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Clinical Specialty

Introduction to Schizophrenia - Mental Health Assessment

Schizophrenia is a complex serious mental disorder where the patients perceive an alternate reality. The disease may manifest as a combination of multiple anomalies in the psychological functioning of an individual that includes hallucinations, disordered thinking, and delusions. As a consequence, the functioning of an individual is disabled hindering completion of everyday tasks and achieving the actual perception of reality. This academic paper will provide a detailed discussion on the clinical manifestation of schizophrenia and also discuss its criteria for diagnosis. Further, the psychopharmacology of the commonly prescribed medication for mental disorder will also be discussed. Patient education is essential for medication adherence. Therefore, a detail on information about patient education associated with the respective drugs will also be discussed. This paper will also explore the existing treatment options and adjunct therapies that are available with the disease and evaluate two critical standards from Australian National Standards for Mental Health (ANSMH) to assess their impact on the patient and the carer experience for an individual diagnosed with schizophrenia. 

Clinical Manifestation and Criteria for Diagnosis

Schizophrenia is a psychiatric disorder that is characterized through perceived thoughts and experiences of an individual that build a constructed alternate reality differing from what they live in giving rise to delusions, hallucinations, and a bewildering attitude in the patients (Lezenweger, 2018). The patients also show critical signs of detachment and decreased participation in daily activities. The symptoms of the disease are manifested in a multimodal manner in the patient with severe impact on behavioural, cognitive, and psychological parameters and also with evident changes in the speech and physical manifestation of fatigue. A patient of schizophrenia is likely to exhibit behavioural changes like social isolation and disorganized behaviour with incidences of uncontrolled aggression and agitation (Henriksen & Parnas, 2017). Compulsive behaviour may be observed in the patients with incidences of repetitive movements, excitability, self-harm and common lack of restraint. Cognitive manifestations that are associated with the health condition include thought disorders and delusion with the incidence of amnesia (Henriksen & Nilson, 2017).

Disorientation and confusion are also commonly observed. The patient may also experience severe mood changes with an exhibition of rage, apathy, and significant detachment. The individuals may also exhibit discontent and loss of interest in activities with the inappropriate response to discussions. The psychological manifestations of the disease include hallucinations either visual or audible or both (Henrikson & Nordgaard, 2016). Paranoia, fear, and depression are also commonly manifested with the onset of schizophrenia. Patients with schizophrenia are also likely to develop circumstantial speech or incoherent speech and exhibit fatigue with a lack of emotional response and impaired motor coordination (Lezenweger, 2018). These manifestations are associated with neurological disturbances in the patient and are often also related to the catatonia. The diagnosis of the mental health condition is associated with the assistance of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a test for behavioural disorders. A person is diagnosed with schizophrenia if he or she possessed two or more core symptoms that are listed in the manual (Drislane et al., 2019).

These symptoms include hallucinations, delusions, disorganized speech, and mania. The patient must be experiencing these symptoms for more than a month to have a conclusive diagnosis of the mental health condition. Other common symptoms that are outlined for the diagnosis of schizophrenia in the patients include diminished emotional expression or detachment along with gross disorganization. In case of presence of precursor symptoms, the disease is diagnosed within a period of six months. The early common signs that are taken into consideration include depression and social withdrawal, suspiciousness or hostility, deterioration of personal hygiene, lack of emotional expression, disturbance in sleeping patterns, failure to concentrate. However, a differential diagnosis is required to confirm schizophrenia in the patient (Drislane et al., 2019). 

Psychopharmacology and Patient Education

Psychopharmacology is defined as the study of the drug-induced changes in the behavioural and psychological patterns of an individual (Kawa et al., 2019). These include the alterations in moods, thinking, and overall behaviour of an individual. The common drugs that are prescribed to an individual with schizophrenia belong to the class of antipsychotics that are either typical or atypical in nature. The common medications that are prescribed for the treatment include Risperidone, Haloperidol, Olanzapine, etc. (Grover & Avasthi, 2018). The antipsychotics function by altering the effect of particular brain chemicals that include serotonin, dopamine, acetylcholine, and noradrenaline. These chemicals affect changing the moods, emotions, and behaviour of an individual and therefore, by targeting these, the antipsychotic effects of the medication are produced (Haddad et al., 2018). One of the most common medications used for the treatment of schizophrenia is risperidone. The drug is an SGA with higher affinity for the 5-HT2A receptors than the D2 receptors (Werner & Covenas, 2017b). This results in the reduction of the dopaminergic neurotransmission in the mesolimbic pathway of the body.

Olanzapine is also a common class of antipsychotic medication that is used for the treatment of schizophrenia. The mechanism of action of this particular drug is unknown but is hypothesized to be regulated through the mitigation of dopamine and serotonin type 2 receptor (5HT2) antagonism (Tollens et al., 2018). Haloperidol functions through a strong antagonism on the D2 family of the Dopamine receptor and in particular effect on the mesocortical systems of the brain. Consumption of the antipsychotic medications must be approached with caution and as per the prescription of the doctor. Therefore, patient education is critical with the administration of medications as they may also present with multiple side effects (Patel et al., 2014). The Nursing and Midwifery Board of Australia identifies patient education as a primary standard to ensure that the patient is well informed and aware of the medical procedures, medications, benefits, and potential side effects of the intervention applied. This helps the patient as well as the carer to make an informed decision and thus participate in ensuring their well-being, disease management, and recovery (Nursing and Midwifery Board of Australia, 2018).

The common side effects that are associated with the administration of antipsychotics include shakiness or stiffness in the body of the patient, uncomfortable restlessness, changes in sleeping cycle, weight gain, and an increased risk of diabetes (Nagamine, 2018). Hyperprolactinemia can occur to up to 87% of the patients that consume antipsychotic risperidone or paliperidone that can cause sexual dysfunction and reduced libido (Patel et al., 2014). Orthostatic hypotension is also observed in about 75% of the patients that consume antipsychotic drugs (Patel et al., 2014). Other common side effects include dystonia and increased risk of seizures. Therefore, adequate education of patient as well as the carer is absolutely essential to ensure that the management of the condition is done with suitable precautions and adverse side effects are avoided. 

Treatment Options and Adjunct Therapies

The treatment and the management of the schizophrenia are mediated either through pharmacological intervention and/or non-pharmacological therapies in conjunction (Patel et al., 2014). The rehabilitation of patients with schizophrenia is difficult without the use of antipsychotic drugs due to the presence of a wide array of symptoms and complex psychological manifestation of the disease (Werner & Covenas, 2017a). The drug therapy is used for the treatment in cases of psychotic episodes to reduce the hostility in an attempt to normalize the functioning of the patient. Once the acute psychotic episode of the patient is managed, the maintenance therapy is introduced to ensure the wellbeing of the patient. This intervention is done to prevent relapse (Patel et al., 2014). Electroconvulsive therapy (ECT) is used only when the initial therapies fail to trigger a response in the patient. Combination therapy may be used at the later stages of the schizophrenia in the patient (Sanghani et al., 2018). Augmentation therapy with both ECT and mood stabilisers along with combination therapy with the antipsychotics is used for patients with treatment resistant schizophrenia and failure to generate a response from clozapine (Jauhar et al., 2019).

In addition to clinical therapies, adjunct therapies for the symptom management and induction of behavioural changes are also recommended for the patients with schizophrenia. These adjunct therapies include individual psychotherapy, cognitive behaviour therapy, and psychosocial therapy. The individual psychotherapy is used where the patient is involved in a direct conversation with the mental health professionals to focus on the improvements, problems, and feelings to improve the current medical condition (Sanghani et al., 2018). Adjunct therapies like psychosocial therapies are used to promote social and vocational training of the patient. The cognitive behaviour therapy helps in countering the urges, actions, and thoughts and can be effective in the prevention of relapse in the patients with schizophrenia by limiting their negative patterns and promoting positive changes (Jauhar et al., 2019). 

Australian National Standards for Mental Health (ansmh) Standards and Their Impact on Recovery and Experience

Mental health services are critical for a healthy community and the Australian National Standards for Mental Health aims to provide guidelines for the assessment, care provision, and management of the mental health patients in Australia to ensure constant support and beneficence to the patients with mental illnesses in Australia (National Standards for Mental Health Services, 2013). The National practice standards constitute thirteen practice standards. These standards include, first, acknowledgement of rights, responsibilities, safety, and privacy. The second standard asserts the importance of working with the people, families, and the carers in a recovery focused manner. The third standard asserts the need for meeting diverse needs. The fourth national standard for mental health is to ensure working with the indigenous population of Australia. Adequate access, individual planning, and provision of treatment and support are in accordance with the fifth, sixth, and seventh standards respectively. The eight national standard is to include and manage transitions in care with integration and partnership, that is the ninth standard. The tenth standard of the national standard document identifies the need for quality improvement with the need for effective communication as the eleventh standard. Health promotion and ethical practice have been designated as the twelfth and the thirteenth standard (National Standards for Mental Health Services, 2013).

The two most suitable standards for the treatment and management of the patients with schizophrenia will be standard two and seven. These two standards have been identified as they can directly benefit the patient suffering from schizophrenia by ensuring their involvement in the care practice and also encouraging the support from their family and friends, this not only enhances a participatory approach towards recovery buts also helps in limiting the stigma around mental illness through direct participation (Bademli et al., 2016). Through the application of the second standard, that is, working with families and carers in a recovery focused way ensures the participation of the patients and promotes collaborative recovery. This also enhances the care provided to the patient by engaging the close allies and facilitates inclusion. This also promotes participatory decision making and encourages feedback and advocacy (Widyawati et al., 2020). The seventh standard, treatment and support are crucial as it helps in meeting the are goals and deliver quality with applied interventions. It also helps in the development of shared understanding and provides constant support to both the patient and the carer in the course of treatment (National Standards for Mental Health Services, 2013). 

Conclusion on Schizophrenia - Mental Health Assessment

This essay presents a crucial discussion on a complex mental health condition, schizophrenia. This essay discusses the clinical manifestation of the mental health disorder and also identifies the criteria for its diagnosis. The disease possesses multiple cognitive and behavioural manifestations and is diagnosed through DSM-5 checklist along with a differential diagnosis. The psychopharmacology of the common medications prescribed in schizophrenia has also been included in this essay with a detailed focus on possible side effects on their consumption. Further, the available treatment options and therapies that are used in the treatment of the disease have also been discussed. From the Australian National Standards for Mental Health, the standard two and seven have been identified of prime significance for the improved carer experience and suitable care for the patient suffering from the disorder through timely management and recovery oriented participatory care. 

References for Schizophrenia - Mental Health Assessment

Bademli, K., & Duman, Z. Ç. (2016). Emotions, ideas and experiences of caregivers of patients with schizophrenia about" family to family support program". Archives of Psychiatric Nursing, 30(3), 329-333.

Dedovic, J., Tomcuk, A., Mijatovic-Papic, T., & Matkovic, N. (2017). The influences of antipsychotics therapy at cognitive impairments in schizophrenia spectrum disorders. European Psychiatry, 41(S1), S133-S133.

Drislane, L. E., Sellbom, M., Brislin, S. J., Strickland, C. M., Christian, E., Wygant, D. B., ... & Patrick, C. J. (2019). Improving characterization of psychopathy within the Diagnostic and Statistical Manual of Mental Disorders, (DSM–5), alternative model for personality disorders: Creation and validation of Personality Inventory for DSM–5 Triarchic scales. Personality Disorders: Theory, Research, and Treatment, 10(6), 511.

Grover, S., & Avasthi, A. (2018). Clinical practice guidelines for management of delirium in elderly. Indian journal of psychiatry, 60(3), 329.

Haddad, P. M., & Correll, C. U. (2018). The acute efficacy of antipsychotics in schizophrenia: a review of recent meta-analyses. Therapeutic Advances in Psychopharmacology, 8(11), 303-318.

Henriksen, M. G., & Nilsson, L. S. (2017). Intersubjectivity and psychopathology in the schizophrenia spectrum: Complicated we, compensatory strategies, and self-disorders. Psychopathology, 50(5), 321-333.

Henriksen, M. G., & Nordgaard, J. (2016). Self-disorders in schizophrenia. In An experiential approach to psychopathology (pp. 265-280). New York: Springer, Cham.

Henriksen, M. G., & Parnas, J. (2017). Clinical manifestations of self-disorders in schizophrenia spectrum conditions. Current Problems of Psychiatry, 18(3), 177-183.

Jauhar, S., Laws, K. R., & McKenna, P. J. (2019). CBT for schizophrenia: A critical viewpoint. Psychological Medicine, 49(8), 1233-1236.

Kawa, A. B., Allain, F., Robinson, T. E., & Samaha, A. N. (2019). The transition to cocaine addiction: The importance of pharmacokinetics for preclinical models. Psychopharmacology, 236(4), 1145-1157.

Lenzenweger, M. F. (2018). Schizotypy, schizotypic psychopathology and schizophrenia. World Psychiatry, 17(1), 25.

Nagamine, T. (2018). Combination therapy with blonanserin and other antipsychotics may alleviate psychotic symptoms in patients with dopamine supersensitivity psychosis. International Medical Journal, 25(2), 131-132.

National Standards for Mental Health Services (2013). Australian National Standards for Mental Health. Retrieved from: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwiOyt6d96frAhULb30KHRCWDSoQFjACegQICxAF&url=https%3A%2F%2Fwww.health.nsw.gov.au%2Fmentalhealth%2FPages%2Fnational-standards.aspx&usg=AOvVaw2N9AMUK1I-gPB28uwTti_1

Nursing and Midwifery Board of Australia (2018). Code of conduct. Retrieved from: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwjE1_jH96frAhXCF3IKHQ42CnEQFjABegQICxAD&url=http%3A%2F%2Fwww.nursingmidwiferyboard.gov.au%2Fdocuments%2Fdefault.aspx%3Frecord%3DWD17%252F23850%26dbid%3DAP%26chksum%3DL8j874hp3DTlC1Sj4klHag%253D%253D&usg=AOvVaw2_EwvXELm1PrjH5t5kPGZh

Patel, K. R., Cherian, J., Gohil, K., & Atkinson, D. (2014). Schizophrenia: Overview and treatment options. P & T :A Peer-reviewed Journal for Formulary Management, 39(9), 638–645.

Sanghani, S. N., Petrides, G., & Kellner, C. H. (2018). Electroconvulsive therapy (ECT) in schizophrenia: A review of recent literature. Current Opinion in Psychiatry, 31(3), 213-222.

Tollens, F., Gass, N., Becker, R., Schwarz, A. J., Risterucci, C., Künnecke, B., ... & Meyer-Lindenberg, A. (2018). The affinity of antipsychotic drugs to dopamine and serotonin 5-HT2 receptors determines their effects on prefrontal-striatal functional connectivity. European Neuropsychopharmacology, 28(9), 1035-1046.

Werner, F. M., & Covenas, R. (2017a). Extrapyramidal Symptoms in Patients Treated with Antipsychotic Drugs. Journal of Bioequivalence & Bioavailability, 9(3), 412-415.

Werner, F. M., & Covenas, R. (2017b). Long-term administration of antipsychotic drugs in schizophrenia and influence of substance and drug abuse on the disease outcome. Current drug abuse reviews, 10(1), 19-24.

Widiyawati, W., Yusuf, A., Devy, S. R., & Widayanti, D. M. (2020). Family support and adaptation mechanisms of adults outpatients with schizophrenia. Journal of Public Health Research, 9(2), 229.

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