Good Essay On The Main Diagnosis For Charlie
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The chosen case study is Case study 3: Schizophrenia, Charlie Robinson
According to Shergill, et. al (2014), schizophrenia is a condition characterized by difficulty in distinguishing between reality and imaginations. Patients suffering from this condition find it hard to relate to other people, to manage their emotions, and to function normally. Schizophrenia is a psychotic disorder whereby the victim starts loosing contact with reality and gets lost in own world with make-up beliefs. Charlie is described as a person who has many friends, but hardly relates to any of them. He likes spending his time in his bedroom, and refers to himself as Goth. Charlie has a deep-rooted fear of terrorism and he fear that his mother will get hurt due to terrorism in her job.
Charlie also has delusions, hallucinations, and disorganized behavior. Charlie’s mother finds the house in a bad mess after leaving him alone for eight weeks. He just sits up in his room listening to loud music and doesn’t associate with his age-mates. He also abandons school and doesn’t bother to look for a job although he is old enough to do so. Additionally, Charlie stays in his room smoking the joint, although he denies this fact during medical assessment. Later after being admitted to the mental facility, Charlie became hostile towards the caregivers, used strange incomprehensible words to communicate, and after discharge he slept more than 12 hours per day.
Prevalence of Schizophrenia in Australia
According to NICE (2014), the mental disorder affects one in every 100 people in Australia, with a higher incidence among males than in females. NICE (2014) also estimates that 1% of the total adult population is affected by schizophrenia every year. A study carried out among patients with schizophrenia also revealed that the disorder is most prevalent among immigrants to Australia than in the natives. In total, about 150000-200000 Australians of all ages, races, and gender are affected by the mental disorder. 20% to 30% of people suffering from schizophrenia experience episodic cases, while the rest suffer from the disorder for a lifetime (NICE, 2014). Additionally, approximately 10% of the people diagnosed with the disorder are at the risk of committing suicide.
Predisposing Factors for Developing Schizophrenia
According to Suvisaari, et. al (2014), some people are more predisposed to the development of the disease than others. Environmental factors, genetics, and abnormal development of the brain are all predisposing factors of schizophrenia. This disorder has a strong hereditary component, with a 10% chance of someone developing the disorder if there is a first-relative who has suffered from it in their family. However, it should be understood that the disorder is influenced by genetics, rather than being determined by genetics. Also, of 60% people with the disorder do not have a history of it in their families, which shows that even though someone maybe genetically predisposed to the condition, it is possible not to develop it (Ferentinos & Dikeos, 2012). Charlie Robinson’s father who died when he was four years from a motor vehicle accident could have been a victim of the disease, although Charlie’s mother admits that he wasn’t diagnosed. However, it is indicated that Charlie’s father may have knowingly exposed himself to the accident, which amounts to suicide. Therefore, it Charlie’s father suffered from schizophrenia, this could have genetically inclined the possibility of Charlie acquiring it as well.
Environmental factors, according to Lane, Tsai, Chang & Lin (2014), have also been seen to increase the chances of development of schizophrenia, although the interplay of genes is more likely to be present for the environment to contribute to the development of the disorder. Studies show that a person who is genetically inclined to schizophrenia has even higher chances to the disease if they are exposed to certain environments. For example, exposure of a mother to stress during pregnancy is an environment that increases the chances of the baby developing the disorder in the future (Mattila, et. al., 2014). This is because stress elevates the production of a hormone known as cortisol, which is a trigger to schizophrenia. Other stress-inducing factors that may contribute to the development of the mental disorder include exposure to viral infections before birth, early parental loss, and childhood abuse. Charlie lost his father when he was four years old and this trauma may have predisposed him to the disorder. To add to the factors that inclined Charlie to develop the illness is the fact that he is smoking marijuana, although he denies it when asked in the hospital.
According to D’Souza & Markou (2012), use of drugs is a symptom of schizophrenia, and it is also a factor that increases the development of the disease. To the general population, abnormal development of the brain is another predisposing factor to schizophrenia. According to Suvisaari, et. al (2014), schizophrenics have been found to have enlarged brain ventricles, which results to a decrease in brain tissue. Consequently, this contributes to low activity on the frontal area of the brain which is responsible for reasoning and planning. However, although these abnormal brain developments may be connected to schizophrenia, there is no evidence that schizophrenia can cause brain related problems.
Common Co-Morbidities Related to Schizophrenia
Schizophrenia is characterized by the presence of other disorders like substance abuse, obesity, high blood pressure, diabetes, high cholesterol levels, and certain types of cancer. The most common co-morbidity is substance abuse mostly alcohol, smoking, and use of marijuana. According to Dyck, et. al (2013), most schizophrenics use medications to relieve symptoms and to self medicate. Use of drugs also contributes to the worsening of the condition. Charlie is shown in the case study as a smoker. He locks himself up in his room smoking the joint. Obesity is co-morbidity to schizophrenia because schizophrenics usually refuse to take care of themselves, abandoning healthy eating and physical exercise. Since they become less social, schizophrenics lack interest in any kind of physical exercises. Charlie, after his mother left for work for 8 weeks, spent all his time in the house. On her return, the mother found leftovers to unhealthy foods, with Charlie locked up in his room. Also, after he was discharged from hospital, Charlie gained a lot of weight, which could also have been the effect of the medications that he was taking. Additionally, he would spend more than 12 hours sleeping, which contributed more to obesity due to inactivity.
Schizophrenics are at the risk of developing diabetes due to unhealthy eating and lack of exercise. According to Ferentinos & Dikeos (2012), the symptoms observed in schizophrenics predispose them to the development of diseases like diabetes because they abandon healthy eating habits and healthy lifestyles. This consequently increases the risk for cardiovascular disease as well. According to Shergill, et. al (2014), fatalities among people with schizophrenia with such conditions is higher than those among the general population. Also, hyperlipidemia is high among schizophrenics, as medications used in the treatment of the disorder have been found to have an effect on the body lipids. Cases of HIV/AIDS and Hepatitis C have been found to be higher among schizophrenics than in the general population.
Common Interventions: psychological, pharmacological, physical for schizophrenic Symptoms
Schizophrenia can be managed through psychological interventions, pharmacological, and physical interventions. Psychosocial interventions involve continuous support, rehabilitative information, and therapies for the schizophrenics. Psychosocial treatments involve individual psycho-education, behavioral therapy, Assertive Community Treatment, case management, and familial intervention (Mattila, et. al., 2014). Individual psycho-education is delivered by a qualified psychologist who helps the patient dispel his fears, explaining that what the patient is fearful of is not real. Charlie is fearful that they might be attacked by terrorists, and hopes to save his mother. A psychologist can help dispel these fears by talking and engaging Charlie in therapy to help him get back to reality. This is usually used in combination with rehabilitative information. Additionally, assertive community treatment is a team of professionals that help attend to schizophrenics out of hospital. Similarly, case management involves taking care of the patient out of hospital by providing a good environment for recovery. However, NICE (2014) observes that the area of psychosocial intervention for schizophrenia is under-researched as there is no enough evidence as to exactly how they work towards managing schizophrenia.
Pharmacological interventions require the understanding of efficacy and effectiveness of the drugs before administering. Pharmacological interventions can be antidepressants and antipsychotic medications. These medications are effective in treating the symptoms of schizophrenia like hallucinations and emotional instability, and the dosage depends on the stage the disease. However, these medications can also cause side effects such as involuntary movements and decreased motivation. Thoraxine, navane, mellaril, and trilafon, usually known as neuroleptics, are some of the pharmacological interventions used in the management of schizophrenia (Attux, et. al, 2013). Physical interventions include retraining the patients, especially those who are determined to the dangerous to themselves and to others. Use of restraints, although resorted to as a last minute intervention, is usually used either I hospital, care centers, or home environment. However, legal and ethical implications should be considered before physical measures are used on schizophrenics, as they are argued to cause more harm to the patient than good.
In my experience, this is what would give my life meaning and help me to feel that I am contributing:
If I could find a job, it would add meaning to my life, especially if it involves helping others because I would feel that I am contributing to something bigger than myself
In my experience, these are the relationships that support my wellness:
I would wish to have a closer relationship with my fellow age mates, since such a relationship would support my wellness. I would learn how to relate better with them if I got to spend more time with them, and I could share my fears and ambitions with them as well.
These are some things that I would like to try, to see if these activities would support my wellness:
I would like to try to see a psychologist to help with my emotional instability, in addition to getting a job and connecting more with my friends and age mates
Daily Maintenance Plan
Part of my maintenance plan involves the support I receive from my family and / or friends. My immediate support network involves:
My mother, a doctor and close friends, as well as doctors from the care hospital.
I have decided to take an antipsychotic drug called Fanapt, which was prescribed by the doctor, since it will help in reducing the psychotic symptoms of hallucinations, delusions, and lack of coherence.
I will be able to stop taking this medication when the symptoms reduce to a level that will be determined by the doctor
Some of the medications I take have side-effects. Here are some ideas about how to manage these side effects:
For example, the antipsychotic drug, Fanapt, has caused weight gain. However, to manage this side effect, I will engage in daily physical activities, as well as observe a healthy and nutritious diet
Psychological interventions recommended to me include; Psychotherapy, family education, and community assessment team. These interventions are important for me because they will help me in recovery. I will continue to participate in these interventions to continue getting mutual support, as well as in learning more about my condition and how to manage it.
If it became necessary for me to take additional psychotropic medication, for example, when I become acutely mentally unwell and I am unable to explain my preferences or I am at risk of harm, then I would prefer to take Saphris because this medication acts fast, unlike other medications which take a while to start acting. This medication can be taken orally, but in case I am not in a position to take it orally or sublingually, an injection would be best.
If it became necessary for me to take additional medication, for example, for example, when I become acutely mentally unwell and I am unable to explain my preferences or I am at risk of harm, I would prefer NOT to take chlorpromazine because of the adverse side effects associated with the drug
If it became necessary for me to accept other kinds of treatments or interventions in an emergency, the treatments or interventions that I would prefer to take are rehabilitation, including vocational and social training that would help me overcome difficulties associated with the disease. Additionally, I need to engage in more social activities so as to get engaged more socially, as well as engage in physical exercises to manage my weight. However, I will need to engage less in eating unhealthy foods, drugs, and seclusion in order to uphold my wellbeing. I know that I need to let go of my fears about terrorism for the sake of my wellbeing, although for some reason I haven’t been able to observe it.
Certain environments and situations can trigger the attack. some of these triggers include the absence of my mother when she goes away to work, and news on TV about terrorist attacks. Also, the loss of a close loved one is another trigger to the disorder. To handle these triggers, I can get myself engaged in social activities and other activities to keep my mind of the triggers. Also, I can avoid watching news to prevent encountering such triggers. To cope with the triggers when they occur, I can engage with my case manager and psychotherapist. This engagement can also prevent the condition from worsening.
The early warning signs are hallucinations, withdrawal from the rest of the people, lack of interest in activities, and delusions.
When I recognize the early signs, I can contact my psychotherapist and schedule a meeting. Additionally, I can warn my family members, especially my mother since she is the nearest, and I can also visit the hospital.
Other people also notice when these changes are occurring in me, and these warning signs recognizable by other people are important because I may not always be alert to the changes. These changes include withdrawal from normal activities, seclusion, and increased agitation.
Personal Crisis Plan
This plan was made on 25th March, 2015
Part 1: Remembering What I am like when I’m feeling well
When I am well, I am usually jovial, active, and social with other people. I am also able to concentrate better on anything that I undertake including taking part in schoolwork and engaging in physical activities.
Part 2: When it gets too bad
When it gets too bad, those responsible for my wellbeing like my doctors, the psychotherapist, and my mother can take precedence in ensuring that my wellbeing is observed and maintained. I have discussed this with the above mentioned people and made clear of what I expect from each of them in case things get bad.
Part 4.Settling issues between supporters
If there is a disagreement among the supporters, I would like them to consider my best interests based on the information provided above. If there is lack of congruence on issues, the supporters should take a vote, with the majority taking precedence in regards to the situation.
Part 5: Alternatives to being in Hospital: staying at Home-Nursing other safe places
The care that I require can be offered from home, but when that is no longer possible, a mental institution chosen by my supporters. The environment should be good enough to discourage triggers, and it should also be safe for me. Nursing care homes is a best alternative to being in hospital, and it should be considered my first choice
Part 6: Help from others
The most important help that I can receive from others is emotional support. The emotional support can be from my mother, friends, and the medical team that is taking care of me. Additionally, social support groups with people going through the same issues can also be of great help in helping me to recover and manage the condition. Disagreement from my supporters is something that I would hate, since I think it would worsen my condition.
Part7: When there is risk
When there I become a risk to myself and/or to others, I would like my supporters to consider restraints, whether physical or chemical.
The crisis plan becomes inactive when I am able to make my own decisions again, which can be determined by the psychotherapist and the doctors involved in my care plan.
Post Crisis Planning
Even after a successful crisis care plan, the crisis can also recur. However, the plan can serve as a framework for improving on the parts of the care plan that were not effective.
Engagement with Consumer, Carer, and Family Members to Support Consumers on their Recovery journey
As a future healthcare professional, I would use my skills and expertise to partner with the consumer, the carers, and the family members to provide care in hospital, as well as when the patient is discharged from hospital. According to Mattila, et. al. (2014), schizophrenia can be triggered by certain situations and events. Engaging with the family members ensures that these triggers are avoided. In Charlie’s case, separation from his mother and news about terrorism are major triggers to the condition. Therefore, it would be imperative for the family members to ensure that these situations are avoided so as to maintain the wellness of the consumer.
In addition, partnering with the other care givers can help in development of a good car plan, whereby evidence-based practice can be used. Moreover, partnering with the other caregivers can be beneficial in development of research that can lead to better care for schizophrenics. Research not only adds to the evidence-based care, but also contributes to discovery of new methods of care plans. Advocacy is a role that healthcare professionals play. Identifying areas that require improvement in the nursing and health care of people with schizophrenia is crucial for the development of policies that improve their well being. Carers and healthcare professionals can, therefore, partner to advocate for the revision, or improvement of existing policies that address the issue of schizophrenia.
Attux, C., et. al. (2013). A 6-month Randomized Controlled Trial to Test the Efficacy of a
Lifestyle Intervention for Weight Gain Management in Schizophrenia. psychiatry,
13(1), 60. http://www.biomedcentral.com/1471-244X/13/60
Barnes, T. R. (2011). Evidence-based Guidelines for the Pharmacological Treatment of
Schizophrenia: Recommendations from the British Association for
Psychopharmacology. Journal of Psychopharmacology, 1-54
D’Souza, M. S., & Markou, A. (2012). Schizophrenia and Tobacco Smoking Co-morbidity:
nAChR Agonists in the Treatment of Schizophrenia-associated Cognitive Deficits.
Neuropharmacology, 62(3), 1564-1573.
Dyck, D. G., et. al. (2013). Service Use among Patients with Schizophrenia in
Psychoeducational Multiple-family Group Treatment.
Ferentinos, P., & Dikeos, D. (2012). Genetic Correlates of Medical Comorbidity Associated
with Schizophrenia and Treatment with Antipsychotics. Current Opinion in
Psychiatry, 25(5), 381-390. http://journals.lww.com/co psychiatry/Abstract/2012/09000/Genetic_correlates_of_medical_comorbidity.10.aspx
Lane, H. Y., Tsai, G. E., Chang, H. T., & Lin, C. H. (2014). U.S. Patent Application
Mattila, T., et. al. (2014). Impact of DSM-5 Changes on the Diagnosis and Acute Treatment
of Schizophrenia. Schizophrenia Bulletin, sbu172.
National Institute for Health and Care Excellence, NICE, (2014). Psychosis and
Schizophrenia in Adults: Treatment and Management. Retrieved 29 March, 2015,
Shergill, S. S., et. al. (2014). Evidence for Sensory Prediction Deficits in Schizophrenia.
American Journal of Psychiatry, 162(12), 2384-2386.
Suvisaari, J., et. al. (2014). Association between Prenatal Exposure to Poliovirus Infection
and Adult Schizophrenia. American Psychiatric Association
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