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  • Subject Name : Nursing

Clinical Scenario

Ans 1. Communication means the process of exchanging ideas, thoughts, feelings and attitudes through spoken, written and nonverbal techniques to shape human meaning. This essay will discuss the four most importantly effective communication techniques which are useful to communicate with Angelo to gain information and to build a therapeutic relationship such as active listening.

The first and foremost important part of effective communication is active listening which means listening with the whole being- mind, body and spirit for being an attentive listener. In this scenario, it is important to build trust with Angelo so he could express himself to give related history. To listen attentively nurse needs to ensure there is no physical barrier such as fidgeting, breaking eye contact for that maintain eye contact if culturally appropriate, leaning forward slightly and nodding and reacting calmly to acknowledging when Angelo speaks. Besides, it also creates a sense of connection which enables relationship development (Sten-Parbury, 2013).

Another technique for obtaining hidden information is a method of paraphrasing which means re-saying someone else’s message briefly with the use of one's own words. It is important to let others know their talk was understood. In this case, the nurse can connect with Angelo by paraphrasing his statement accurately. This will also clarify what Angelo is trying to communicate to the nurse and the nurse need to ensure that message is not distorted during paraphrasing. Moreover, paraphrase also is a useful way to reassure Angelo for further interaction by indicating that the nurse is trying to understand Angelo's experience (Sten-Parbury, 2013)

The third technique for effective communication is clarity and reassurance as it reduces fear and assists in being calm during the interview. Since the patients with mental health disorders have lack of self-reassurance, the nurse needs to must acknowledge patients feeling and ensure that information is provided clearly with the use of simple, concise language (Byrne & Morrison, 2013). It is important to note that empathy has distinct ways to respond to others such as sharing others' feelings, inferring what others feel and why and a desire for someone else's wellbeing to improve (Zaki, 2020).

Asking relevant questions and maintaining silence during the assessment is another crucial factor as it gives the chance to the patient to feel relaxed. These questions should be in a logical sequence from the general to the more specific with the use of Open-ended questions. This technique can help not only for a conversational lead for the nurse but also introduce pertinent information about a topic. With this technique, hidden information can be obtained. However, the nurse needs to avoid the overburden of asking too many questions to Angelo as that would make him more uncomfortable.

To conclude, this essay has ascertained how these effective communication techniques; active listening, empathy, paraphrasing and asking relevant questions could help the nurse to obtain a clinical history from Angelo for further analysis.

Ans 2. Psychosis can be defined as a severe mental disorder that causes abnormal thinking and assumptions. It is a serious medical condition associated with significant distress. There are many symptoms of this disorder including sleeping too much or too little, difficulty in concentrating and withdrawal from reality. The two of the major symptoms of this behaviour are hallucinations and delusions (National Alliance on Mental Illness, n.d.). In this scenario too, Angelo parents report that his behaviour has changed gradually as he has started talking about his thoughts being controlled by energy waves emitted by television and sometimes has been overheard talking to himself. This behaviour is caused by several factors including stress, drug or alcohol use, injury or illness. Angelo’s parents have reported his use of cannabis in the past which can increase the risk of psychosis in vulnerable people.

Psychosis is characterised by a damaged relationship with reality. The delusions cause false belief and separation reality. Also, the person starts having hallucinations which means a sensory perception of something that isn’t present (Healthline, 2018). People with psychotic illusions are often not aware of their delusions and confuse them with reality which leads them to feel more distressed and frightened. Paranoid personality disorder and schizotypal personality can stay very near the edge of psychosis. The psychotic features bring in mood disorders in the patient. The patients often face major depressive episode and also have psychotic symptoms including personal inadequacy, guilt, disease and delusion of control. As per Angelo’s colleagues have also noticed his changed mood and behaviour which is in turn affecting his work performance.

People suffering from primary psychosis are likely to have significant cognitive disorders and complicated delusions. If this disorder is resulted due to a medical condition, then the person may show abnormal prominent signs along with cognitive changes. Moreover, illicit drug exploit is the most common medical reason of major psychosis which is taken as the cause for Angelo’s condition (Griswold, Regno & Burger, 2015). The most common psychiatric illnesses with psychotic features include schizophrenia, bipolar disorder, major depression, and brief psychotic disorder. The overall appearance of the patient could be either normal or unkempt. Any person with an initial diagnosis of the psychotic disorder may benefit from a close amalgamation among initial physician care and behavioural health specialist.

Ans. 3 Schizophrenia is a serious mental disorder wherein the patient is impaired with reality. This disorder can cause serious hallucinations and delusions that deteriorates daily functioning (Mayo Clinic, 2020). This can have both negative and positive symptoms on the sufferer. Positive symptoms can be seen as any change in behaviour or thoughts which include delusions and hallucinations. A person’s behaviour can get more unpredictable and disorganised. Some people even sense their body and thoughts being handled by someone else.

Some symptoms are named “negative” because they are an absence of some normal behaviour of feeling whereas “positive” symptoms are the presence of certain detrimental behaviour. The initial negative symptoms are often linked to as the prodromal period of schizophrenia. The negative symptoms of schizophrenia are linked with poor functional outcome and have a significant burden on the patient with this disorder. For example, the patient may neglect general hygiene and appear to lack emotion. Few studies have shown that negative symptoms might be primary to schizophrenia or secondary to other factors. 

 Positive symptoms make the condition appear to be more urgent and can sometimes be cured with the help of antipsychotic drugs. However, the negative symptoms make them more sensitive and distress them most as then they can’t live by themselves and handle everyday social situations (Harvard Health Publishing, 2006). 

The treatment of schizophrenia requires an amalgamation of psychological, medical and psychosocial inputs. In the pharmacological treatment of schizophrenia, the antibiotics are the mainstay for treatment. However, the medications often render ineffective and patients continue to have psychotic symptoms (Malhotra, 2001). Another outfit with these antipsychotic drug treatment is for them to cause serious adverse effects. Therefore, they are to be monitored regularly for any drug side effects. If a person is facing metabolic abnormalities, the switching of antipsychotics may be considered. In some countries, the electroconvulsive technique is used which may benefit in adding to the treatment of patients who are not responding to antipsychotics. Also, psychosocial interventions are an integral part of schizophrenia management which vary from home-based care to cognitive training (Avasthi, Chakrabarti, Grover & Kulhara, 2019). The risk of development of diabetes mellitus has been shown to increase by antipsychosis. The patients being managed at the training centres and resourceful settings should consider complete monitoring of metabolic parameters. Considering this, various guidelines have been proposed to monitor frequency.

Ans. 4 Potential roles of neurotransmitters in the development of schizophrenia

Neurotransmitters are defined as the chemicals that carry messages between brain cells. These are substances which the neurons use to communicate with one another and their target tissues. There exists a connection between schizophrenia and neurotransmitters because the antipsychotics that alters the level of neurotransmitters in the brain are known to relieve some of the symptoms of schizophrenia. The two neurotransmitters by the change of which causes schizophrenia are dopamine and serotonin. Some research suggests that imbalance between these two neurotransmitters causes the problem of disorder. Other suggest that change in the body’s sensitivity to the neurotransmitters is part of the cause of schizophrenia (NHS, 2019). Even though there is little indication of primary dopamine or serotonin neurotransmission in the disorder, recent research has depicted an increase in the stimulated release of dopamine in the brain of the sufferer.

The neurotransmitter, dopamine, was primarily reported to influence function but later found to be associated with reward and motivation in different studies. The nervous system stimulants can sour dopamine release and may cause psychotic symptoms (Yang & Tsai, 2017). The too much of dopamine in certain areas of the brain results in over-simulation and excess sensory information which causes difficulty in concentration and thought process. This generates the problem in processing different sound, sights, smells and tastes which can also result in delusions and hallucinations.

Certain studies have shown that people with schizophrenia can have problems with certain types of brain cells. The abnormalities in serotonin activity also play a significant role in this illness. Schizophrenia is probably a heterogeneous disorder, where the neurotransmitter imbalances of various kinds may be considered. It could be induced by the deficiency of the glutamate pathway. A few observations on post mortem brains of schizophrenic patients do also suggest that abnormalities exist in schizophrenia. A prolonged period of stress can deteriorate levels of the neurotransmitter. Certain drugs, substances or hormonal changes can also be a cause of these imbalances in the brain. In Angelo’s case, the nurse must do sophisticated tests to evaluate his brain cells for imbalances. This will help determine the root cause of his illness as laboratory tests can now give detailed information on neurotransmitter deficiency.

Referencing for Clinical Practice Guidelines for Management of Schizophrenia

Avasthi, A., Chakrabarti, S., Grover, S. & Kulhara, P. (2019). Clinical Practice Guidelines for Management of Schizophrenia. Department of Psychiatry 59(5), 19-33. Retrieved from http://www.indianjpsychiatry.org/article.asp?issn=0019-5545;year=2017;volume=59;issue=5;spage=19;epage=33;aulast=Grover

DOI: https://doi.org/10.1111/papt.12013

Byrne, R. E., & Morrison, A. P. (2013). Young people at risk of psychosis: Their subjective experiences of monitoring and cognitive behaviour therapy in the early detection and intervention evaluation 2 trial. Psychology and Psychotherapy: Theory, Research and Practice, 87(3), 357–371.Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1111/papt.12013

DOI: https://doi.org/10.1016/s0140-6736(20)31685-8

Griswold, K. S., Regno, P. A. D., & Burger, R. C. (2015). Recognition and Differential Diagnosis of Psychosis in Primary Care. Retrieved from https://www.aafp.org/afp/2015/0615/p856.html

Harvard Health Publishing. (2006). The negative symptoms of schizophrenia. Retrieved from

NHS (2019). Schizophrenia - Causes. Retrieved from https://www.nhs.uk/conditions/schizophrenia/causes/

Sten-Parbury, J. (2013). Interpersonal Skills in nursing. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=EZvQAgAAQBAJ&oi=fnd&pg=PP1&dq=Stein-Parbury++2013&ots=F8vIZVacvM&sig=l_Rmlgso-U2tP7RJKY2ovJJwieY#v=onepage&q=Stein-Parbury%20%202013&f=false

Zaki, J. (2020). The caregiver’s dilemma: in search of sustainable medical empathy. The Lancet, 396(10249), 458–459 Retrieved from https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31685-8/fulltext

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