Abstract
Despite numerous attempts at exploring schizophrenia, its nature remains an elusive mystery. The existing symptoms of the disorder include, but are not limited to, hallucinations and changes in social interaction patterns. Addressing the disorder may become a problem due to the complexities associated with the retrieval of informed consent from patients and their legal guardians or family members. Nevertheless, the problem can be handled by introducing a combination of treatment and medications so that the parent’s behavior could be shaped and that their hallucinations and delusions could be vanquished.
DSM-V Diagnosis
Schizophrenia: Diagnosis
Schizophrenia is a severe chronic mental condition that has become increasingly widespread (National Institute of Mental Health, 2016). Schizophrenia typically manifests itself in a radical change in the way of processing information, social interactions, etc. (American Psychiatric Association, 2013). Hallucinations and delusions are typically listed among the key indicators of schizophrenia. However, because of the similarities between schizoaffective disorders and schizophrenia, the process of diagnosing the latter may become complicated (Tandon, 2014). Furthermore, negative changes in data processing quality and the accuracy of patient’s movements can be viewed as the signs of schizophrenia (American Psychiatric Association, 2013).
Historical and Political Roots of Schizophrenia
The history of schizophrenia as a mental disorder is long and rather convoluted. It can be traced to ancient India, where various aspects of health were singled out, and the emphasis on the balance between them as the foundation for health was placed. Particularly, Vedas specify the necessity to maintain a balance between Bhuthas and Doshas, which are the elements that constitute a person’s physical and mental health (Ashok, Baugh, & Yeragani, 2012).
However, it was not until the early 20th century that the disease was acknowledged as a mental health issue. In 1908, the very term “schizophrenia” was coined by Eugen Bleuler, who used the word to describe impairments of physical functioning (Maatz, Hoff, & Angst, 2015). Particularly, the professor emphasized that the term “dementia praecox” could not be deemed as legitimate since the disorder could not be related to either dementia or precociousness completely (Maatz et al., 2015). The split of physical functions of an individual, in turn, was declared to be the primary characteristic of the phenomenon (Maatz et al., 2015). Thus, the term “schizophrenia” derived from the Greek schizoid “to split” was born and quickly became common for defining the mental disorder in question.
Current Literature on Schizophrenia
Schizophrenia is widely discussed in a range of contemporary studies. Apart from hallucinations and delusions mentioned above, patients are tested for the signs of thought and movement disorders (Maatz et al., 2015). Furthermore, the emotional range of a patient is explored extensively to see if the signs of the so-called “flat affect” (Cohen, Mitchell, Docherty, & Horan, 2016, p. 306) can be traced. By definition, the flat affect implies that a patient has a very narrow range of emotional reactions, which are somewhat dulled (Cohen et al., 2016). Speech impairments and problems with cognitive functioning (e.g., troubles memorizing facts, processing and understanding information, etc.) are also viewed as the primary symptom of schizophrenia development (Maatz et al., 2015). The identified range of symptoms is typically divided into three subgroups, i.e., positive symptoms, negative ones, and cognitive signs (Cohen et al., 2016).
When considering the factors that impede the process of diagnosing schizophrenia, one must mention the issues such as logical fallacies occurring during the analysis of the available data. For instance, the assumption that the absence of evidence implies the same outcomes as the actual absence of the disorder symptoms often hinders the process of determining and addressing schizophrenia in patients (Tandon, 2014). Particularly, the authors of the research specify that the identified issue may lead to misdiagnosing the problem and, therefore, reducing the possibility of a positive outcome for patients:
An important point to make is the common logical fallacy that the absence of evidence is the same as evidence of absence. Few research data can address the question as to whether diagnoses confirmed at 24 months are stable in the immediate period thereafter. (Harvey et al., 2013)
Ethical and Multicultural Issues
Schizophrenia: Ethical Considerations
Of all the possible issues that one may face when addressing ethical aspects of schizophrenia, one must mention the problems associated with receiving patients’ informed consent first. Because of the mental impairments that schizophrenia triggers, the target population cannot be deemed as eligible for signing the informed consent. Therefore, their legal guardians must confirm that they accept the provided treatment and are going to follow the instructions provided by the therapist. However, in a range of scenarios, the stage of schizophrenia development is far too early for patients not to take account of the situation. In case a patient and their legal guardian disagree about a particular point, allowing the patient to sign the informed consent can be legal, yet it may trigger huge legal repercussions in case the patient will be defined as ineligible for making decisions on their own volition by the corresponding legal bodies (Harvey et al., 2013).
Herein the primary area of concern lies. It is, therefore, imperative to make sure that both a patient and their legal guardian should be provided with extensive information about the health issues that the former is likely to face, as well as the available treatment options and the opportunities for recovery (Harvey et al., 2013). As long as the outcomes of refusing from the suggested treatment become obvious to a patient and their legal guardian, the premises for building a dialogue between the parties involved, including a nurse, will be created.
Schizophrenia: Multicultural Considerations
Seeing that different cultures have different conceptualizations of mental illness, misunderstandings between a nurse and a patient or a nurse and the patient’s legal guardian are highly expected (National Institute of Mental Health, 2016). The issue regarding signing the informed consent described above may be the result of a culture clash and the misunderstandings occurring as a result. Therefore, it is crucial to make sure that a nurse should be aware of the essential specifics of the patient’s and their legal guardian’s culture, traditions, and their concept of health, treatment, and the related issues (National Institute of Mental Health, 2016).
Cultural differences may also lead to a misinterpretation of the data concerning the dynamics of changes in the patient’s state. As a result, the efficacy of the suggested treatment is likely to be very low, thus, affecting patients’ well-being negatively. Therefore, building an efficient communication process is essential for ensuring the successful recovery of the target population.
Finally, multicultural misconceptions may lead to a rapid rise in the levels of discomfort experienced by a patient during the administration of the necessary medications and treatment. Seeing that the development of schizophrenia is linked directly to a patient’s emotional state, it is crucial to make sure that the target population should be placed in a comfortable and relaxing setting. Thus, the threats of culture clashes will be reduced significantly. Furthermore, nurses are in desperate need of training sessions teaching the basics of cultural sensitivity. The active acquisition of the communication skills based on acknowledging and encouraging patient diversity is a necessary step toward successful diagnosing and management of schizophrenia (American Psychiatric Association, 2013). Therefore, nurses need to be provided with a set of rigid guidelines and numerous training sessions allowing them to develop the skills for efficient multicultural communication. As a result, a significant increase in the number of positive patient outcomes is expected.
Case Study
Demographics: Description
Patient L. is a 17-year-old Hispanic male with the signs of a rapidly progressing schizophrenia. L. is single and lives with his mother. The patient’s health record shows that he has been having hallucinations with varying degrees of intensity. The patient is slightly overweight (3.28 feet tall; 209.5 pounds).
Presenting Problem: Reasons for Counseling
L. visited the therapist over his sprung ankle; however, during the conversation with a nurse, he confessed that he had been receiving signals from outer space and communicating with extraterrestrial beings. Therefore, a more detailed overview of the patient’s mental health was viewed as a necessity. In the progression of his disorder, L. reached the point at which his delusions affect the quality of not only his life but also the lives of people around him. Particularly, the well-being of L.’s family members is currently jeopardized since his hallucinations may lead to violent outbursts toward the people around him.
Presenting Symptoms: Schizophrenia
At present, the patient has been suffering mainly from auditory hallucinations that manifest themselves in “voices” in his head. The specified symptom can be defined as the most graphic evidence of the development of schizophrenia in the patient. However, apart from the issues associated with auditory hallucinations, other signs of the disorder can be spotted. For instance, the fact that the patient’s speech lacks organization needs to be brought up as one of the signals that a mental disorder may have developed.
Particularly, L.’s inability to connect cause and effect in his speech can be deemed as graphic evidence of the fact that he is suffering from schizophrenia. Also, the fact that L.’s level of social engagement and communication-related activity has dropped significantly over the past few years shows that there is a possibility of schizophrenia. Furthermore, the fact that the patient’s working memory has been suffering significant negative consequences needs to be listed among the primary indicators of schizophrenia (Osborne, Solowij, Babic, Huang, & Weston-Green, 2017). The identified cognitive deficit is characteristic of schizophrenia and, therefore, must be viewed as a sign of the disorder development in the patient (Osborne et al., 2017).
Social History: Interactions
A closer look at the history of the patient’s social life will reveal that L. has been avoiding communicating with his friends for quite a while. The identified behavior stands in sharp contrast to what could be observed several years before, when L. could be described as a social butterfly, being open to new interactions and ready to engage in a conversation. Therefore, the identified changes in his communication patterns and social behaviors can be deemed as a rather graphic signal of schizophrenia development.
Family History: Relatives
Depressive symptoms can be considered the definitive characteristic of L.’s family history. While depression has not been occurring in every family member, the propensity among the patients’ relatives to suffer from the identified psychological issue is very clear. The fact that depression is a common occurrence in L.’s family also signifies that the threat of schizophrenia development is very high (Nuhu, Eseigbe, Issa, & Gomina, 2016). Furthermore, there seems to be a strong genetic predisposition toward schizophrenia L.’s family. Indeed, a closer look at the family history has revealed that one of L.’s great-grandparents, as well as his uncle, had schizophrenia that manifested itself to a varied degree yet was quite obvious in both cases.
Occupational and Educational History
The patient does not have job experience yet. L. is a high-school student, and he is graduating this year. The patient has been showing moderate success in his academic endeavors; while his progress could not be defined as lackluster, he is not an A-student. However, with the recent development of schizophrenia, his academic success rates seem to have been dropping, which means that he may have problems passing his exams and experiencing academic success.
Treatment
To make sure that L. should get rid of his hallucinations and experience a psychological recovery, one should combine medical treatment with therapy. L should take antipsychotic medicine regularly so that his delusions should not progress and, instead, could be vanquished successfully. Asenapine (Saphris) should be prescribed so that hallucinations could be addressed successfully. One must keep in mind that the consumption of Asenapine (Saphris) is a second-generation antipsychotic drug that is likely to lead to fewer and less intense side effects than the cheaper option belonging to the first generation of schizophrenia medications (Thomas, Caballero, & Harrington, 2015).
Furthermore, active therapy should involve the use of Cognitive Behavioral Therapy (CBT). The specified approach is bound to help L. recover some of his cognitive functions successfully (Morrison et al., 2014). As a result, his recovery and reintegration into society will become a possibility.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.
Ashok, A., Baugh, J., & Yeragani, V. (2012). Paul Eugen Bleuler and the origin of the term schizophrenia (schizopreniegruppe). Indian Journal of Psychiatry, 54(1), 95-96. Web.
Cohen, A. S., Mitchell, K. R., Docherty, N. M., & Horan, W. P. (2016). Vocal expression in schizophrenia: Less than meets the ear. Journal of Abnormal Psychology, 125(2), 299-309. Web.
Harvey, P. D., Heaton, R. K., Carpenter, W. T., Green, M. F., Gold, J. M., & Schoenbaum, M. (2012). Diagnosis of schizophrenia: Consistency across information sources and stability of the condition. Schizophrenia Research, 140(1-3), 9-14. Web.
Morrison, A. P., Pyle, M., Chapman, N., French, P., Parker, S. K., & Wells, A. (2014). Metacognitive therapy in people with a schizophrenia spectrum diagnosis and medication resistant symptoms: A feasibility study. Journal of Behavior Therapy and Experimental Psychiatry, 45(2), 280-284. Web.
National Institute of Mental Health. (2016). Schizophrenia. Web.
Nuhu, F. T., Eseigbe, E. E., Issa, B. A., & Gomina, M. O. (2016). Strong family history and early onset of schizophrenia: About 2 families in Northern Nigeria. Pan African Medical Journal, 24, 282-286. Web.
Osborne, A. L., Solowij, N., Babic, I., Huang, X., & Weston-Green, K. (2017). Improved Social Interaction, Recognition and Working Memory with Cannabidiol Treatment in a Prenatal Infection (poly I:C) Rat Model. Neuropsychopharmacology, 42(7), 1447-1457. Web.
Thomas, J. E., Caballero, J., & Harrington, C. A. (2015). The Incidence of akathisia in the treatment of schizophrenia with Aripiprazole, Asenapine and Lurasidone: A meta-analysis. Current Neuropharmacology, 13(5), 681-691. Web.