In addition to the abnormalities of neurochemistry in Tardive Dyskibesia, psychological factors play a role in depression. For example, there is an increased likelihood of early onset depression when Parkinson’s disease begins before age 55, even though symptoms may not be severe at this younger age
The Physical effects of the condition play a huge role in the sociological and psychological, emotional responses of which can develop from as early as diagnosis. Many believe Tardive Dyskinesia to be a physical condition, and tend to overlook the effects the condition has on the sufferer's mental health. Just the development and progression of the disease alone, can cause a traumatic life crisis that can have a huge impact on the psychological well-being and social functioning of both the person with the disorder and the family (Susan L. Reese 2007)
From the early stages between diagnosis and severe physical decline, sufferer's and their families begin to question the future and their quality of life. The condition has a huge impact on the lives of both the sufferer and their family. The sufferer's tend to leave work, as it becomes increasingly difficult to work, and members of the family possibly dropping or also leaving work to be able to care for their loved one.
Worries about finances, future health and stigmatization can have a devastating effect on the mental health of the family. Studies show that the worrying and stress are the main factors which contribute to a diagnosis of depression, which effects 40%-50% of Tardive Dyskinesia sufferer's. Other conditions such as Anxiety and Social Phobias can also manifest.
Sufferer's tend to already have a mental health condition such as schizophrenia or bi-polar, which may already bring some stigmatization from society. Porter (1991) discussed that the stigma of psychiatric illness is a negative factor in its presentation, detection and treatment. Whether in public perception or through media representation, stigma does not differentiate between individual mental illnesses.
Stigmatization of Tardive Dyskinesia is usually down to the lack of education to the general public and society as a whole. Mental illness from diagnosis brings a label with it. This label of mental illness can cause society to stigmatize the sufferer unknowingly or purposely. Social exclusion, abuse and bullying can occur when society discovers somebody has a mental illness, even when there are no obvious symptoms. Sufferer's of Tardive Dyskinesia feel the blow of stigmatization more as they will already have stigmatization from mental illness, and may be experiencing some forms of abuse, whether it be physically or psychologically. Nijhof (1995) wrote an article for Sociology of Health and Illness, He discovered that a large number of the participants felt embarrassed by their illness and felt shame.
Some psychiatric disorders can be controlled with medication, and the symptoms can be little to non existent whilst on medication, which can reduce the amount of stigmatization. However, medication may not mask the symptoms of Tardive Dyskinesia, which makes the symptoms obvious for society to see and leaves the sufferer vulnerable and open to different forms of attack and abuse.
The ultimate effect of stigmatization which Tardive Dyskinesis can have on the sufferer is the thought or eventual implementation of suicide. Katz (2007) a sufferer of Tardive Dyskinesia wrote that her very numb and limited existence only added to her depression and sense of low self-worth, and she finally reached a personal crisis because of this constant effort to hide her mental illness, she lost hope and attempted suicide.
Social policy shows us that mental illness is more common than society seems to want to believe. studies show that 1 in 6 adults are experiencing signs of mental illness and 1 in 4 will experience mental illness in their lifetime. Phifer et al (1986) writes that disability is an important prospective risk factor for depression in older adults and mediates most of the effects of specific physical health conditions in this group. Social support is an effect modifier. However, Bruce (1994) argues that depression predicts the onset and progression of both physical and social disability. The most recent information regarding Mental Health in the news is the recent white paper, which proposes to improve mental health and well being and improve the outcomes.
Holistic care is a term which is used to describe nursing as a whole approach. This means when caring for a patient, caring for their physical, mental, emotional and social needs. When dealing with a client who has Tardive Dyskinesia, it is important to respect that, although they have a crippling physical condition, Many chronic diseases create a psychological burden which can lead to guilt, loss of social support, or breakdown of key relationships. Physical care is important when somebody is suffering Tardive Dyskinesia. Also support is needed from the Multi-disciplinary Team, including possibility of counseling, talking therapies or to provide treatment for their prevelant mental health conditions. This can help with the psychological well-being. They need social support like an outreach team to help the sufferer and the family to cope with everyday stuggles, and they need information about the quality of life and other risk factors associated with the illness.
References
BECK C K et al (1988) Mental Health Psychiatric Nursing: A Holistic Life Cycle Approach. C V Mosby St. Louis.
KLAWANS et al, The Pharmacology of Tardive Dyskinesias, American Journal of Psychiatry, (1973) 130:82-86,
STARKSTEIN S E et al (1989) Depression in patients with early versus late onset of Parkinson’s disease. Neurology; 37:1441–1445
REESE, Susan L. (2007) Psychosocial Factors in Parkinson’s Disease. Disease a month, 53 (5),291-295.
PORTER R, Faber Book of,Madness, London: Faber & Faber, 1991
NIJHOF G, Towards a sociological hypothesis on the accounting for chronicity. (1992) International Journal of Health Sciences. 3, 3-11.
BRUCE ML,et al. (1994) The impact of depressive symptomatology on physical disability: MacArthur Studies of Successful Aging. American Journal of Public Health; 84: 1796–99.
PHIFER JF, MURRELL SA. (1986) Etiologic factors in the onset of depressive symptoms in older adults. Journal Abnormal Psychology; 95: 282–91.
