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Dual Diagnosis - Case Study Example

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Introduction: Substance misuse and addictive behaviour are very common and are regarded as a major public health problem in the United Kingdom. In this critical review, the author, a mental health value stream worker critically reviews the assessment and engagement processes of a client with dual diagnosis…
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Dual Diagnosis
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Download file to see previous pages This is designed to demonstrate the scientific rationale and clinical efficacy of an assessment tool and the engagement process that would have been used while assessing a client of this kind. The primary diagnosis of this client was paranoid schizophrenia with a subsequent secondary diagnosis of a substance-related disorder, drugs and alcohol dependence.
The patient has been with Early Intervention Services since July 2007. The client has a recent exacerbation of symptoms with deterioration of mental health, and the paranoiac component of schizophrenia has increased recently in that he developed evident persecutory delusions. He believes neighbours are tracing him with electronic devices. He was verbally abusive and threatening to the attending community team, and the mother reported threatening behaviour. He had also assaulted mother in the recent past. He is on psychotropic medications, and despite being on those, he continues to abuse illicit drugs and alcohol.

Clients with a dual diagnosis are difficult to assess because they are not a homogenous group. In addition, these clients often are poor historians and are noncompliant during the assessment process (O'Connell DF, 1998). Individuals with dual diagnosis often have complex and multiple needs that are difficult to assess in a comprehensive manner. The key process is engaging with the client that can lead to a successful interview to extract information from the client. This interview process also would need to be a medium of developing a therapeutic relationship with the client. When this interviewer approaches the client, the client may appear isolated and lost in thought. This interviewer needs to introduce him/herself and explain the reasons of the interview to the client. The lack of knowledge and skills in assessing mental health or taking a drug and alcohol history and exploring the attitude towards substance misuse is difficult. Often during the first encounter, the client would not respond. The assessor must ensure that the place of interview is private, secluded from outside, and ascertain that all the client's conversations remain confidential. With this, most of the clients would ease a little bit, opening up would demand more.
During this process, it is important to face the patient with an open mind taking care to exclude social prejudice, negative attitudes, and stereotyped perceptions about the substance misusers. When the patient needs utmost care, these factors in the mental health workers may lead to inappropriate assessment and consequently inadequate care, and the patients may end up receiving minimal care. Due to the basic mental condition and social stigma associated with substance abuse, the patients would normally be very reluctant to answer questions. Most clients would verbalize after the initial screening period is over, provided the assessor persists to develop an empathic attitude. When the client starts verbalizing, this opportunity needs to be taken to facilitate both verbal and nonverbal communication, taking care to ensure empathic statements. During the conversation, the content must be summarized and recapitulated frequently, gradually advancing from points of dissent to negotiation. As things would start falling in place, the nature of questions needs to be changed from open to closed questions. The interviewer must remain guarded in terms of normalizing statements, making premature reassurance, false reassurance, switching topics, and asking leading questions.
In his psychiatric history, his presenting complaint was that neighbours are following him with electronic gadgets, and his mother is ...Download file to see next pagesRead More
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