Personal experience with mentally ill patients - Essay Example

Practical Experience in Psychology Introduction This report will focus on describing my personal experience with mentally ill patients during my placement in clinical psychology at Arbours Association last ____ (insert date). In the process of discussing my personal experience with several patients, this report will focus on integrating my clinical experience with psychological research and other related theories. Personal Experience in Undergoing Placement in Clinical Psychology at Arbours Association Working with several mentally-ill patients in the clinical psychology has been a great experience for me. First of all, the clinical exposure made me able to gain better insight and understanding as to what people with borderline personality disorder and schizophrenia are literally going through. By closely examining the behaviour of each patient, I was able to adapt with and make use of different psychological theories in analyzing why these patients are showing unique set of personality, characteristics, and behaviour from that of a normal person. Differences between Borderline Personality Disorder and Schizophrenia Several clinical psychologists are working together with registered nurses to provide intensive care for patients with mental disorders. Based on what I personally witnessed in the clinical placement at Arbours Association, I started asking myself what is the difference between borderline personality disorder and schizophrenia. After going investigating the true meaning of each type of mental disorder, I learned that borderline personality disorder is totally different from schizophrenia in the sense that borderline personality disorder is a type of personality disorder which can be closely observed in a clinical setting (Barlow & Durand, 2012, p. 453) whereas DSM-IV schizophrenia is a type of brain neurobiologic disorder that is often characterized by showing signs of thought disorder and disturbances in the way a person thinks, feels, perceives, and relate to other people (Swearingen, 2012, p. 706). By knowing the differences between these two psychiatric disorders, it will be easier to determine the main reason why a patient has been confined in a psychiatric ward. Positive and Negative Symptoms and Management of Schizophrenia The behavioural symptoms of patients with schizophrenia can be characterized by either positive or negative symptoms (Kalat, 2009, p. 449). After attending to a group of patients with schizophrenia, I noticed that some of these patients would show signs of positive symptoms such as delusion, hallucination, thought disorders, and movement disorders (NIMH, 2012; NHS, 2010). There were also some cases wherein some of this group of patients would show signs of negative symptoms such as the act of talking in monotonous or repetitive tone and loss of functions such as slow thoughts or reaction, slow speech, expressionless emotions, attention deficits, loss of social interests and lack of motivation (Tung & Procyshyn, 2007; Vyas & Ahuja, 1999, p. 12). One thing that is common among the patients with schizophrenia is their tendency to be socially withdrawn from other people. Delusion is basically a mental state wherein the patient would strongly believe something that is contrary to facts or reality. For example, a person with schizophrenia may strongly believe that he is being persecuted by some unknown person. In reality, nobody is trying to cause harm to that person (Kalat, 2009, p. 449). Based on the two-factor theory that was explained by Coltheart (2010), delusion can occur either when there is a neuropsychological impairment in the right lateral prefrontal cortex that directly triggers delusional beliefs or a second neuropsychological impairment is present which disrupts the normal process of belief evaluation. To learn more about the occurrence of paranoid delusion in patients with schizophrenia, I personally asked one of the clinical psychologists whether or not all patients with schizophrenia can show signs of paranoid delusion and whether or not paranoid delusion in patients with schizophrenia can be cured. I was told that not all patients with schizophrenia can show signs of paranoid delusion. In general, atypical antipsychotic drugs like 425 mg of clozapine per day can be use to control the symptoms of “paranoid delusion, disorganized behaviour, perceptual disturbances, and social isolation” (Eseonu & Carlson, 2010). Since the presence of severe depression can cause patients with schizophrenia to suffer from paranoid delusion, undesirable external factors can sometimes make the patients with schizophrenia experience remission of paranoid delusion. Based on what I understand in the clinical term “hallucination”, a patient is said to be hallucinating if he or she is hearing voices coming from an unknown sources. Based on the clinical explanation behind hallucination, hearing voices coming from an unknown sources is possible because of an “increased activity in the thalamus, hippocampus, and parts of the cortex” that is responsible for hearing (Kalat, 2009, p. 449). This partly explains why patients with schizophrenia who are in the process of hallucinating can show or display strange behaviours. Similar to paranoid delusion, hallucination can also be treated using atypical antipsychotic drugs like amisulpride, clozapine, olanzapine, paliperidone, risperidone, quetiapine, and ziprasidone (Sommer et al., 2012; Tung & Procyshyn, 2007). Antipsychotic drug like chlorpromazine can also be used in treating patients’ symptoms of delusion and hallucination (Wonodi, Hong, & Thaker, 2005, p. 337). Thought disorder is all about the inability of the patients to think clearly. As explained by Andreasen (1999), thought disorder occurs because of the atypical interface between the cerebellum and thalamus with the cortex [cited in Kalat, 2009, p. 449]. Unlike schizophrenia symptoms like paranoid delusion or hallucination, it is more difficult to explain the theory behind thought disorders. The only thing that is certain about thought disorders is that people who suffer from this particular symptom tend to show deficit in both “attention and working memory” (Kalat, 2009, p. 449). Movement disorders such as the tardive dyskinesia are basically a type of neurologic syndrome that causes “abnormal involuntary movements of the tongue, mouth, face, trunk, and extremities” (Wonodi, Hong, & Thaker, 2005, p. 336). This partly explains why I was able to see some patients with schizophrenia who were continuously smacking their lip or moving their tongue laterally. Basically, there are quite a lot of relevant theories that can help explain why patients with schizophrenia could show signs of symptoms related to movement disorders. Among the possible reasons why patients with schizophrenia could show signs of symptoms related to movement disorders include excessive and prolonged use of dopamine-blocking antipsychotic drugs or simply because of pure motor disorder (Wonodi, Hong, & Thaker, 2005, p. 348). Up to the present time, the pathophysiological explanation behind the causes of spontaneous dyskinesia amongst the patients with schizophrenia is still unknown to (Chong & Sachdev, 2005, p. 39). In the past, Waddngton and Crow (1988) suggested that the main cause of spontaneous dyskinesia amongst the patients with schizophrenia is due to possible risk of brain damage. Waddington (1989) also suggest that spontaneous dyskinesia amongst the patients with schizophrenia is just a central part of having schizophrenia. Even though Waddngton and Crow (1988) and Waddington (1989) suggest that spontaneous dyskinesia amongst the patients with schizophrenia is caused by either brain damage or just a central part of having schizophrenia respectively, no other studies suggest that the claims of Waddngton and Crow (1988) and Waddington (1989) are scientifically proven. Using verbal and non-verbal cues, there was one occasion when I tried to communicate with some patients with schizophrenia. I noticed that most of the patients with schizophrenia were unable to make use of information that has been given to them using different senses (i.e. sense of smell, sense of sight, etc.). Most probably, this is because of the fact that patients with schizophrenia are at the stage of experiencing a “premature mental deterioration” (Kalat, 2009, p. 449). It is also possible that the main reason why patients with schizophrenia reacts slowly or does not respond to me is because of the antipsychotic drugs were administered to them on a regular basis. Several studies suggest that the use of antipsychotic drugs can also be used to explain why patients with schizophrenia can show signs of negative symptoms or being totally withdraw from other people (Tung & Procyshyn, 2007; Wonodi, Hong, & Thaker, 2005, p. 348). In line with this, Tung and Procyshyn (2007) explained that the typical or conventional antipsychotic drugs such as chlorpromazine, haloperidol, trifluoperazine, perphenazine, and fluphenazine blocks the dopamine receptor (D2) to improve the patients’ positive symptoms. However, the use of one of these typical or conventional antipsychotic drugs could somehow “block the D2 receptors in areas outside the medolimbic pathway” which causes the “worsening of the negative symptoms” (Tung & Procyshyn, 2007). Positive and negative symptoms of schizophrenia associated with the antipsychotic drug intake are among the common psychological issues within the placement organisation. For this reason, clinical psychiatrists and registered nurses who are working within the placement organisation should be careful in taking down or recording significant changes in the symptoms of each patient with schizophrenia especially right after they have been given one or more of these antipsychotic drugs. By doing so, clinical psychiatrists and registered nurses can play a significant role in providing a better quality life for these patients. Symptoms and Management of Borderline Personality Disorder According to Ashman and Haigh (2006, p. 585), “people with borderline personality disorder have other personality disorders and Axis I illness” which are commonly related to the excessive use of alcohol and drugs. Furthermore, the borderline personality disorder is commonly linked to the presence of mood disorders (Barlow & Durand, 2012, p. 454). It means that people with borderline personality disorder have inability to handle their emotional problems well. Even though mood disorder is characterized with less severity as compared to depression, people with mood disorders have a higher risk of undergoing severe depression as compared to those individuals without or have a lesser degree of mood disorder. Among the common factors that could trigger mood disorder include: genetics or hereditary, a sudden changes in the neurotransmitters in the brain (i.e. serotonin), history such as childhood neglect or family and/or relationship problems chronic stress, and poor coping mechanism among others (Gunderson, 2011; Distel et al., 2010; Chapman & Gratz, 2007, pp. 42 – 43). Furthermore, people with borderline personality disorder tend to show signs of hopelessness, fatigue, low-self-esteem, extreme guilty feeling, inability to control their anger, suicidal tendency such as a self-inflicted cut or drug overdose, problems in handling relationship, problem in concentration, sleeping problems, fear of being left alone, and abnormal eating habit (The Ohio State University, 2013; Gunderson, 2011; Chapman & Gratz, 2007, pp. 19 – 24). Even though patients with borderline personality disorders could be at risk of not being able to control their anger, it is a myth that this group of patients are seeking attention, manipulative, violent and has the ability to hurt other people (Chapman & Gratz, 2007, pp. 30 – 31). Borderline personality disorder is not permanent because it can be cured and treated through the use of proper psychiatric intervention (Chapman & Gratz, 2007, pp. 32 – 33). Therefore, patients with borderline personality disorder should receive proper psychotherapy intervention as their first-line treatment (i.e. CBT) (Gunderson, 2011; Weinberg et al., 2011; Oldham et al., 2001). In most cases, the length of psychotherapy intervention that each patient with borderline personality disorders should last between 2 to 3 hours each week (Gunderson, 2011; Weinberg et al., 2011). In general, patients with borderline personality disorder are known for their ability to hurt themselves physically (Chapman & Gratz, 2007, p. 31). Therefore, one of the challenges that most of the clinical psychologists need to face is to learn more strategic ways on how they can uplift their lives by motivating them to live. Patients with borderline personality disorder are not mentally ill such as in the case of the patients with schizophrenia (Chapman & Gratz, 2007, p. 39). Therefore, clinical psychiatrists should not be scared of patients with borderline personality disorder. Since patients with borderline personality disorder may have experience difficulty in controlling their anger, one of the challenges that clinical psychologists need to face is how to make this group of patients overcome their anger. For example, clinical psychologists should know more about the root cause of their anger. By being able to identify the root cause of each patient’s anger, clinical psychologists will be able to develop and find useful ways on how they can allow these patients to control their anger. In most cases, this can be done through acceptance. As soon as the clinical psychologist found out that a patient with borderline personality disorder is often angry right after being abandoned or cheated by his girlfriend or a wife, then, allowing the patient to accept the fact that the other person will no longer come back. By encouraging the patient or convincing him that there is so much more that life can offer, the clinical psychologist could somehow help the patient realise his self-worth. However, clinical psychologists should always keep their guards up especially each time they are dealing with patients who are in a serious relationship rebound. This precautionary measure applies in case the clinical psychologist is treating patients of the opposite sex. When performing psychotherapy on patients with borderline personality disorder, clinical psychologists should be aware that the symptoms of this particular psychiatric disorder have at least a combination of five of these symptoms and that each patient will have a different set of symptoms as compared to other patients (Chapman & Gratz, 2007, p. 24). Due to the fact that patients with borderline personality disorder are at risk of committing suicide or engage in a self-destructive behaviour, clinical psychologists should constantly remind the registered nurses or family members who are looking after this group of patients to carefully monitor the patient for the risk of committing suicide (American Psychiatric Association, 2001, p. 36). This specific intervention applies each time the patient is undergoing a feeling of rejection or is being excessively hurt emotionally right after losing someone or something important to him. Each person has a different coping mechanism when it comes to dealing with internal and external stressors. In some cases, people with weaker coping mechanism could show negative reinforcement such as drinking excessive alcohol or the use of drugs such as tranquilizers, cannabis, cocaine, narcotics, stimulants, hallucinogens, or PCP (Mondimore & Kelly, 2011, pp. 87 – 89). Therefore, clinical psychologists together with people who are caring for patients with borderline personality disorder should always look after signs when the patient is becoming totally dependent on the use of alcohol or drugs (American Psychiatric Association, 2001, p. 36). Conclusion Attending the placement in clinical psychology at Arbours Association enabled me to learn more about the differences between patients with borderline personality disorders and those who were diagnosed with schizophrenia. Basically, borderline personality disorders are curable disorders whereas schizophrenia is a non-curable mental disorder. For this reason, patients with borderline personality disorders should be encouraged to receive necessary psychotherapy treatment such as the CBT. Even though schizophrenia is a non-curable mental disorder, atypical antipsychotic drugs should be administered to patients with this type of mental illness. 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