Psychological Aspects of Schizophrenia

The case refers to a 57 year old lady admitted to the special ward  with bipolar disorder. Her mental state was suicidal.She appeared alert but was furious on admission to the hospital. Her argument was that her husband tried to hurt her so she had jumped from the floor. But police report said  that the patient  hostile  towards her  husband. Her husband said that the condition of his wife was  deteriorating for the last couple of months,. All along she was aggressive, sleeping less  and  having drinks frequently. The medical past history said she was admitted to hospital 9 times prior to this. Her family background also indicated her mother was also a mental patient.  At the time of admission, the patient reported that she was feeling highly depressed and  was prepared to commit suicide but her overall behaviour was not alarming. The nursing staff members were very rude to the patients. She was tied to the bed so that she cannot move. Moreover, she was not given the due attention when she had multiple fractures of her left leg.

Answer to question 1.

Bipolar disorder is a mood disorder and the sympom is frequent swings in a person’s mood.  (nhs. uk, 2019).  During the phase of depression, the patients pass through a state of depression sometimes may be acute which may result in the patients feeling hopeless, despairing and lethargic. It becomes difficult to cope with everyday life and there may be a tendency to socially isolate them. Sometimes it may lead to suicidal tendency. (Psychiatry.org, 2019). In case of manic he talks irreverent. Another symptom is lack of sleep..  

The answer to Q2.

One of the more aspects of bipolar disorder is the potential for developing a degree of cognitive deficit as part of the illness.. For some with bipolar disorder, it is like they’ve experienced a gradual decline of brain power from their previous steady level when the patient was normal. It can be explained as  some kind  of intellectual disability on a future date. This means that those having past record of acute bipolar mood symptoms are more susceptible to cognitive deficit. But those whose symptoms are well-attended over the years will be less likely to experience cognitive impairment. (Lima, Peckham and Johnson, 2019) Those who have experienced a more difficult course of their disorder due to treatment-resistant symptoms, treatment non-compliance and choice of unhealthy lifestyle suffer more cognitive impairments. 

Cognitive Aspect of Schizophrenia

The answer to question 3

Challenging behaviour is the behaviour of such frequency, duration and intensity that safety of the person both physically and mentally is under threat which most likely may deny access to use of community facilities. (Monash Education, 2019)

If a patient becomes violent, aggressive or threatening, the nurses should use therapeutic communication techniques to pacify the patient, followed by counselling.

The answer to question 4

The patients with bipolar disorders when they are in normal state behave normally but when there is a mood swing, they try to keep them aloof from friends, relatives and also social activities. Those who are doing some job, their job will be seriously affected as during that phase they try to avoid companion with anybody. The management of the disease requires optimal use of proper communication, right treatment and sometimes mandatory  treatment and care during the period of crisis. Preventive strategies are invaluable. (Bassett, 2019).

The answer to Question number 5

The national framework for recovery oriented mental health services (Australian Government)   is about methods of  recovery and live  experience to treat all kinds of mental health patients including those affected with bipolar disorder It works as a guide to the mental health workforce to function  in tune with recovery-oriented principles. It is supported  by a number of  research  and consultation  items and  information with  live experience. (Health.gov.au, 2019)

The guiding principle of recovery-oriented practice which is essential for patients with bipolar disorder, ensures that psychosocial services are provided in a way that supports the recovery of mental health patients and empower people to recognize that they are at the center of the care they receive. Health.gov.au, 2019)

Evidence based  practice in the care of bipolar care , is based on scientific treatments based on  scientifically proven results under similar situation. In this concept, more importance is given to scientific evidence on approach mechanism of treatment supported by both sociological and psychological evidence and the findings of biological researches. (Frese et al., 2001)

The answer to question 6

The overall consumer’s perspective relates to the facilities and treatments that a patient affected with bipolar disorder should receive. But in reality the fact is that such patients are ignored at the first point of service at hospitals  and when there are complaints or  some influential person is involved, then only the carer gets the required attention and treatment he deserves. The nurses have the tendency to behave differently with different people, although it is not clear whether this is because of  the  degree of severity of mental disorders ,or whether there are some other  issues with  that particular professional groups. (Lammers and Happell, 2004) Mental health professionals  many times  can be  opinion leaders and role models  within their own sector, and they are the most prominent  personalities  whom the  consumers look for  when they are at their most difficult  position  and whom they  can depend on for assistance. Additionally, many mental health professionals have become mentors and teachers who become role models whose for  the  future professionals and carers. It  is important how mentally ill people will view those health professions, and it may  have huge  repercussion on  treatment and the value of life  for these people. (Wahl and Aroesty-Cohen, 2010). The carer expects treatment by such an expertise when he is admitted to a hospital.

Management of Behaviors in Patients with Schizophrenia

The answer to Question 7

There have been plenty of research works on  stigmas on account of  mental illness but very little work has been done specifically on mental illness with bipolar disorder. However, people affected by bipolar disorder creates more stigma psychological in nature on themselves and the members of their family compared to people suffering from depression (Lazowski et al., 2012).They avoid social participation, suffer lack of confidence and are hated by the people surrounding them.

The answer to Question 8

The stigma associated with anxiety and depression has three components –knowledge related problem (ignorance or misinformation), problems of behaviour and problems of attitude (prejudice), (Francis and Francis, 2006).The patients find themselves isolated from society, and some of them are not even given necessary treatment so they can recover.

The answer to question 9

The MENTAL HEALTH CARE LAW issued guidelines and protection for mental health patients as per Division of Mental Health and Prevention of Substance Abuse World Health Organization Geneva, 1996 The document describes some basic law of mental health care. The protection under law gives the mental health patients some kind of sense of security. (Patel, 2009). The law is having provisions in involuntary admission, consumer rights, involuntary review processes, seclusion and restraint, admission procedure, community treatment orders, role of mental health practitioners, consent and confidentiality.

Involuntary admission : It is generally observed a t patient suffering from bipolar disorder, when he  becomes  violent and somewhat unmanageable are involuntarily admitted to hospitals.

Seclusion and restraint : The law says that patients suffering from mental disorder like bipolar disorder should not be socially boycotted, instead should be given more encouragement  in the form of counselling so that they can recover.

The answer to question 10

Sometimes bipolar disorder has symptoms that can be attended most effective way using inpatient psychiatric treatment. It is desirable to find out what treatment is available, and what steps can be taken during a crisis before the crisis occurs, if possible. (Secure2.convio.net, 2019).

To pacify the patient suffering from depression stage of bipolar  disorder it is advisable that the healthcare professions attending him should  should stay calm, talk slowly and use reassuring tones using the therapeutic Communication techniques. Moreover when the situation improves , she  can be given the desired entertainments like television shows or music of his choice so that his attention is diverted..  

The persons who are staying with her should be familiar with various triggers of bipolar disease so that she can be given proper attention for recovery process.

Effects of Stigma and Discrimination in Patients with Schizophrenia

The role of both her relatives as well as the health professionals are important. The relatives should not create a situation so that it triggers the symptoms of the disorder. They should allow her to freely mix with her relatives and friend and create a healthy environment. The health professionals should go through the case history to know the patient and then start recovery process.

The answer to Question 11

Oral problems are most common among mental health patients particularly those suffering from bipolar disease. The factors may be because the patients are less caring for self, as a result, they do not take care the basic things like cleaning, brushing teeth regularly as they are not conscious about health. Moreover, there may be a lack of nutrition, because of irregular food taking and that too not the quantity required. Moreover, most of the oral symptoms are because of the side effects of medications like injections, make the mouth dry and cause severe mouth ulcers.  It is because of the reduction in salivary secretions which may be experienced as a dry mouth. Other reasons are irregular dental attendance and resistance to taking medicines to cure oral ulcers.

Client Number 2 is a 32-year-old lady having a history of depression, anaemia; diabetes, end-stage renal disease , hypertension and polysubstance abuse. At the age of 12, she was affected with diabetes, this leading to hypertension; when she was 23 she had a daughter and because of the pregnancy she had kidney failure and had to go on dialysis. The medical history report of the patient also has a history of depression, anxiety and frequent ulcers in the mouth. She is  suffering from acute depression for last five years and presently she is not able to tolerate anybody, when  the level of depression is high she stops talking to anybody, does not sleep and takes frequent wine.

The answer to Question 1

Some of the psychological aspects of patients suffering from acute depression are they feel highly depressed and helpless. They stop talking to anybody including close relatives. Though depression and bipolar disorders are more or less similar but whereas in case of bipolar disorder there may be a high (manic) in case of depression there will be only the state of low (depression). To deal with patients suffering from depressions, the health professions should understand the condition of the patients and use their experience bring back confidence in the patients. The service like proper attendance and care are the important traits of nurses dealing with such cases. (Rolfe, 2014)

Objective

The answer to question 2

Cognitive therapy means the technique used by health professional to create an environment so that the patient can start thinking in a positive direction and can start talking to people. This therapy includes use of therapeutic communication techniques to normalize the patient’s mood  and start counselling the patient. We should know that there is a strong bi-directional relationship between depression and disability, because prolonged depression may lead to disability. (Kenny et al., 2013). 

The answer to question 3

Challenging behaviour is the behaviour of such frequency, duration and intensity that safety of the person both physically and mentally is under threat which most likely may deny access to use of community facilities. (Monash Education, 2019).

If a client becomes violent, aggressive or threatening the nurses should use therapeutic communication techniques to pacify the client, they should create an environment of mutual trust and the close relatives also should be advised by the health professional how to behave with such kind of patients so that symptoms are not triggered because of isolation of the patient.

The answer to question 4

Patients suffering from depression suffer heavily in their place of work. Their colleagues always try to maintain safe distance from such kind of patients. This isolation creates more harm to the patients.

So management is all about optimal use of therapeutic communication skill, proper  treatment and at times  compulsory care during crises. Preventive strategies are highly recommended. (Bassett, 2019).

The answer to question 5

The national framework for recovery oriented mental health services (Australian Government)   is about methods of  recovery and live  experience to treat all kinds of mental health patients including those affected with acute depression. It works as a guide to the mental health workforce to function  in tune with recovery-oriented principles. It is supported  by a number of  research  and consultation  items and  information with  live experience. (Health.gov.au, 2019)

The guiding principle of recovery-oriented practice which is essential for patients with depression , ensures that psychosocial services are provided in a way that supports the recovery of mental health patients and empower people to recognize that they are at the center of the care they receive. Health.gov.au, 2019)

Evidence based  practice in the care of depression , is based on scientific treatments based on  scientifically proven results under similar situation. In this concept, more importance is given to scientific evidence on approach mechanism of treatment supported by both sociological and psychological evidence and the findings of biological researches. (Frese et al., 2001)

Understanding Bipolar Disorder

The answer to question Q6.

The overall consumer’s perspective relates to the facilities and treatments that a patient affected with depression  should receive. But in reality the fact is that such patients are not given due care when they are admitted to a hospital. The health professionals have the tendency to behave differently with different people, although it is not clear whether this is because of  the  degree of severity of mental disorders ,or whether there are some other  issues with  that particular professional groups. (Lammers and Happell, 2004) Mental health professionals  many times  can be  opinion leaders and role models  within their own sector, and they are the most prominent  personalities  whom the  consumers look for  when they are at their most difficult  position  and whom they  can depend on for assistance. Additionally, many mental health professionals have become mentors and teachers who become role models whose for  the  future professionals and carers. Itt is important how mentally ill people will view those health professions, and it may  have huge  repercussion on  treatment and the value of life  for these people. (Wahl and Aroesty-Cohen, 2010). The carer expects  quality treatment by such an expertise when he is admitted to a hospital.

The answer to question 7

Stigma can affect patients  suffering from depression in a number of ways including social relationship and social participation , reduces self-confidence and self-esteem which may lead to abuse of human rights,. According to Corrigan (2004), it “ reduces self-esteem of people and also  social opportunities”. This may include opportunities denied such as employment or accommodation. The hospitals should  refuse  to  tolerate  any kind of stigma  and  the nursing staffs  should  commit to change  their  language and attitude towards  people living with mental illness.. (Stopstigmasacramento.org, 2019) .

The answer to question 8.

Some of the discrimination that patients suffering from depression includes use of force by their relatives or neighbors to restrict the patients from participating any kind of social functions. The Equality Act (Legislation.gov.uk, 2019) protects specified groups of people against discrimination and unfair treatment. Discrimination is on account of a person with a disability (because of mental illness) not getting the desired treatment. However, in a real sense, the patients are subjected to various kinds of discrimination like social boycott and other benefits what a normal citizen gets.

The answer to question 9

The MENTAL HEALTH CARE LAW issued guidelines and protection for mental health patients as per Division of Mental Health and Prevention of Substance Abuse World Health Organization Geneva, 1996 The document describes some basic law of mental health care. The protection under law gives the mental health patients some kind of sense of security. (Patel, 2009). The law is having provisions in involuntary admission, consumer rights, involuntary review processes, seclusion and restraint, admission procedure, community treatment orders, role of mental health practitioners, consent and confidentiality.

Cognitive Impairment in Bipolar Disorder

Involuntary admission : It is generally observed a t patient suffering from depression , when he  becomes  violent and somewhat unmanageable are involuntarily admitted to hospitals.

Seclusion and restraint : The law says that patients suffering from mental disorder like depression  should not be socially boycotted, instead should be given  more encouragement  in the form of counselling so that they can recover.

The answer to question 10.

Sometimes depression has symptoms that can be attended most effective way using inpatient psychiatric treatment. It is desirable to find out what treatment is available, and what steps can be taken during a crisis before the crisis occurs, if possible. (Secure2.convio.net, 2019).

To pacify the patient suffering from depression, it is advisable that the healthcare professions attending him should stay calm, talk slowly and use reassuring tones using the therapeutic Communication techniques. Moreover when the situation improves , she  can be given the desired entertainments like television shows or music of her choice so that her  attention is diverted..  

The persons who are staying with her should be familiar with various triggers of her disease so that she can be given proper attention for recovery process.

The role of both her relatives as well as the health professionals are important. The relatives should not create a situation so that it triggers the symptoms of the disorder. They should allow her to freely mix with her relatives and friend and create a healthy environment. The health professionals should go through the case history to know the patient and then start recovery process.

Most of the psychiatrist have become so much mechanical that they never spend more than ten minutes with the patient and without telling any reason   either replace the  existing medicine or change  the dosage and throw the patient out  of the cabin to get another patient from long waiting line.. This is what the patients face in real life. However, there may be exceptions. Those who are really dedicated and patient-centric, use their knowledge and experience to take care of mental patients. They try to analyze the root cause of the problem and help the patient to recover. 

The answer to question 11.

Oral diseases are most common among patients suffering from depression. Because lack of nutrients, not taking care of teeth and gum by irregular brushing of teeth,  abnormal  food habits including taking food at irregular intervals, depression, side effects of medicine oral disease is common problem for mental health patients.

References

Bassett, D. (2019). Risk assessment and management in bipolar disorders. [online] Mja.com.au. Available at: https://www.mja.com.au/journal/2010/193/4/risk-assessment-and-management-bipolar-disorders [Accessed 31 Jan. 2019].

Francis, D. and Francis, E. (2006). Raising awareness of HIV-related stigma and its associated prejudice and discrimination. South African Journal of Higher Education, 20(1).

Frese, F., Stanley, J., Kress, K. and Vogel-Scibilia, S. (2001). Integrating Evidence-Based Practices and the Recovery Model. Psychiatric Services, 52(11), pp.1462-1468.

Health.gov.au. (2019). Department of Health | Principles of recovery oriented mental health practice. [online] Available at: https://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-i-nongov-toc~mental-pubs-i-nongov-pri [Accessed 31 Jan. 2019].

Kenny, R., Coen, R., Frewen, J., Donoghue, O., Cronin, H. and Savva, G. (2013). Normative Values of Cognitive and Physical Function in Older Adults: Findings from The Irish Longitudinal Study on Ageing. Journal of the American Geriatrics Society, 61, pp.S279-S290.

Lammers, J. and Happell, B. (2004). MENTAL HEALTH REFORMS AND THEIR IMPACT ON CONSUMER AND CARER PARTICIPATION: A PERSPECTIVE FROM VICTORIA, AUSTRALIA. Issues in Mental Health Nursing, 25(3), pp.261-276

Lazowski, L., Koller, M., Stuart, H. and Milev, R. (2012). Stigma and Discrimination in People Suffering with a Mood Disorder: A Cross-Sectional Study. Depression Research and Treatment, 2012, pp.1-9.

Legislation.gov.uk. (2019). Equality Act 2010. [online] Available at: https://www.legislation.gov.uk/ukpga/2010/15/contents [Accessed 1 Feb. 2019].

Lima, I.M., Peckham, A.D. and Johnson, S.L., 2018. Cognitive deficits in bipolar disorders: implications for emotion. Clinical psychology review, 59, pp.126-136.

Monash Education. (2019). Understanding and Managing Challenging Behaviour. [online] Available at: https://www.monash.edu/education/future-students/short-courses/counselling/understanding-and-managing-challenging-behaviour [Accessed 31 Jan. 2019].

nhs.uk. (2019). Bipolar disorder. [online] Available at: https://www.nhs.uk/Conditions/Bipolar-disorder/ [Accessed 31 Jan. 2019].

Patel, K. (2009). Applying Health Care Reform Principles to Mental Health and Substance Abuse Services. JAMA, 302(13), p.1463.

Psychiatry.org.(2019). DSM-5. [online] Available at: https://www.psychiatry.org/psychiatrists/practice/dsm [Accessed 31 Jan. 2019].

Recovery, Disorder, G., Someone Who Looks Like Me, P. and Someone Who Looks Like Me, P. (2019). NAMI: National Alliance on Mental Illness. [online] NAMI: National Alliance on Mental Illness. Available at: https://www.nami.org/ [Accessed 1 Feb. 2019].

Rolfe, G. (2014). Foundations for a human science of nursing: Gadamer, Laing, and the hermeneutics of caring. Nursing Philosophy, 16(3), pp.141-152.

Secure2.convio.net. (2019). Helping Someone in Crisis – Depression and Bipolar Support Alliance. [online] Available at: https://secure2.convio.net/dabsa/site/SPageServer/PageServer?pagename=help_crisis [Accessed 31 Jan. 2019].

Stopstigmasacramento.org. (2019). Stop Stigma Sacramento. [online] Available at: https://www.stopstigmasacramento.org/ [Accessed 1 Feb. 2019].

Wahl, O. and Aroesty-Cohen, E. (2010). Attitudes of mental health professionals about mental illness: a review of the recent literature. Journal of Community Psychology, 38(1), pp.49-62.