Essay 1: Communication between patient-nurse is the most significant practice. It is important so that both the patient and as well as the nurse can develop a therapeutic relationship. On the other side, if communication is not proper than dissatisfaction can be caused to the patient and the nurse will not be able to deliver the quality care (Kee et al., 2018).
Therefore, as a nurse, the best techniques to use for obtaining the clinical history from a patient who is not very receptive is to non-verbal communication. The nurse should also maintain eye contact and should keep a positive facial expression. They should not showcase any negative emotion towards the patient. They should speak softly to the person and should be involved in active listening. They should not threaten the patient or make use of inappropriate words that could harm the patient well being. The nurse should also show empathy towards the patient and should not get angry if he/she doesn’t communicate properly. Nurses should not be rude towards the patient and should always respect him/her (Kee et al., 2018, Hungerford et al., 2015). The time which the nurse spends with the patient should also be lengthened so that nurse could better understand the patient’s problem. Besides this, nurses should value patient in the communication Cingi & Yalım, 2018, Edward et al., 2018). Nurses should also show concern about the patient while talking to them. The nurses in addition to that learn about the patient's non-verbal cues such as facial expressions, gestures, emotion reactions, postures and behaviour. Nurses should make sure that sometimes the signs and symptoms are not expressed by the patient so they should focus on non-verbal hints that are put forward by the patient. They should also be non-judgmental towards the patient and his/her condition. Also, nurses should ask open-ended questions or else directional questions that will help the patient in building communication which is necessary for providing relevant information (Slade & Sergent, 2019, Evans, Nizette & O'Brien 2016).
In conclusion, it can be said that patient and nurse communication is the most important element in a patient's treatment. For that nurse could use various methods like to maintain eye contact with the patient, learn about the non-verbal cues shown by patient, they can also demonstrate sympathy and concern towards him and so on. These techniques will help in obtaining a clinical history from the patient.
Essay 2: Psychosis is a very common and damaging implication of various other psychiatric, neurological, neurodevelopmental and medical conditions. It also is a defining characteristic of the spectrum of schizophrenia. Very frequently in psychosis, it can be seen that the patient have a mood disorder or have a history of substance abuse which later cause patient many degenerative medical and neurological conditions (Arciniegas, 2015).
Psychosis is known to be a mixture of observable clinical features. There are various symptoms involved in this. Most of the population who have epigenetic, developmental or genetic risks may be more vulnerable to developing the signs and symptoms of psychosis. Some study models also stated that people may experience delusions and hallucinations with other problems. This could also tell about more serious factors of danger which are associated neurologically. Psychosis is also represented in DSM-5 which consists of all the psychiatric disorders. Psychosis occurs to the patients who have schizophrenia and is the defining feature of it. It may also occur to people who have bipolar disorder during their depressing or manic episode. Psychosis in addition to this happens to people who are suffering from a major depressive disorder. The symptoms of psychosis which is hallucination or delusions could develop from intoxication or the withdrawal of the material (Arciniegas, 2015). Dopamine also plays an important role in the psychosis pathophysiology which is further supported by the efficiency of antagonist’s dopamine receptors in curing the signs and symptoms. It also provides proof against drugs that produce psychosis which are cocaine, levodopa and methamphetamine. There can be various reasons why psychosis can be caused. They can be medical or psychiatric reasons. Some of the medical reasons are hypo or hyperglycemia, withdrawal or interaction of medicines, abnormalities in metabolism or serum electrolyte, hypoxia, sepsis, sleep deprivation, nutritional conditions like deficiency of vitamin B, pharmacologic causes like substance abuse, its withdrawal etc. The psychiatric causes can be depression, bipolar disorder, schizoaffective disorder, schizophrenia and so on. Diagnosis can be done by seeing hallucination, inability to perform their work, changes in the behaviour, hopelessness, and changes in appetite or sleep pattern etc Griswold, Del Regno & Berger, 2015).
Therefore it can be concluded that psychosis is a condition which can happen because due to various reasons. They can be medical or psychiatric reasons. Psychosis can be identified in people who are having various problems like delusions or getting hallucination. They also have felt hopeless and disinterested in their work.
Essay 3: Schizophrenia is a disorder which is multidimensional and there are various symptoms of it. The most symptoms in this disease can be various dimensions such as negative, positive and cognitive. Studies in the past have demonstrated that there is a relationship between all three kinds of symptoms within patients suffering from schizophrenia (Joseph, Narayanaswamy & Venkatasubramanian, 2015)
According to studies, the positive symptoms include having delusion of death and therefore they inhibit in taking any kinds of medications and ultimately hope to stay unwell. Other researchers have found out that insights associated with positive symptoms are disorganization and delusions symptoms. At last, it can be said that the schizophrenia patients lost their touch with reality (Joseph, Narayanaswamy & Venkatasubramanian, 2015, Association, American Psychiatric, 2013). Negative symptoms refer to the absence of behaviour which is normal or diminution or are related to interest and motivation example can be asociality, anhedonia and avolition. Other signs can be expressions such as alogia or blunted affect. With schizophrenia, many deficiencies develop like lacking motivation in communication or low functional results in patients. Positive symptoms are usually managed effectively and efficiently with the use of antipsychotic medications. However, symptoms which are negative don’t have many options for the treatment. In the case of pharmacologic treatment, it was found out the antipsychotic medicines cure the acute episodes of psychosis which further improve the signs of schizophrenia. Antipsychotic monotherapy is also used to treat patients with schizophrenia. Other than this, drugs are administered to treat the negative symptoms of schizophrenia. Several studies have indicated better treatment by taking an antidepressant. Patients are also given psychological treatment. In those treatments, the main focus is placed on attitudes, psychosocial functioning and behaviour of the schizophrenia patient. Some other factors are also taken under considerations like exercise, diet, consumption of alcohol, sleep, smoking and so on. Treatment is also done with the help of family members. The family generally provides help to the patient to cope up with negative symptoms. Hence, the implications of the treatment can be good but more research has to be done for treating negative symptoms of schizophrenia (Correll & Schooler, (2020).
In conclusion, it can be said that there are various positive symptoms of the schizophrenia-like delusion of death or disorganization. These can be treated by taking medicines or help from a psychologist. On the other hand, the negative symptoms such as lack of motivation, abnormal behaviour and so on cannot be treated that easily and the treatment requires much more research.
Essay 4: Adrenaline, noradrenaline and dopamine are few neurotransmitters that belong to the family of catecholamine. Dopamine is synthesized in the ventral tegmental and substantia nigra region of the human brain and alteration in the level of dopamine can cause schizophrenia. In the previous pieces of literature, it was founded that increased transmission of the dopamine results in the symptoms of schizophrenia (Brisch et al., 2014).
Production of more dopamine in the body and its increased release causes stress to the patient. Moreover, striatal dopamine alterations are associated with changes in the cortical functions while performing cognitive tasks. Environmental factors such as facing social isolation or trauma from childhood can also influence dopaminergic functions. Advances made in clinical work have indicated towards the association of dopamine, psychological stress and psychosis. Various genes like the ones which are coding for dopamine D2 receptor are also involved in developing schizophrenia in people (Howes et al., 2017). Other than this, dopamine and glutamate deviations are also reported in schizophrenia patients in the region of the prefrontal cortex. NMDA- receptors in addition take part in releasing dopamine within frontal cortex and striatum in diseased individuals. These dealings are joined by changes which are dependent on the calcium and interchange between G72 and DAT in multiple areas of the brain. The commotion of the dopamine is controlled by glutamate and GABA. Higher levels of glutamate were present in the dorsal caudate nucleus of the patients suffering from schizophrenia. Therefore, it can be sum up that D (1)-receptors and NMDA- receptors in the brain cortical region and surplus amount of D (2)-receptors in brain’s subcortical region are connected with each other via positive feedback machinery. Dopamine dysfunction or dysregulation in the area of basal ganglia in schizophrenia patient acts as a significant internal feature in the schizophrenia pathology (Brisch et al., 2014).
Therefore in conclusion it can be said that schizophrenia can occur due to dysfunction or dysregulation of neurotransmitter. The most important neurotransmitter which is involved in schizophrenia symptoms is dopamine. Dopamine is made in substantia niger and ventral tegmental area of the brain. Schizophrenia can happen in people when the dopamine levels in the brain are altered. Factors of the environment like facing isolation or going through the trauma which was an experience in childhood can also change the functions of dopaminergic. Other than this, dopamine and glutamate deviations are also reported in schizophrenia patients.
Arciniegas D. B. (2015). Psychosis. Continuum (Minneapolis, Minn.), 21(3 Behavioral Neurology and Neuropsychiatry), 715–736. https://doi.org/10.1212/01.CON.0000466662.89908.e7
Association, American Psychiatric. (2013). Diagnostic and statistical manual of mental disorders. American Psychiatric Publishing: Washington, D.C: United States of America.
Brisch, R., Saniotis, A., Wolf, R., Bielau, H., Bernstein, H. G., Steiner, J & Henneberg, M. (2014). The role of dopamine in schizophrenia from a neurobiological and evolutionary perspective: old fashioned, but still in vogue. Frontiers in Psychiatry, 5, 47.
Cingi, C. C., & Yalım, S. D. (2018). Communication breakdowns-uninformative doctors or ignorant patients?. ENT Updates, 8(2).
Correll, C. U., & Schooler, N. R. (2020). Negative symptoms in schizophrenia: A review and clinical guide for recognition, assessment, and treatment. Neuropsychiatric disease and treatment, 16, 519–534. https://doi.org/10.2147/NDT.S225643
Edward, K. L., Munro, I., Welch, A., & Cross, W. (2018). Mental health nursing: Dimensions of praxis. Oxford University Press Australia and New Zealand.
Evans, K., Nizette, D., & O'Brien, A. (2016). Psychiatric & Mental Health Nursing. Elsevier Health Sciences: Amsterdam, Netherlands.
Griswold, K. S., Del Regno, P. A., & Berger, R. C. (2015). Recognition and differential diagnosis of psychosis in primary care. American Family Physician, 91(12), 856-863.
Howes, O. D., McCutcheon, R., Owen, M. J., & Murray, R. M. (2017). The role of genes, stress, and dopamine in the development of schizophrenia. Biological Psychiatry, 81(1), 9-20.
Hungerford, C., Hodgson, D., Clancy, R., Monisse-Redman, M., Bostwick, R., & Jones, T. (2015). Mental health care: An introduction for health professionals in Australia. John Wiley & Sons: Hoboken, United States of America
Joseph, B., Narayanaswamy, J. C., & Venkatasubramanian, G. (2015). Insight in schizophrenia: relationship to positive, negative and neurocognitive dimensions. Indian Journal of Psychological Medicine, 37(1), 5–11. https://doi.org/10.4103/0253-7176.150797
Kee, J. W., Khoo, H. S., Lim, I., & Koh, M. Y. (2018). Communication skills in patient-doctor interactions: learning from patient complaints. Health Professions Education, 4(2), 97-106.
Slade, S., & Sergent, S. R. (2019). Interview techniques.StarPearls Publishing: Treasure Island, United States of America.
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