Understanding Schizophrenia, with Brooke Kempf, PMHNP

Brooke Kempf, PMHNP

Credit: Psych Congress NP Institute

In an interview with The Educated Patient, Brooke Kempf, PMHNP, an adjunct lecturer in the Indiana University Indianapolis Psychiatric-Mental Health Nurse Practitioner (PMHNP) program, discusses the persistent stigma around schizophrenia, attributing it to a lack of understanding and the negative portrayals in media.

Common misconceptions include the belief that individuals with schizophrenia are always dangerous or incapable of living independently, despite many leading stable lives with proper treatment. Kempf highlights promising new treatments, such as long-acting injectable medications, which help improve adherence and independence for patients. She emphasizes the need for comprehensive care, early intervention and public education to combat stigma and promote better outcomes for individuals with schizophrenia.

Schizophrenia is one of the most stigmatized mental illnesses. Why do you think there is still so much stigma around it?

Brooke Kempf, PMHNP: Efforts have been made to reduce the stigma surrounding mental health; however, schizophrenia remains highly stigmatized due to a lack of knowledge and understanding. Many individuals rely on social media, television or films for information, where schizophrenia symptoms are often exaggerated or sensationalized, leading to fear and misunderstanding.

Each of us has experienced feelings of depression or anxiety, but we are unable to relate to schizophrenia symptoms, such as auditory or visual hallucinations, which then can be perceived as odd or frightening. Additionally, the negative and cognitive symptoms of schizophrenia may affect a patient’s attention to personal grooming and hygiene or their communication with others, potentially causing misjudgment if not properly understood.

What are some common misconceptions about schizophrenia?

BK: Misconceptions about schizophrenia often include beliefs that individuals with the condition are perpetually ill, dangerous, incapable of self-care, should be institutionalized and are unemployable. While there is a slightly elevated incidence of violent acts among those with serious mental illness compared with those without, contributing factors often extend beyond mental illness itself, including substance use, environmental influences and trauma.

During episodes of schizophrenia, individuals may experience auditory hallucinations or delusions, which can lead to behaviors that are aggressive. However, many individuals with mental illness do not engage in violent crimes, and misrepresentations can exacerbate stigma and actual cause violence against those with schizophrenia. With effective treatments available that can significantly reduce symptoms, individuals with schizophrenia often experience extended periods of stability, and even achieve remission. Many live in supportive environments or group homes, but some maintain employment and are perfectly capable of living independently. Schizophrenia is a medical diagnosis, just like diabetes or heart disease; the brain happens to be the affected organ with this illness.

Are there any new treatments or approaches on the horizon that could change the way we manage schizophrenia?

BK: Yes! It is an exciting time to be in psychiatry. For decades we have focused on the dopamine hypothesis of schizophrenia and treated patients with dopamine-blocking agents. Newer treatment options may provide us with different approaches to modulate dopamine, which may allow a broader range of symptom improvement in areas of positive, negative and cognitive symptoms of schizophrenia with improved side effect profiles. Issues with medication adherence have been improved with growing acceptance of long-acting injectable medications that also include options with longer dosing intervals.

Can you explain how long-acting injectable medications work and why they might be beneficial for people with schizophrenia?

BK: Long-acting injectable medications provide a consistent delivery of treatment for schizophrenia over extended dosing intervals, ranging from every two weeks to every six months. Certain medications are available in formulations that align with the patient's current medication and dosage and can be available in both subcutaneous and intramuscular options. The use of long-acting injectables enhances medication adherence by providing a dependable and convenient alternative to daily oral medications. This approach fosters patient independence, alleviates the burden on family members or caregivers responsible for medication oversight, and reduces hospitalizations related to symptom relapse.

What are some of the challenges people with schizophrenia face in adhering to daily medication routines, and how can long-acting injectables help?

BK: Individuals diagnosed with schizophrenia face similar challenges as everyone else when it comes to adhering to daily oral medication regimens. Forgetfulness is common, even with the best intentions. Some patients may struggle with accepting their diagnosis and the necessity of medication, and there are times when they might feel improved and believe they no longer require treatment. Additionally, side effects can be burdensome, leading to reluctance in taking medication. Long-acting injectables offer an alternative by minimizing the daily reminder of illness, reducing the frequency of decision-making regarding medication adherence and decreasing conflicts that may arise from external pressure to take medication.

How can families and caregivers best support a loved one who is dealing with schizophrenia?

BK: Family members can most effectively support their loved ones by gaining a deeper understanding of the illness and treatment options. Increased knowledge enables them to better comprehend the patient's experiences. Advocate for your loved one. Make sure to attend appointments whenever possible and feel confident in asking their provider questions about their treatment plan. Healthcare providers must adhere to confidentiality regulations, and while patients may decline to consent to family discussions, this does not inhibit family members or caregivers from providing information to the provider. I encourage caregivers to seek support groups to ensure they receive necessary support, as this is a lifelong illness and caregiving can be exhausting. Prioritizing good self-care is essential.

How do you think the role of mental health professionals will evolve in helping patients with schizophrenia lead more independent lives?

BK: Caring for individuals with schizophrenia requires a comprehensive and multidisciplinary strategy that combines medical treatment with psychosocial interventions, vocational training and peer support. I believe a priority must focus on early intervention. Emphasizing early interventions and refining strategies for early detection and treatment will significantly enhance long-term outcomes for individuals with schizophrenia. I'm eager to witness the wide range of new treatment options emerging in healthcare and anticipate how implementing these treatments can not only enhance the management of challenging symptoms but also offer varied side effect profiles, which are crucial for maintaining independence. Telehealth and mobile applications can improve access to care, monitor symptoms and support adherence to treatment plans. Additionally, virtual reality and other innovative tools may contribute to cognitive and social skills training. Overall, it is imperative that healthcare professionals actively advocate for policies and resources that diminish stigma, ensure service accessibility and foster social inclusion.

What are some effective ways to educate the public and reduce stigma surrounding schizophrenia and other serious mental illnesses?

BK: To effectively address schizophrenia and other serious mental illnesses, it is crucial to educate ourselves and disseminate this knowledge within our communities. Begin locally and, when possible, extend efforts to broader areas. Utilize diverse media platforms, including social media, documentaries, podcasts and public service announcements, to reach a wide audience. Engage in advocacy meetings and hearings, participate in walks or fundraisers that support education and the destigmatization of mental illness. Collaborate with educational bodies to promote early awareness and education in schools regarding mental health. Stay informed about governmental decisions that may affect mental health care and advocate for those unable to do so themselves. Provide factual information to others by educating about the biological, psychological and social dimensions of mental illness to challenge stereotypes.

Kempf has spent 30 years with Hamilton Center, where throughout her career she served as chief nursing officer, psychiatric nurse and outpatient PMHNP provider for medication management for adults with psychiatric illness. Kempf has participated in pharmaceutical advisory boards and is on the steering committee for Psych Congress to provide feedback in the development and presentation of education for her peers.