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NURS5085 Mental Health Nursing Practice
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NURS5085 Mental Health Nursing Practice
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Course Code: NURS5085
University: The University Of Sydney
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Country: Australia
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Psychosis can be described as a state of unusual disorder of mind that makes it difficult for the sufferer to determine the reality. Psychosis encompasses mental illnesses like schizophrenia, sleep deprivation, bipolar disorder and may also possibly be caused due to some medications, heavy intake of cannabis or alcohol. Certain irregularities in levels and functioning of dopamine mainly in the mesolimbic pathway is understood to be the precursor. The two main proof given to back this proposition are that dopamine receptor D2 obstructing drugs (i.e., antipsychotics) tend to lessen the intensity of psychotic signs, and drugs that increase dopamine discharge, or prevent its reuptake (such as cocaine and amphetamines) can trigger psychosis in some people.
The dysfunction of NMDA receptor in psychosis has been suggested as a mechanism. This proposition is strengthened through the fact that dissociative NMDA receptor adversaries such as dextromethorphan, ketamine and PCP (because of overdose) prompt a psychotic state. The fact that medicines recognized to decrease in brain, the effects of dopamine and also brain scans give appropriate proof that dopamine has a major role in a patient suffering from psychosis. Hallucinating about a departed loved one, severe sleep deficit which are considered normal can also be a trigger or cause of psychosis.
Hostile childhood experience can also increase the possibility of developing psychosis of some kind. Often undergoing the indications of psychosis is mentioned to as having a psychotic event. Psychosis is mostly said to be a symptom and not a disease in itself and it is mostly prevalent amongst people with schizophrenia, bipolar disorder, severe depression, epilepsy, dissociative disorders, post-traumatic stress disorder et cetera.
Generally, a person’s first psychotic experience happens in puberty, a critical time in development of individuality, relations and long-term occupational plans. The patient may have trouble in trying to fall asleep, abrupt pause in the middle of speech, limitations in variety of emotional expression, societal withdrawal (Lutter, 2009). Manifestations of unclear suspiciousness, anger, irritation, anxiety, mood swings, tension, trouble trying to concentrate, deterioration of performance in academic activities and work. False beliefs, sighting or hearing things that others can’t see or hear, unable to express oneself through speech because of emotions, societal withdrawal, absence of enthusiasm and trouble doing day-to-day activities. A person can perceive threat to their own life.
They perceive voices, visuals, tastes, smell stuffs that are not perceived by others. The person can have sudden loss of thought causing an abrupt silence in between a conversation. These delusions can lead to severe suffering and an alteration of behavior. Psychosis can be said to be a short-term disorder which with proper treatment can frequently lead to complete recovery (Morgan, et al., 2014). Individuals with psychosis are mostly not threat to others but rather they harm themselves
Three out of every hundred people in overall population will experience a psychotic condition at some period of their lives. Schizophrenia is the major diagnosis in young people who come in contact with public mental health services in Australia (AIHW, 2018). It is likewise the third major cause in the problem of injury and disease in Australian men aged 15-24, and the fifth major cause for women of similar age. Psychotic disorders remain rare before 14 years of age, however there is a sharp growth in its occurrence between the 15-17 years of age. Generally, around 50% of people grow psychotic disorder before they reach their initial 20s. The mean age of onset in women is a bit late at 25-35 years, then in men which is at 18-25 years of age.
The commonest source of psychosis is schizophrenia. Schizophrenia is labelled by the doctors as a sort of psychosis very often. During their lifetime around 0.3 to 0.7% of people are affected by schizophrenia. In 2013, an estimated 23.6 million schizophrenic cases were diagnosed globally. About 20% of people ultimately become well and a few recuperate totally; whereas roughly 50% have lifetime impairment (Harvey, et al., 2017). The normal life expectancy of people with this illness is ten to twenty-five years fewer than the over-all population According to an estimate 17,000 people have died globally from activities connected to, or triggered by, schizophrenia. Schizophrenia tends to run in family. Different grouping of genes makes people more vulnerable to schizophrenia.
Indication that the condition is partially inherited comes from various study of twins. Same genes are shared by the Identical twins. If one of the identical twins got diagnosed with schizophrenia the other one has fifty percent chance of suffering from it too even when their upbringing is done separately. On-identical twins, are with dissimilar genetic combinations, when one twin gets diagnosed with schizophrenia the other has 15% chance of being diagnosed with the same. Schizophrenic brains have different physical structures to that of normal brains studies show. The sufferers are likely to have had birth complications like a premature labor, asphyxia in the course of birth and a small birth weight.
Postpartum psychosis is an unusual disorder in which indications of racing thoughts, depression, high mood, loss of inhibition, hallucinations, severe confusion, paranoia and delusions are seen which begin all of a sudden within few weeks after child delivery. Estimates are that out of 1000 women who give birth, one woman suffers from Postpartum psychosis. Woman with Schizophrenia and bipolar disorder before child birth are most likely to suffer from Postpartum psychosis (Royal, 2016). It needs hospitalization every so often, where patients are treated with mood stabilizers, antipsychotic medications also electroconvulsive therapy for patients who have greater chances of committing suicide. Women who were hospitalized for a psychiatric illness instantly after child birth are at greater threat of suicide for the period of a year after delivery. Around half of women with postpartum psychosis had no risk aspects
Neuro generative disorders like Alzheimer’s disease, Parkinson’s disease, dementia; Focal neurological disease like multiple sclerosis, brain tumors, stroke; post infectious and infectious syndromes like HIV/AIDS, Viral encephalitis, syphilis, malaria; endocrine diseases like hypothyroidism, hyperthyroidism, Cushing’s syndrome; even child delivery can lead to psychosis medically termed as postpartum psychosis, sexual category hormones can too affect indications of psychosis; nutritional deficiency of vitamin B12; failure of kidneys or livers, metabolic illnesses comprising electrolyte turbulences like hypernatremia, hypocalcemia, hypokalemia; auto immune and connected illnesses like systemic lupus erythematosus, Hasimoto’s encephalopathy, anti-NMDA-receptor encephalitis; sleep disorders like narcolepsy; parasitic illnesses like neurocysticerosis can also cause psychosis.
These medical conditions are also occasionally known as secondary psychosis (Arciniegas, 2015). The social defeat proposition incorporates both biological and social factors that add to the increase of psychotic indications, which illustrates the link between the social defeat and the biology of what takes place on the inside of body when exposed to the discrimination or social defeat. Individuals could be exposed to social defeat through lengthier period social circumstances that an individual takes as being negative due to social economic status, racism, sexual orientation, gender, prejudice or language barriers (Yung & Lin, 2016). The patients of psychosis should focus to balance blood sugar and shun stimulants. Vitamin C is an anti-stress vitamin and could counter excessive quantity of adrenalin which is seen in psychosis. Due to smoking the level of oxidants inside the patient rises and smoking also terminates vitamin
PART B
Cognitive-behavioral therapy (CBT) is an intervention at a psychological and social level that targets to improve emotional and mental health. CBT focuses on to challenge and change unsupportive cognitive distortions like beliefs, thoughts behaviors and attitudes to improve emotional regulation, to develop personal strategies in order to cope with a target to solve existing difficulties. Originally, it was aimed at to treat depression, lately its being used to treat numerous mental health conditions. It is unlike older methods of psychotherapy, like the psychoanalytic method where the psychotherapist looks at the unconscious meaning of the conducts and then articulates a diagnosis.
In its place, CBT is an action-oriented and problem-focused method of therapy, and is used to treat particular problems connected to an identified mental disorder (Brabban, Byrne, Longden, & Morrison, 2016). The therapist’s role is to assist the client in finding and practicing effective strategies to address the identified goals and decrease symptoms of the disorder. CBT is centered on the conviction that thought alterations and poor adaptive behaviors play a role in the development of psychological disorders, and that indications and related distress can be reduced by teaching different information processing abilities and managing mechanisms.
CBT aimed at psychosis, centers on decreasing the distress triggered by hallucinations and strange beliefs. The patient is made to realize that it is the analysis of the event by the person through their thought process is what causes distress rather than the event itself therefore the patient should check for the correctness of analysis (A review of Schizophrenia: Cognitive Theory, Research, and Therapy, 2008). Patients are to be counseled how their existing behaviors could trap them into the vicious cycle of their problem and make them question themselves whether their current behavior would be helpful for them. Other aimed areas are at indications of anxiety and depression, past traumatic events, lack of motivation, social skills, being decisive and problem solving, developing coping abilities and relapse deterrence preparation.
All research reviewed (Wood, et al., 2014) validated the opinion that individual CBT was effective in enabling change for individuals suffering from psychosis.
Holding (JC, L, & G, 2016) acknowledged that the most common helpful results of CBT was also intended for psychosis as remedy in symptoms, that included distressing beliefs, voices, mood, anxiety and self-concept. Enhancements in job-related and societal functioning was also constantly emphasized. A number of key elements of CBT were emphasized in all three assessments. The first constantly acknowledged advantage of CBT to be a transformation in acceptance of psychotic experiences; Specifically, a move towards acceptance of psychosis in the perspective of traumatic or problematic life experiences (Kelleher & Cannon, 2011). The cooperative development of an individual
case preparation amongst client and therapist was constantly recognized as a significant procedure for Finding and showing associations amongst current and past experiences, amongst
thoughts and experiences, sentiments and responses aided CBT undergoing patients to gain significant new knowledge or acceptances about their experiences. One more important feature of therapy takers’ experience of CBT was normalization. To some therapy takers the general therapeutic process can be integrally normalizing and acts as an apparatus of change in itself.
By offering non-judgmental acceptance, Likewise CBT has the ability to decrease experiences of stigma or embarrassment frequently linked with psychosis.
The study conducted for the effectiveness of CBT has also been a subject of persistent controversy. According to some study CBT is much effective than other cures. CBT failed to deliver corroborative proof for the estimation that CBT is better than other genuine non-CBT treatments according to a 2013 meta-analysis subject published in Clinical Psychology Review paralleling CBT to other therapies. Sweden’s Lund University conducted an eight-week clinical study in November 2014 which decided that CBT was not much effective than mindfulness centered therapy for those suffering from mental health disorders.
Controlling or reducing the patient’s anxiety is one of the important considerations to control psychosis. It is often found that the patient suffering from acute psychosis are intensely frightened. Fear is considered as one of the most prevalent problem in the initial phase of the treatment. The intensity of the symptoms rises with the rise of the intensity of the fear in the patient experiencing acute psychosis (Mahone, Maphis, & Snow, 2016). It can be assumed that the more the patient is indulged in taking through delusions, there are higher chances of patient being more anxious and frightened. The best way of controlling this is by bringing the patient back to reality.
This can be achieved by calming the patient by saying things which reduces the his or her anxiety. Even sitting with the patient at times helps in reducing the patient anxiety. This gives the patient a sense of security that they are not alone and can rely on other’s person reality for a while (Tofthagen, Fagerström, & Talseth, 2014). Hence, spending time, sharing the reality and responding rather than interpreting are some of the techniques that can help patient to reduce their anxiety.
References
A review of Schizophrenia: Cognitive Theory, Research, and Therapy. (2008). In A. Beck, N. S. Rector, & P. Grant, Schizophrenia: Cognitive Theory, Research, and Therapy (pp. 1-4). Guilford Press.
AIHW. (2018, 7 17). Mental health services in Australia. Retrieved from Australian Institute of Health and Welfare:
Arciniegas, D. B. (2015). Psychosis. Continuum?: Lifelong Learning in Neurology, 715-736.
Brabban, A., Byrne, R., Longden, l., & Morrison, A. P. (2016). The importance of human relationships, ethics and recovery-orientated values in the delivery of CBT for people with psychosis. Psychosis, 1-9.
Harvey, S. B., Deady, M., Wang, M. J., Butterworth, P., Christensen, H., & Mitchell, P. B. (2017). Is the prevalence of mental illness increasing in Australia? Evidence from national health surveys and administrative data, 2001–2014. The Medical Journal of Australia, 490-493.
JC, H., L, G., & G, H. (2016). Individuals’ experiences and opinions of psychological therapies for psychosis: A narrative synthesis. US National Library of Medicine National Institutes of Health.
Kelleher, I., & Cannon, M. (2011). Psychotic-like experiences in the general population: characterizing a high-risk group for psychosis. Psychological Medicine, 1-6.
Lutter, F. S. (2009, 12 23). Subjective Symptoms of Schizophrenia in Research and the Clinic: The Basic Symptom Concept. Schizophrenia, 5-8.
Mahone, I., Maphis, C., & Snow, D. (2016). Effective Strategies for Nurses Empowering Clients With Schizophrenia: Medication Use as a Tool in Recovery. Issues in Mental Health Nursing, 372-379.
Morgan, V., Mcgrath, J., Jablensky, A., Waterreus, A., Bush, R., & Cohen, M. (2014). Psychosis prevalence and physical, metabolic and cognitive co-morbidity: data from the second Australian national survey of psychosis. US National Library of Medicine , 2163-2176.
Royal, B. (2016). Schizophrenia: Nutrition and Alternative Treatment Approaches. Schizophrenia Bulletin, 1083-1085.
Tofthagen, R., Fagerström, L., & Talseth, A.-G. (2014). Mental Health Nurses’ Experiences of Caring for Patients Suffering from Self-Harm. Nursing Research and Practise.
Wood, L., Burke, E., Byrne, R., Pyle, M., Chapman, N., & Morrison, A. (2014). Stigma in psychosis: A thematic synthesis of current qualitative evidence. Psychosis, 152-165.
Yung, A. R., & Lin, A. (2016). Psychotic experiences and their significance. World Psychiatry, 130-131.
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