Paranoid schizophrenia - Assignment Example

?Running Head: PSYCHIATRIC ILLNESS Paranoid Schizophrenia Paranoid Schizophrenia Outline I A. History B. Schneiderian Symptons II Case Study A. Emily’s Childhood B. Manifestations in Adulthood III Diagnosis and Treatment A. DSM-IV Multiaxial Evaluation, Axis 1-5 B. Pharmacological and Non-Pharmacological Treatment Paranoid Schizophrenia Description Schizophrenia is a mental disease which is typified by a disintegration of the mind in which emotions and cognitive awareness are diminished. The term ‘schizophrenia’ is relatively new, having only emerged in the last century. Based on information about conditions that have been relevant to individuals throughout history, it is undoubtedly a psychosis that has existed well before it was identified. According to Weinberger and Harrison (2011) one of the first incidents of recorded schizophrenic symptoms might be seen in the actions of King Saul from the Old Testament who becomes increasingly paranoid and plots the death of David in repeated patterns that are manifested from his hallucinatory states. The symptoms of schizophrenia are included in a long list of various reactions to the disease, but it is typified by an unhinged view of reality. The list of symptoms for the illness of paranoid schizophrenia include a great number of different manifestations, leading the clinician to understand that the nature of the disease is not defined by a specific set of symptoms, but certain criteria in which the disease can be diagnosed. Kurt Schneider identified a group of symptoms that can be identified as foundational basis symptoms towards development of a diagnosis of schizophrenia. These ‘first rank’ Schneiderian symptoms are: voices commenting, voices discussing or arguing, audible thoughts, through insertion, thought withdrawal, thought broadcast, made will, made acts, made affect, somatic passivity, and delusional perception (Stein and Wilkinson, 2007, p. 168). In looking at these symptoms it appears that when the mind starts believing that what is done is influenced by sources outside of the mind, but still are from within it, then schizophrenia is quite possible the cause. Stein and Wilkinstein (2007) state that 72% of all people who suffer from schizophrenia exhibit one of these manifestations. Paranoid schizophrenia is typified by feelings of threat and focus from others upon the individual that are not truly there. Schneider also emphasized that even those these symptoms are first – rank symptoms for the illness, can also be seen in other illnesses. Therefore, the diagnosis of schizophrenia is not as simple as the development of one or more of the ‘first rank’ symptoms. Schizophrenia is defined by a general decompensating mental faculty in which functions are reduced. The nature of the overall condition is a hallucinatory responsiveness to imagined input from seemingly external source that does not exist. Those who have been considered schizophrenic in history Joan of Arc, and numerous saints who had visions and talked to God. The disease is not a temporary state or a state that might become better with time. Only medication has an effective influence on the progression or experience of the illness. Case Study Dr Michael Robbins wrote a case study about a young woman who exhibited signs of having schizophrenia. The woman, who he called Emily, was nineteen when she came under his care. According to Robbins (1993), “Emily was raised in a depressed, non-verbal family” (p. 49). Her father was a physician who was largely absent and her mother was disconnected emotionally combined with a parenting style that emphasized independence. This independence that was expected of Emily became long periods of loneliness. Her mother was chronically depressed and had periods of masochistic behavior. As a child, Emily was a loner and was extremely sensitive to sound, becoming upset from such things as passing airplanes or trains. She developed a great many phobias, had night terrors, and began to develop fears about going to school. As a child, Emily began to scratch her stomach until it would bleed. When she displayed this behavior, her mother would give her attention. Her mother and father had divorced in her pubescent years and her father would make efforts to take her hiking and camping, but did not pay much attention unless she injured herself and required medical attention. She was a walking ghost within her own life. Her mother’s condition worsened after the divorce and her theories on pain and reality were fed to Emily in doses of separation and isolation. Emily’s mother would be pleased when after an extended absence she would respond to the question as to whether or not she missed her mother with a negative answer (Robbins, 1993). Emily was an academically high rated student who was successful in her learning pursuits. After her mother and father had divorced and her mother remarried, she was sent to boarding school where manifestations of her illness began to appear, although no one knew she was experiencing hallucinations. She was excelling in school, her teachers believing that she had “radiated a kind of charisma that attracted the attention of her teachers” (Robbins, 1993, p. 50). Meanwhile, she was seeing robed figures that gave her advice and criticized her performances. She began to believe that she was Van Gogh, her identity becoming somewhat absorbed by her perceptions of being this historic figure. After high school she attended a university, but soon dropped out and began to outwardly exhibit the manifestations of her illness. Emily stopped attending to her hygiene and her manner of dress began to deteriorate. She wandered from city to city; homeless and her judgment began to become impaired. Eventually she moved in with her father. She began a relationship with a man whose culture was specific to the belief in the inferiority of women. While she appeared to be managing to function within society at a minimal level, her interior mental struggles were weighing heavily on her experiences. Her father, despite his normally inattentive manner, began to have concerns for the way in which her life was going and when it came down to a confrontation, Emily moved back with her mother (Robbins, 1993) At this point, Emily confined herself to the attic, spending her time writing and painting. She would have violent episodes where she would smash and destroy things around her. She attempted suicide via pills on several occasions. After a suicide attempt where she ingested pills and slit her wrists she was finally hospitalized and “revealed a person who did not experience herself as autonomous and whose defenses were unstable. Emily was delusional and her logic was autistic. She tended to make arbitrary, grandiose, global synthesis of information and to engage in paranoid thinking” (Robbins, 1993, p. 51). According to the Mental Health Exam as given by Durand and Barlow (2006), Emily profoundly exhibited behaviors in regard to her appearance that defined through her dress and hygiene. She also appeared detached and without a connection to the world. After hospitalization the doctor listened to her speak about people within the hospital who wanted to kill her and in response she had carved a cross in her forehead to protect herself. She would have moments of apparent happy moods that would swiftly shift to raging paranoia (Robbins, 1993). Her thought process was without logical progression and her mood and effect levels were unstable and shifting swiftly within a single session. Emily’s intellectual functioning was in a confused state, often her verbal language, her body language and her affect would have an entirely different type of communication. She would speak in compliance and passivity, but her body language suggested that she was a threat to her psychiatrist at times, which when she was beginning to manage her illness was confirmed. Meanwhile, her hallucinations in the form of hooded figures were constantly advising her, seducing her and acting as a barrier between herself and the exterior world. Her sensorium was sometimes impaired as she would lose herself into the world of her hallucinations. She would still fly into rages where she smashed and destroyed everything that she could and often injure herself, but it was disconcerting that she seemed to enjoy the attention that she got as her wounds were treated, putting into question her sense of control over these episodes. Diagnosis and Treatment The DSM-IV Multiaxial Evaluation, Axis 1-5 begins with axis on in which Emily shows signs of schizophrenia and can be assessed at a level 10, presenting a danger to her and to others. At Axis II she can be seen for her dependent personality disorder, paranoid personality disorder, although Axis III shows no sign of physical disability. On Axis IV, Emily has experienced parents whose skills were not nurturing and healthy, her mother in particular showing signs of her own mental illness. The environment that Emily has experienced has exacerbated the emotional responses to her hallucinatory events. Emily’s overall functioning for Axis V is defined by a complete deterioration of her ability to function within the world, her ability to care for herself and engage the world around her impaired to the point that she had to be removed from society for a time. Talk therapy is the standard for treating the emotional and mental issues that need to be sorted out where schizophrenia is concerned. Because of the pressures of hallucination and the isolation that occurs during episodes, the patient needs to experience discussions about their illness and ways in which to cope through the initial stages of medical treatment and through the re-integration process when medical treatment has been achieved to the point of a level of coping. Emily could be put on trifluoperazene at a dosage of 10mg per day (Robbins, 1993). This drug is used to treat schizophrenia, has an effect on disturbed and unusual thought patterns and is considered an anti-psychotic. It is put into the category of a phenothiazine with the brand name of Stelazine. Side effects can include drowsiness, dizziness, dry mouth and difficulty urinating, changes in appetite and weight gain, hormonal changes and effects, confusion, itching, and seizures (Medline Plus, 2011). References Durand, Vincent M, and David H. Barlow. (2006). Essentials of Abnormal Psychology. Belmont, CA: Thomson/Wadsworth. Medline Plus. (2011). Trifluoperazene. American Society of Health-System Pharmacists, Inc. Accessed 11 July 201 from http://www.nlm.nih.gov/medlineplus/druginfo/med s/a682121.html Robbins, Michael. (1993). Experiences of Schizophrenia: An Integration of the Personal, Scientific, and Therapeutic. New York: Guilford Press. Stein, George, and Greg Wilkinson. (2007). Seminars in general adult psychiatry. London: Gaskell. Weinberger, Daniel R., and P. J. Harrison. (2011). Schizophrenia. Chichester, West Sussex, UK: Wiley-Blackwell. Read More