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Mental Health Nursing - Answer 1

Collecting of personal and medical information from the patient experiencing mental difficulties is extremely important to understand the symptoms, prevalence, impact and potential causes of the mental issue (Crouse et al., 2020). For some individuals, the psychiatrist and/or the clinical psychologist have to employ different strategies to collect information from them. Tests, screening, and psychiatric evaluation are the initial steps to understand the thoughts, moods and demeanour of the person. It is important to acknowledge the difficulty the person is facing. The medical practitioner should be receptive and understanding of the problem. Listening carefully of whatever is being said, empathizing with feelings and reacting neutrally is the first step of making the individual comfortable (Njoku, Jason & Johnson, 2019).

The medical practitioner should possess skills such as the ability to make the client comfortable with eye contact, generic listening, giving attention, body orientation should be receptive, and reflecting on what is being said. This will make the patient more confidence and Angelo will be encouraged to say more, asking open-ended questions rather than just providing options or close-ended questions, demonstrating empathy, and paraphrasing what is being said by the client so that the client is indulged in the conversation (Wu, 2020).

Family interventions have been extremely useful with the patients with psychotic symptoms and who are not willing to share the information (Valentine et al., 2020). As the family is in the direct and close contact with the patient, the members are in the best position to inform the medical practitioner about the observable condition. Information through family, recording their statements, understands the behaviour of the patient through their eyes works as an addition for the medical examiner. Thus, the family is often regarded as the substitute when faced with the scarcity of occupational, residential and therapeutic resources (Urízar, Calafell, Urzúa, Escudero, & Maldonado, 2015). Apart from this, communication skills training has also been provided to mental health service providers. This involves using e-learning exercises, experiential methods such as simulated patients and/or role-playing. It includes using structured didactic techniques. This tends to increase the effectiveness and efficiency of mental health professionals while communicating with patients who might not be very willing to share their information (Mohr et al., 2017).

Mental Health Nursing - Answer 2

Psychosis can be explained as a medical condition in which there is a loss of touch to reality. The individual might see, hear and/or believe things that are not present in reality. The condition has an impact on how the information is processed by the brain. Psychosis is not considered as an illness but rather treated a symptom to mental disorders (Arciniegas, 2015).

Both American Psychiatric Association (2013) and World Health Organization have identified hallucinations (seeing or experiencing sensations/people that are not present in real), delusion (consistent false beliefs that have no base in reality) or both as the necessity for an individual to be having psychosis. Nonetheless, psychosis has been a significant symptom in a range of mental disorder such as schizophrenic spectrum disorders, mood disorders, substance abuse and degenerative neurologic conditions.

Stages of psychosis usually grow gradually wherein the person experiences change in one’s thoughts and perceptions which often leave the individual confused about the current state. Some early warning signs include inappropriate emotions, uneasiness, difficulty in concentering, irrational thoughts, inability to carry out daily errands effectively, deterioration in performance at work and isolating oneself (Sullivan et al., 2018). Self-care is also extremely affected by individual isolating oneself from friends and family. Some individuals at the very early stage may experience hearing, tasting, seeing and/or believing things/sensations/ people that are not present in reality which was seen in case of Angelo as well.

With the range of symptoms that can be observed in psychosis, hallucinations and delusions are central features of the condition. Examples include hearing voices (auditory) and/or experiencing normal things taste weird (gustatory). Delusions can be consistent feeling that somebody else is controlling one’s thoughts and actions (delusion of control) and/or feeling that one have special powers (delusion of grandiosity) (Arciniegas, 2015).

A wide array of factors have been identified as causing psychosis in an individual. These include biological understandings such as hormonal disturbances in the brain which might occur during puberty, combinations of certain genes and/or physical illness or injury such as strokes, tumours, brain diseases like Alzheimer or dementia. Other than this, any type of event that was traumatic and hurt the individual can trigger and push them towards this psychological condition. Also, dependency and abuse of substance can increase the risk of having a psychotic episode (Sullivan et al., 2018). Early identification and diagnosis support from family and friends, appropriate medical assistance, and suitable treatment implementation can help the individual to deal with psychotic episodes before they turn worse.

Mental Health Nursing - Answer 3

Schizophrenia is understood as psychiatric chronic disorder which is characterized by disturbing, continuous and relapsing episodes of psychosis (Owen, Sawa & Mortensen, 2016). Central to the disorder include symptoms such as hallucinations, delusions, bizarre behaviour, disorganized thinking patterns, social withdrawal, and decreased emotional expression. Positive symptoms are experienced by the people during a psychotic episode, characterized by the presence of excessive.

Hallucinations are explained as the presence of sensory perception in the absence of the external stimuli (Corlett et al., 2019). The most common is auditory wherein the individual hears someone talking to them or people having a conversation among them. Other than this, seeing people who do not exist in real (visual), having the sensation of things tasting weird (gustatory), having smell unpleasant odour (olfactory), and sensation of something moving in one's body (tactile).

The second characteristic of positive symptoms of are delusions which are explained as a persistent belief about something that has no basis in reality. The delusion of persecution (individual constantly feels that they are being persecuted, plotted, stalked, spied and conspired against). The delusion of grandiosity is one in which there is a belief that one is very influential and have many powers. Individuals who constantly feel that they are ill and something wrong with their health experience somatic delusion (Owen et al., 2016).

 The third characteristic of positive symptoms is disorganized speech and thought. The individual experiences impairment in one's communication abilities. This includes word salads (putting together certain meaningless words), and neologism (making up phrases and words that have no meaning to others) (Diagnostic and statistical manual of mental disorders: DSM-5, 2013).

Negative symptoms are characterized by abnormally lacking or absence; such as decreased emotional expression, declined willingness to interact socially, reduced contact with others, and reduction in the experience of pleasure. Five domains are:

  1. Blunted affect- the individual experiences very minimal emotions and showcases flat expressions
  2. Alogia is characterized by lack or poverty of speech.
  3. Anhedonia is when the person’s ability to experience pleasure in activities outside is severely disturbed.
  4. Asociality involves the lack of willingness to interact socially or form relationships.
  5. Avolition- deficit in motivation to carry to any task in one’s life.

The mental disorder tends to have a severe effect on the thinking, feeling, perception and social behaviour of an individual. The disturbance is experienced severely in one's personal and social life. In comparison to positive symptoms, negative symptoms are harder to tackle with medications and require more attention (Owen et al., 2016).

Mental Health Nursing - Answer 4

Stępnicki, Kondej and Kaczor (2018) state that patients suffering from schizophrenia in the general population have to deal with societal and economic implications, often don't have homes and any jobs. With the drugs prescribed only affecting positive symptoms and but little to no effect on negative symptoms which constitute social withdrawal. Complex pathophysiology behind the effect of neurotransmitters, in particular of dopamine is heavily implicated followed by glutamate, serotonin, and Gamma-aminobutyric acid (GABA). All of these neurotransmitters play an important role in the event of schizophrenia development (Stępnicki, Kondej, & Kaczor, 2018).

As the psychotic symptoms present themselves in the person by dopamine stimulants, those with schizophrenia tend to be more affected. Imaging studies revealed an increase in "subcortical synaptic dopamine content" and in its synthesis capacity as well. Both of these phenomena are linked with the positive symptoms of schizophrenia. Changes of the dopamine function occurring in the associative striatum display a crucial role in the event of "delusions and psychosis" (Kesby, Eyles, McGrath, & Scott, 2018). Kesby, Eyles, McGrath, and Scott, 2018 state that in patients with schizophrenia, an increase in subcortical synaptic dopamine content has also been found in patients ultra-high risk subjects.

Through post-mortem studies, there is evidence of changes present of the presynaptic as well as the postsynaptic dopaminergic system of schizophrenic patients. They highlighted increase changes in striatal dopamine level and D2 receptor density as well. Imaging techniques such as Positron Emission Tomography (PET) and Single Photon Emission Computed Tomography (SPECT) have shown quantifiable changes in dopamine, its release, stimuli response, thereby adding support to its role in schizophrenia (Howes, McCutcheon, & Stone, 2015).

Some of the glutamate receptors subtype i.e. N-methyl-d-aspartate (NMDA) on multiple occasions had been known to induce positive, negative, and cognitive symptoms which are similar to be found in schizophrenia. Some of the structural alterations researched are in related to somal volume, dendrite arborisation, dendritic spine density, and axon boutons. Although some of them show correlating in the glutamate development of schizophrenia due to confounders, it is in-conclusive (Hu, MacDonald, Elswick, & Sweet, 2015).

The primary basis of the pathophysiological, biochemical changes, in particular, the role of neurotransmitters playing in developing schizophrenia has been the concept of dopamine dysfunction, as well the majority of treatments is based on it. There are many studies which show inconclusive evidence, for this more imaging studies need to done to observe the change, study biomarkers and look into the genetic factors as well (Yang, & Tsai, 2017).

References for The Glutamate Hypothesis of Schizophrenia

American Psychiatric Association, DSM-5 (2013). Task Force. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Washington, DC: American Psychiatric Association.

Arciniegas, D. (2015). Psychosis. Continuum (Minneap Minn), 21(3), 715–736. doi: 10.1212/01.CON.0000466662.89908.e7

Corlett, P. R., Horga, G., Fletcher, P. C., Alderson-Day, B., Schmack, K., & Powers III, A. R. (2019). Hallucinations and strong priors. Trends in Cognitive Sciences, 23(2), 114-127. https://doi.org/10.1016/j.tics.2018.12.001

Crouse, J. J., Chitty, K. M., White, D., Lee, R. S., Moustafa, A. A., Naismith, S. L., ... & Hickie, I. B. (2020). Modelling change in neurocognition, symptoms and functioning in young people with emerging mental disorders. Journal of Psychiatric Research, 131, 22-30. https://doi.org/10.1016/j.jpsychires.2020.08.028.

Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.) (2013). American Psychiatric Association, 99–105. Available at DOI ISBN 978-0-89042-555-8.

Howes, O., McCutcheon, R., & Stone, J. (2015). Glutamate and dopamine in schizophrenia: An update for the 21st century. Journal of Psychopharmacology, 29(2), 97–115. https://doi.org/10.1177/0269881114563634

Hu, W., MacDonald, M. L., Elswick, D. E., & Sweet, R. A. (2015). The glutamate hypothesis of schizophrenia: evidence from human brain tissue studies. Annals of the New York Academy of Sciences, 1338(1), 38–57. https://doi.org/10.1111/nyas.12547

Kesby, J. P., Eyles, D. W., McGrath, J. J., & Scott, J. G. (2018). Dopamine, psychosis and schizophrenia: the widening gap between basic and clinical neuroscience. Translational Psychiatry, 8(1), 1-12. Doi https://doi.org/10.1038/s41398-017-0071-9

Mohr, D. C., Lyon, A. R., Lattie, E. G., Reddy, M., & Schueller, S. M. (2017). Accelerating digital mental health research from early design and creation to successful implementation and sustainment. Journal of Medical Internet Research, 19(5), e153. https://doi.org/10.2196/jmir.7725.

Njoku, M. G. C., Jason, L. A., & Johnson, R. B. (Eds.). (2019). The Psychology of Peace Promotion: Global Perspectives on Personal Peace, Children and Adolescents, and Social Justice. Springer.

Owen MJ, Sawa A, Mortensen PB (2016). "Schizophrenia". Lancet. 38, 86–97. Available at https://doi.org/10.1016/S0140-6736(15)01121-6

Stępnicki, P., Kondej, M., & Kaczor, A. A. (2018). Current concepts and treatments of schizophrenia. Molecules, 23(8), 2087. Doi https://doi.org/10.3390/molecules23082087

Sullivan, S. A., Hamilton, W., Tilling, K., Redaniel, T., Moran, P., & Lewis, G. (2018). Association of primary care consultation patterns with early signs and symptoms of psychosis. JAMA Network Open, 1(7), e185174-e185174. https://doi.org/10.1001/jamanetworkopen.2018.5174.

Valentine, L., McEnery, C., O’Sullivan, S., Gleeson, J., Bendall, S., & Alvarez-Jimenez, M. (2020). Young people’s experience of a long-term social media–based intervention for first-episode psychosis: Qualitative analysis. Journal of Medical Internet Research, 22(6), e17570. https://doi.org/10.2196/17570.

Wu, Y. (2020). Psychotherapist’s empathic responses to client’s troubles telling/feelings talk in psychotherapy: A conversation analysis. Applied Linguistics Review, 1(ahead-of-print). https://doi.org/10.1515/applirev-2019-0038.

Yang, A. C., & Tsai, S. J. (2017). New Targets for Schizophrenia Treatment beyond the Dopamine Hypothesis. International Journal of Molecular Sciences, 18(8), 1689. https://doi.org/10.3390/ijms18081689

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