provide structured activities designed to help individuals deal with their problems. They assist in diagnostic and personality evaluation through observing clients during activities. Activity therapists often prescribe activities that enable individuals to express emotions and develop skills in relating with others.

Resources

BOOKS

Chitty, Kay. Professional Nursing: Concepts and Challenges, 3rd edition. Philadelphia: W.B. Saunders, 2001.

Corrigan, Patrick, & Daniel Giffort. Building Teams and Programs for Effective Psychiatric Rehabilitation. Jossey-Bass, 1998.

Pratt, Carlos. Psychiatric Rehabilitation. Academic Press, 1999.

Stanhope, Marcia, & Jeanette Lancaster. Community and Public Health Nursing, 5th edition. St. Louis, MO: Mosby, 2000.

Townsend, Mary. Essentials of Psychiatric/Mental Health Nursing. F.A. Davis, 1999.

PERIODICALS

Garske, Gregory. "The challenge of rehabilitation counselors: Working with people with psychiatric disabilities." Journal of Rehabilitation (Jan/Feb/Mar 1999).

Bill Asenjo, MS, CRC