The Mental Health Condition of a Person - Essay Example

? Nursing Nursing Case: John aged 23, was assessed by the Crisis Resolution Team because his family had become concerned about his behaviour. Over the last 6 months he had terminated his part time work. He had also become increasingly reclusive by spending more time alone in his flat, and refusing to answer the door to see his friends. After some inappropriate suspiciousness, he allowed the team into his flat and then disclosed that government scientists had started to perform experiments on him over the last year. These involved the insertion of an electrode into his brain that detected gamma rays transmitted from government headquarters, which issued him with commands and ‘planted’ strange ideas in his head. When they asked how he knew this, he replied that he heard the ‘men’s voices’ as ‘clear as day’ and that they continually commented on what he was thinking. He explained his suspicion as ‘all was not right’ was confirmed when he heard the neighbor’s dog barking in the middle of the night –at that point he knew ‘for certain’ that he was being interfered with. Prompted by nurses John also mentioned that a man in his local pub knew of this plight and had sent him a ‘covert signal’ when he overheard the man conversing about the dangers of nuclear experiments. He also admitted to ‘receiving coded information’ from the radio whenever it was turned on. The team found no evidence of abnormal mood, incoherence of speech or disturbed motor function. John was admitted to a psychiatric hospital. He agreed to a voluntary admission, as he was now afraid of staying alone at home. Mental Health Condition The patient “J” clearly meets the criteria of Schizophrenia given in the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10). The patient is suffering from delusions and hallucinations which have lasted for almost a year. The diagnosis can further be specified in to Paranoid Type due to the presence of prominent delusion or auditory hallucinations without any “flattening or incongruity of affect, catatonic symptoms, or incoherent speech” (World Health Organization, 1993, p. 78), confirming the diagnosis for Paranoid Schizophrenia according to ICD-10 Manual. He also meets the criteria of Paranoid Schizophrenia given in the ICD 10 Manual.  Signs and Symptoms According to the ICD-10 manual presence of any one of the following symptoms confirms the presence of Schizophrenia: “thought echo, thought insertion or withdrawal, or thought broadcasting”, delusions of control, delusional perception, hallucinatory voices, or persistent delusions that are culturally inappropriate or impossible (World Health Organization, 1993, p. 78). Other than this, schizophrenia may also be diagnosed if any two or more of the following symptoms are identifies: Persistent hallucinations in any modality (for at least one month) along with delusions (fleeting of half-formed) without clear affective content or with persistent over-valued ideas. Neologism Catatonic behavior Negative symptoms including apathy, paucity of speech, and blunting or incongruity of emotional response When diagnosing the patient, it must be made sure that the symptoms are not a result of any medication or meet the criteria of a mood disorder including manic or depressive episode. It must not also be a consequence of an organic brain disease and must not be a result of alcohol or drug abuse, dependence, or withdrawal (World Health Organization, 1993, p. 79). The symptoms of persistent auditory hallucination and prominent delusions are present in J. And since these symptoms are not accompanied by negative affect, it is confirmed that J is suffering from Paranoid Schizophrenia according to ICD-10. Etiology Genetics The main cause of schizophrenia has not yet been identified but the most acceptable cause among the scientists remains genetics. Even though it has not consistently been proven and there is ongoing research on the topic, it is hypothesized that genes are an important determinant of the disorder. Studies have shown that close relatives of an individual with schizophrenia are more likely to develop this disorder some time in life as compared to people who do not have schizophrenic relatives (Barnet, 2011). In addition to certain predisposing genes that lead to schizophrenia, it is assumed that certain parental difficulties and developmental conditions increase the chances of the disorder in people who also have the contributing genes. These conditions include intrauterine starvation, complication in the perinatal phase of development, and parental stress (Haukvik, 2010). Brain Another popular theory of schizophrenia suggests that the disorder is a result of certain chemical defects in the brain related to the communication between neurotransmitters and different nerve cells in the brain. However, no enough evidence is present to prove this theory and scientific work on the topic is still under development. Another theory of brain proposes that schizophrenia is caused by certain physical abnormalities in the brain with respect to the enlargement and decreased size of some areas of the brain regions (Barnet, 2011). It has also been suggested that traumatic brain injury can also produce chronic schizophrenia-like symptoms in a person but there is little evidence to support this claim as there have been very few such cases (Bagary, 2011). Keeping this in mind, a detailed history of J must be taken in order to identify any traumatic brain injury which may be causing these symptoms. Social and Environmental Causes A number of studies have linked schizophrenia with social experiences of the patient in childhood which may include including abuse (European Brain Council, 2011). Other contributing factors include experiences of social exclusion in childhood, belonging to a lower socio-economic status which includes factors of unemployment and poor housing conidtions (European Brain Council, 2011). Other than that, racial discrimination has also been identified as a determinent of the disorder. Treatment In order to treat the symptoms of Schizophrenia, antipsychotic drugs have been tested out to be quite effective in relieving the symptoms of hallucinations, delusions, and incoherence. However, it has been observed that they are not enough for treatment; the patient may still face trouble in getting back to a normal life (Bevan, Gulliford, Steadman, & Taskila, 2013). The patient may experience social and personal dysfunction even after the symptoms have been cured as they have trouble with communication and motivations to improve the quality of their lives (Khan & Daw, 2011). It is thus recommended that the patient also receive some form psychosocial treatment along with medications (Mueser, Deavers, Penn, & Cassis, 2013). In case of John, it is very important to identify the cause of his disorder which may be anywhere from genetic to environmental. If any social or environmental causes are identified, then appropriate psychological treatment and education can be applied to improve his condition and an appropriate CBT model may be used.  Rehabilitation, psychotherapy, cognitive behavioral therapy, self-help groups are some of the examples of such treatments. These forms of treatment can help in teaching the patient many daily living skills and help them take control of their lives. CBT has especially proven to be very effective in treating many symptoms and helping with social impairment (Morrison, 2009). Considering this, J’s voluntary admission to the psychiatric hospital was a positive step toward his betterment. The hospital can provide him with both medical and therapeutic care to relieve his symptoms and being him back to living a normal life (Mueser, Deavers, Penn, & Cassis, 2013). CBT will also help him develop insight in to his illness which can prove to be quite helpful in his process of treatment (Bird, premkumar, Kendall, & Washington, 2010). Role of Nurses in Treating Schizophrenia In is clear that social intervention is just as important as the medical care in treating schizophrenia. It does not require proper medication and support but also calls for care and education of the patient. Nurses play an important role in this process and they are one constantly in contact with the patient and the family. Along with the patient, the family too needs to be guided and supported so that they are able to help the patient on a personal level. The role of the nurse begins as soon as the patient is bought to the hospital since it is the responsibility of the nurse to correctly identify and assess the symptoms and severity of those symptoms (Bhugra, 2010). Rapport building is another important factor in the treatment process as without trust it will not be possible to effectively communicate with the patient. In case of J, absence of trust can prove to be quite harmful as he is suffering from the Paranoid Type and appears to be very suspicious. It will not be long before he begins suspecting nurses and doctors in the facility and make an attempt to run away. First and foremost, the nurse must work on building trust with the patient and begin the process of educating the patient and his family (Simpson, 2011). This is done through different activities which also help in maintaining the well-being of the patient. Nurse can play an important role in educating J and his family members about his disorder. Since J voluntarily decided to get admitted to the hospital, it shows that he is somewhat aware of the fact that something is wrong with him. CBT can be used to help J develop insight and learn daily living skills so that he may get back to living a normal life once his symptoms of hallucination and delusions are cured through medicine. His family can also be educated to help him cope with his life once he is discharged. Until the patient fully recovers it is the responsibility of the nurse to provide him with care, support, and education. The family of the patient can also be taught basic management skills and understanding of the disorder so they can continue providing care once the patient has been discharged. This process is of key importance as a relapse may occur and the family has to be prepared to take appropriate actions. Reference List Bagary, M. (2011, September 19). Schizophrenia and epilepsy have 'strong link'. Retrieved August 31, 2013, from BBC News: http://www.bbc.co.uk/news/health-14948264 Barnet, E. (2011). Understanding Schizophrenia. Mental Health NHS Trust. Bevan, S., Gulliford, J., Steadman, K., & Taskila, T. (2013). Working with Schizophrenia: Pathways to Employment, Recovery, and Inclusion. Lancasterm, UK: The Work Foundation. Bhugra, D. (2010). Schizophrenia. National Collaborating Centre for Mental Health. The British Psychological Society and The Royal College of Psychiatrists. Bird, V., premkumar, P., Kendall, T., & Washington, C. (2010). Early intervention services, cognitive–behavioural therapy and family intervention in early psychosis: systematic review. The British Journal of Psychiatry, 197, 350-356. European Brain Council. (2011). Schizophrenia Fact Sheet. EBC. Haukvik, U. K. (2010). Effects of obstetric complications on brain morphology in schizophrenia . University of Oslo. Khan, M., & Daw, R. (2011). Do the right thing: How to judge a good ward. London: Royal College of Psychiatrists. Morrison, A. K. (2009). Cognitive Behavior Therapy for People with Schizophrenia. Psychiatry, 6(12), 32-39. Mueser, K. T., Deavers, F., Penn, D. L., & Cassis, J. E. (2013). Psychosocial Treatments for Schizophrenia. Annual Review of Clinical Psychology, 9, 465-497. Simpson, A. (2011). Inpatient Care and Mental Health Nursing. London: City University . World Health Organization. (1993). The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. WHO. Read More