Mental Health Nursing And Psychology: A Critical Overview

Mental Health Nursing: Psychology

Mental Health Nursing

Describe about the Mental Health Nursing of Psychology?

Schizophrenia and anxiety disorders are psychiatric disorders which can occur separately or co-occur in a patient. Schizophrenia patients suffer from numerous symptoms. These symptoms can also change with  respect to time and stages of the  disease. In this case, the patient is a 30 year old man who is diagnosed with Schizophrenia and anxiety. He has been kept  in a medium secure unit from the age of 24 till now. He is also suffering from depression, high blood pressure along with type 2 diabetes. He shows symptoms such as self harming (cutting, ligating, airway blocking). Through the years of study of this case, it is also clear that the man is a risk to women. He also shows violent aggression towards the staffs of the facility. Through the patient’s past history, it is known that the patient was a victim of abuse while he was in a care facility as a young boy. The main aspect of this case study is to critically analyze the patient’s scenario and providing nursing care methods in response. To provide care in cases like this, a nurse needs to acquire a special training to specialize in these types of cases. Nurses who provide care for these patients are called psychiatric nurses or mental health nurses. They provide care to the patients suffering from Schizophrenia, anxiety, psychosis, bipolar disorders. Nurses play a vital role in these types of scenarios. They help to build a bridge between the patient and therapeutic medication. They also provide mental comfort to the patients which helps in the overall medication aspect. With the help of a proper and effective therapeutic plan, condition of a patient can improve with respect to time.

Mental disorders such as schizophrenia, anxiety were neglected for several years, but recently comprehensive studies have been done on this subject (Muller et al. 2004).  According to the studies of Pallanti, anxiety is one of the frequent comorbidity. If there is presence of anxiety in psychological disorders such as schizophrenia, then the patient suffers from suicidal tendency or self harming activity (Dixon et al. 2014). They also suffer from relapses. Pallanti also suggested that, the presence of anxiety with other mental disorders worsens the patient’s situation. Jacqueline suggested in his article that there is s possibility of anxiety, becoming the core problem relating towards schizophrenia. Alison Andrew wrote in an article that there might be several factors which can cause mental disorders in a person. In a journal by Mulder, it was stated that childhood sexual and physical abuse can cause mental disorders. It was also noted that the effect of physical abuse was much greater than sexual abuse in schizophrenia patients (MacMillan et al. 2014). Other most common phenomenon among patients suffering from mental disorders are schizophrenia and anxiety is type 2 diabetes and high blood pressure (Pallanti, Cantisani and Grassi, 2013). There is a relation between type 2 diabetes and schizophrenia. The potential mechanism behind this is still unknown (Pallanti, Quercioli and Hollander, 2014). According to Liu, there might be some pathway and protein-protein interaction for which type 2 diabetes and schizophrenia may be associated with each other. He also identified some genes that may link these two diseases together. His findings influenced the novel hypothesis and co-morbidity of these two diseases. It is seen in most of the cases that patients suffering from schizophrenia and anxiety also have high blood pressure and hypertension. According to the research of Lian, schizophrenia patients are prone to high blood pressure and hypertension. Hypertension is significantly related to body mass and other indexes. So, it is important to develop blood pressure and body weight monitoring system for schizophrenia patients. From the research of Volakfa, it can be concluded that, schizophrenic patients often demonstrate aggressive behavior and violence. Though the rate of the symptom is higher in bipolar disorder, but in some cases of schizophrenia, the syndrome may extend to the extreme point. This syndrome among the adult patient may be conducted through two pathways.  One related to antisocial aspect and the other one is associated with psychopathology of schizophrenia. To treat such symptoms Non-pharmacological methods are important. One of the most effective methods is a cognitive behavioral approach (Young et al. 2013) . Comorbid situations like both schizophrenia and anxiety disorder can be treated with cognitive behavioral approach (Vrbová et al. 2013). Techniques used in this method include switching of the attention of the patient, narrowing the attention, increasing the activity levels of the patient, increased amount of social engagement, increased amount of conversations. Reflecting on the scenario of case study, a Tidal model of nursing is also applicable to the patient (Tidal-model.com, 2015). Tidal model was developed by Barker (Barker et al. 2000), as a recovery model in aspect of psychiatric nursing. This model emphasizes on the discrete nature of the relationship between the patient and the nurse. This model suggests that a patient suffering from mental disorders such as schizophrenia and anxiety needs three types of care. These three types are critical, transitional and developmental. Tidal model is used in many facilities such as in new castle. Another model that is applied in such cases is ACT. It is an intensive and persistent management model which targets severe cases of schizophrenia. It can be said that Cognitive behavioral therapy can be used for this patient as well. Minimum duration of a cognitive behavioral therapy should be about 12 weeks. So it is a method which can be applied to a specific goal and within a given period of time. This will help us to assess the improvement of the patient’s situation and customize the therapy according to the patient’s need.

Literature Review

The patient is a 30 year old man kept in a medium secure unit. He is there from the age 24 and have been diagnosed with Schizophrenia and anxiety. He is currently suffering from depression. He also has high blood pressure and type 2 diabetes. There is always a risk with the patient as he has a tendency of self-harming, ligating and airway blocking. He is a high risk for women as he is specifically violent towards them. He also demonstrates violence and aggression towards the staffs of the unit. This phenomenon is observed, especially when his needs are not met straight away. He has no family and friends. From his case history, it is known that he was a victim of abuse when he was in a care facility as a young boy.

From the case study it can be said that when the patient was young as a boy, he was a victim of abuse. This might have badly affected his mental condition. There might be a possibility that these abuses may have prolonged for a very long time. According to some researchers, child abuse is one of the reasons that may cause schizophrenia. They also concluded that though there is a possibility of child abuse being a reason, but it should not be considered as the main reason (Bronstein, 2012). There is also a possibility that schizophrenia is caused through genetic disorders. It is not clear whether this is the main reason for his mental disorders.

According to a journal by Harriet, If an individual suffers from physical or sexual abuse at the time of childhood, then there is a huge possibility that the individual might associate with lifetime psychopathology. Child abuse can be divided into different categories such as Physical child abuse, sexual child abuse, emotional child abuse, psychological child abuse and child neglect (Relationship Between Dissociation, Childhood Sexual Abuse, Childhood Physical Abuse, and Mental Illness in a General Population Sample: American Journal of Psychiatry: Vol 155, No 6, 2015). As it is still not clear that, the patient suffered from which type of abuse. So, every type of child abuse should be considered in terms of element of care.

Assessment of physical injury: If a child is suffering from physical abuse, then it is often that the child is going through physical assaults (Kemp, 2011). After the reports are made, it is important to monitor all the physical damages that have occurred. Psychological monitoring should also be done to assess the psychological trauma from which the child is suffering. According to Springer, it is difficult to determine the true prevalence of physical abuse. It is also important to consider the fact that only a few numbers of cases are reported. Physical abuse can cause severe mortality and morbidity. So, proper clinical evaluation should be carried out.

Specialized child-abuse advocacy center: The Specialized child-abuse advocacy provides children with adequate amount of security and healthy environment where they can be  examined or interviewed by a multidisciplinary team of experts (Department of community development, 2015). In these facilities the child is helped to overcome the traumatic time. The  Multidisciplinary Team comprises of a nurse specialized in forensic, a nurse practitioner, a child abuse expert physician, a renowned social worker, intake coordinator, emergency legal aid, and a director. If a child has acute injuries and bleeding, the child should be admitted to the closest medical facility.

Case Study

Helping with emotional repercussions: The children suffering from child abuse often suffer from severe emotional and mental trauma as well (American Nurse Today, 2010). As they are not matured enough, they lack the ability to overcome these severe In order to repress their mental trauma, the nurse should try to build a relationship which will assure the patient of trust and security. It should be kept in mind that the child needs empathy. A kind and empathetic approach can be applied in these types of scenarios.

Post-Trauma Syndrome caused by physical or psychological abuse:

GOAL	INTERVENTION	RATIONALE	EXPECTED OUTCOME
	NIC Priority intervention: Counselling: Use of an interactive helping process focusing on the needs, mental situation and care of the child suffering from abuse or other violence.		NOC Suggested Outcome: Abuse/Violence Recovery: healing of psychological and physical wounds of abuse or violence.
The child demonstrates abuse or violence recovery.	·         Assess the child’s affect and behaviors. ·         Evaluate social interactions and build a sense of trust among others. ·         Help the child to identify the feelings and recovery strategies by providing counselling, art therapy, and other strategies.	·         Disturbed child behaviors can demonstrate a sense of mistrust and insecurity. ·         Establishment of close interactions with others demonstrates reestablishment of a sense of trust. ·         A child suffering from abuse or other kind of violences needs a therapeutic approach from the counselor to suppress the mental trauma. It is also important to rebuild trust and respect for others. Recovery and coping strategies should be implementes.	The child identifies feelings related to violent episodes and expresses healing of the self.

The second episode can be demarcated from the age of 24. He was admitted to this particular facility when he was 24 and from then till now, he is still there. During this period he has shown the symptoms of schizophrenia and anxiety. He is currently suffering from depression. He has both high blood pressure and type 2 diabetes. He has a tendency of self harming by cutting, ligating, airway blocking. He is a high risk for women. He shows signs of violence and aggression towards the staffs of the secure unit if his needs and demands are not met straight away. In this scenario the patient is in more severe condition and a pharmacological approach is also needed.

From the details of the case study it can be concluded that the patient is suffering from Catatonic Schizophrenia.

Nursing Interventions: Nursing Intervention is the most important aspect in the treatment of Schizophrenia (Chien et al 2013). Interventions that should be applied in this scenario are,

Spending time with the patient to promote reassurance and support.

In these kind of situations the nurse should not talk about the patient in his presence.

Reduction of distorted perceptions.

Continuous assessment of his signs and symptoms should be done. It should be also checked if he his suffering from any self harm injuries or not.

His basic needs of foods, fluids, exercise should be met. Special care of his nutrition should be taken.

The nurse should be always alert for any kind of violent outbursts. If any kind of Violence outburst occurs, the nurse should ask for help promptly (Matt Vera et al. 2012).

A comprehensive treatment program is needed to be carried out. Antipsychotic medications are useful (Andreasen et al. 2014). Mental support should be provided to that individual. Proper rehabilitation should be provided for improvement of activities and daily living. The patient should also be given vocational and recreational support. Cognitive therapy is also important for the betterment of the patient (Lisman, 2012).

In case of Schizophrenia, pharmacological interventions can sustain for a life long time. The patient can be given ECT and benzodiazepines like diazepam or lorazepam for his conditions. Conventional antiseptic drugs should be avoided as there is a possibility that it will worsen the patient’s situation (Andrew et al. 2012).

Pharmacological interventions can be subdivided into different categories which are discussed below,

Atypical antipsychotics: The second generation atypical antipsychotic drugs have lower side effects. Drugs which are used are Aripiprazole (Abilify), Asenapine (Saphris), Clozapine (Clozaril), Llperidone (Fanapt), Lurasidone (Latuda), Olanzapine (Zyprexa), Paliperidone (Invega), Quetapine (Seroquel), Risperidone (Risperdal), Ziprasidone (Geodone) (org, 2015).

Episode 1

Typical antipsychotics: These drugs can cause severe neurological disorders like Tardive Diskinesia. Chlorpromazine, Fluphenazine, Haloperidol (Haldol), Perphenazine etc. (Mja.com.au, 2015).

Element of care for Hypertension: Hypertension is actually an abnormally high blood pressure. Psychological illness is one of the major causes for which the patient is suffering from hypertension and high blood pressure (Lan and Chen, 2012).

Nursing Intervention: Cognitive Behavioral Therapy can be applied so that the patient does not get agitated or excited. It will help the patient to control his blood pressure. Along with Cognitive behavioral Therapy, pharmacological interventions are also needed to be applied. Pharmacological Interventions:  Pharmacological intervention in these kind of cases should be applied carefully. As pharmacological drugs cause different kind of side effects, there is always a chance if a proper drug is not applied, then the situation can become worse (Mayoclinic.org, 2015).

Thiazide diuretics can be used to regulate blood pressure. Diuretics act on the kidney and helps to eliminate sodium and water from the body. As a result, blood volume decreases and blood pressure are controlled.

Beta blockers such as acebutolol, (Sectral), atenolol (Tenormin) also help to regulate high blood pressure by reducing the pressure on the heart through opening the blood vessels.

Angiotensin converting enzyme (ACE) inhibitors such as lisinopril (Zestril), benazepril (Lotensin), captopril (Capoten) blocks the narrowing of blood vessels.

Calcium channel blocker such as amlodipine (Norvasc), diltiazem (Cardizem, Tiazac) helps to relax the muscles of blood vessels which controls the blood pressure.

Renin Inhibitors like aliskiren (Tekturna) helps to control blood pressure by slowing down the production of rennin.

Sometimes other additional medications such as alpha blockers, alpha-beta blockers, central-acting agents, vasodilators, aldosterone antagonists can be applied to keep the blood pressure at normal levels.

Element of care for type 2 diabetes: Patients suffering from psychological illnesses such as schizophrenia often suffer from type 2 diabetes as well. Both nursing and pharmacological interventions can be applied to maintain the normal diabetes level.

Nursing Intervention: Nurses can strictly maintain a dietary portfolio which will help to reduce and maintain a stable blood sugar level. Sufficient amount of exercise is also very much helpful to regulate diabetes.

Pharmacological Intervention: Insulin therapy is used in those cases where healthy diet and exercise does not affect the high blood sugar levels. Along with insulin therapy pharmacological drugs are also applied to maintain the blood sugar levels.

Metformin (Glucophage, Glumetza) is used to reduce the blood sugar level through improving the sensitivity of body tissues towards insulin.

Sulfonylurease helps to secrete more insulin, which regulates the blood sugar levels.

Meglitinides also are used. It has a same mechanism as sulfonylurease, but works faster than it.

Thiazolidinediones, DPP-$ inhibitors, GLP-1 receptor agonists, SGL T2 inhibitors are also used to regulate the blood sugar levels in case of Type 2 diabetes mellitus (org, 2015).

Conclusion

From the articles in different journals, it can be said that if the patient was treated with care and love when he was young, then his condition would not have been this much severe. As he demonstrates a special violent behavior towards women, it can also be concluded that he might have been abused by a woman when was young (Gilmore, 2014). Facing abuse from a woman when he was young, led to this strong aggression and hatred (Volavka, 2013). There is also a possibility that this might be the effect of a genetic disorder. Due to lack of evidence this cause also can not strongly concluded. As he has no family, it is hard to assume what was the cause, but these incidents led him to such severe psychological disorders. As of now, he is 30 years of age and there is still a chance that with proper nursing and pharmacological interventions, his condition will get better. The nurse should also be aware of the fact that he is dangerous, so proper measures should be taken while he is taking care of him. Understanding of the entire situation is very important. Drugs will help to reduce the effects, but it would not solely cure him. So understanding the case, designing a flexible intervention plan would help the patient. Continuous assessment of the patient should also be done, to monitor the efficacy of the intervention plan and if needed that a treatment plan can be modified according to the needs. This is the biggest advantage of treatment procedure such as Cognitive Behavioral Therapy (Frith, 2015). According to both the nursing and pharmacological intervention stated in this study, it can be expected that the situation of the patient will get better with respect to time.

Elements of Care

References

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