Understanding Mental Health Illness The WritePass Journal

Understanding Mental Health Illness Introduction Understanding Mental Health Illness ) was one study that specifically focused on the effects of a variety of environmental factors on schizophrenia among subjects with a genetic predisposition to schizophrenia. The study found that maternal mental illness was the most significant childhood adversity (44.6%) while disruption in the family setting was identified as the next significant childhood adversity (40.0%). Cannabis smoking was also identified as an important risk factor at 24.5%. Overall the study reported significant association between these cumulative risk factors and the onset of schizophrenia. Galletly et.al (2011) also contributed with the findings that childhood exposure to familial adversities and cannabis smoking carry a high risk for psychosis.     In our case study it is important to notice that Mr. John has experienced some of these childhood adversities that carry a high risk factor for schizophrenia. John’s parents separated 12 years ago when John was just a young 7 year old boy.   The disruption in the family setting and consequently the rearing environment must have caused significant stress for John. Compounding this stress is the fact that John has witnessed violent attacks on his mother by his father and even now continues to witness heated arguments between his mother and his elder sister. It transpires that the cumulative effect of these multiple environmental stressors might have triggered the onset of schizophrenia symptoms in John who has just completed puberty, which is a vulnerable stage as discussed in the previous sections. Treatment for Schizophrenia Pharmaceutical treatment Effective diagnosis constitutes the first step in the treatment of schizophrenia. Though pharmaceutical therapy is available in the treatment of schizophrenia, currently they do not promise a cure for the disorder but help a lot in alleviating the psychotic symptoms.  Ã‚   Antipsychotic drugs are the main pharmaceutical intervention used in the treatment of schizophrenia.   Thorazine, Haldol and Prolixin are some of the earlier antipsychotic medicines used in treating schizophrenia. However, these drugs had adverse effects including tremors, and cognitive dulling for instances (University of Maryland, 2013). Over the last two decades another class of antipsychotics with limited side effects such as Risperdol, Zyprexa are used particularly in the treatment of the acute phase of schizophrenia when the symptoms flare up (Harvard Medical School 2006).  Ã‚   More recently however, a new class of antipsychotics namely injectable long acting antipsychotics are available.   These dru gs are particularly effective among schizophrenia patients who are not medically compliant (Manchanda et.al, 2013). The key to effective management of schizophrenia is to adhere to the treatment plan. It must be noted, however, that though antipsychotic medications are effective against psychotic symptoms they are not useful in the treatment of the so called negative symptoms of schizophrenia.   Other forms of therapies, such as psychotherapy should be utilized. One of the important psychotherapies is cognitive-behavioural therapy (CBT). Cognitive-Behavioural therapy Early intervention using both pharmaceutical as well as behavioural therapies provides the optimum treatment plan for schizophrenia patients. Since providing optimal intervention at the earliest is considered the best for achieving better outcome, it is necessary to include concomitant behavioural therapies. Several studies have proven the efficacy of CBT in the management of the symptoms of schizophrenia (University of Maryland, 2013).   Coupled with family therapy, CBT is found to be very effective in the management of schizophrenia. The underlying idea in cognitive therapy is to change the thoughts and then the behaviour of the patient.   CBT focuses on normalizing the psychotic experience of the patient (Turkington et.al, 2006). CBT provides an action plan for the patient so the next time symptoms appear they are better able to manage them (Turkington et.al, 2006). In the context of the present case study CBT offers an excellent therapy as it is known that CBT is more effecti ve in early stages of psychosis. One significant advantage of CBT is that it has no known side effects (Addington Lecomte, 2012). Diagnosis and management of schizophrenia is very important since suicide presents as a prominent risk for schizophrenia patients.   Palmer et.al (2005)   pointed out close to 5% risk for suicide among schizophrenia patients. Erlangsen (2012) was a recent study that reported a heightened risk for suicide among elderly schizophrenia patients. CBT is a very effective therapeutic tool in aiding self monitoring of thoughts and in developing coping strategies among schizophrenia patients.   As such, John must be provided with CBT. Schizophrenia Support Services Despite the significant improvements in our understanding of the cause of mental illnesses there is very little improvement in terms of the quality of services offered to schizophrenia patients and their families (Schizophrenia Commission, 2012).   In the UK, the recent report by the schizophrenia commission confirms this dismal picture.   The report highlighted that there is only â€Å"a broken and demoralized system that does not deliver the quality of treatment needed for recovery† (Kelland, 2012).   There have been funding cuts for early intervention services despite the fact that research evidence point to the effectiveness of these programs in preventing relapse of psychotic episodes and in improving the overall outcome for the patient.   Another highlight of the report is the poor plight of the psychiatric wards and the lack of treatment plan. It is reported that only 1 in 10 patients are provided with CBT and other forms of beneficial psychological intervention s while in the majority of cases drugs are the only treatment.   Ã¢â‚¬Å"Some wards are so anti-therapeutic that when people relapse and are in need of a period of care and respite, they are unwilling to be admitted voluntarily; so compulsion rates rise.†(Kelland, 2012)  Ã‚   There is also a distinct lack of employment support services with only 8% of schizophrenia patients still working. There is also widespread stigma associated with schizophrenia and other mental illnesses which causes additional burden on the caregivers. There is also increasing coercion in the UK with patients being forced into secure care. As Robin Murray, a psychiatric professor with the British institute of psychiatry puts it, If you develop psychosis and your mind is disturbed and you think people are against you, youd want to be admitted for a period of care and respite and calm and some gentle pharmacological and psychological treatments.   But in fact that doesnt happen. Here, you get admitte d to a mad house. And some of these places are very anti-therapeutic not only for patients but also for staff. No sensible person would want to be admitted to one of these places. (Kelland, 2012). However many private charities and voluntary groups have emerged across Britain that offer useful service to the patient and the carer. For instance, ‘Carers trust’ is a charity group operating across the UK that provides useful respite services for schizophrenia carers and thereby reduces their burden and carer burnout. Similarly the government led ‘meals on wheels’ scheme would be very useful for carers of patients who live alone to ensure that their loved ones are served with hot meals every day.   The government also provides the ‘Independent living fund’ (ILF) that could be utilized to pay for personal assistants to help the schizophrenia patients in managing their day to day tasks (NHS, 2012). Conclusion Schizophrenia is a chronic debilitating mental disorder that impairs social functioning and the autonomy of the patient. As yet, the aetiology remains rather obscure with a myriad of contributing symptoms making diagnosis a lot complicated. Since schizophrenia is a heterogeneous disorder carrying an array of symptoms, an interdisciplinary approach including research based on both biological and behavioural models is necessary to gain valuable insights into its aetiology. Early adulthood is a particularly vulnerable phase with the onset of symptoms.   In view of the symptoms and the risk factors that were discussed in the paper it is clear that Mr John, the 19 year old young adult, is clearly experiencing the various symptoms of schizophrenia. Early parental separation, witnessing family violence, smoking cannabis are all high risk factors. These environmental factors are the triggers for the onset of schizophrenia symptoms. It is clear that in majority of the cases, such as John’s, there is an undue delay in the diagnosis as there is hesitance in approaching a psychiatrist due to the stigma associated with mental illnesses.   Interventions during this early phase of the disorder are critical and offer the best opportunity for delivering optimal care. In John’s case, immediate consultation with the psychiatrist followed by adherence to medication along with psychological therapies like CBT should ensure control of the psychotic symptoms. This would enable John to continue his life with minimal hindrance. The main point is the emphasis that though schizophrenia and some other forms of mental illnesses do not have a cure as of yet, they could be effectively managed with drugs and other behavioural therapies that would drastically improve the quality of life for the patient. Another important and largely ignored fact is that deinstitutionalisation of mental health care also implies a growing burden on the family members as caregivers. Caregiver burden should also be the focus of mental health policies. Respite services must be improved. There is also a need to increase awareness to destigmatise schizophrenia and other mental disorders. Stigma effectively prevents the utilisation of support services. Much work needs to be done. References Addington J, Lecomte T., 2012. Cognitive behavioural therapy for schizophrenia, F1000 Med Rep   4:6. APA., 2000. Diagnostic and Statistical Manual of Mental Disorders , 4th Edition, Paperback. Arendt M, Rosenberg R, Foldager L, Perto G, 2005. Cannabis- induced psychosis and subsequent schizophrenia-spectrum disorders: followup study of 535 incident cases. British Journal of Psychiatry 187, 510-515. Blakemore S, Burnett S, Dahl R., 2010.   The role of puberty in the developing adolescent brain, Human Brain Mapping, 31(6) 926-933. Bruer J., 1999. Neural connections: Some You Use, Some You Loose, [online] Available at: oecd.org/edu/ceri/31709587.pdf [Accessed Nov 25th 2013] Daniel J, Roman K, Lin T, Evelyn J , 2010. Cannabis use and the course of schizophrenia: 10 year followup after first hospitalization. The American Journal of Psychiatry, Vol 167, no 8. Erlangsen A,  Eaton WW,  Mortensen PB,  Conwell Y., 2012. Schizophrenia –a predictor of suicide during the second half of life? 134(2-3):111-7. Faludi G, Mirnics K., 2011. Synaptic changes in the brain of subjects with schizophrenia.  International Journal of   Developmental Neuroscience.  29:305–9 Feinberg I., 1983. Schizophrenia: Caused by a fault in programmed synaptic elimination during adolescence.  J Psychiatr Res.  ;17:319–34. Galletly C, Van Hooff M, McFarlane A., 2011.Psychotic symptoms in young adults exposed to childhood trauma- a 20 year follow-up study.  Schizophr Res.;127:76–82. Harvard Medical School., 2006. Drug treatment of schizophrenia, [online] Available at: health.harvard.edu/fhg/updates/update0205a.shtml [Accessed Nov 23rd 2013] Johns A., 2001. Psychiatric effects of cannabis, The British Journal of Psychiatry, 178:116-122. Kelland K, Britain condemned for mad house treatment of schizophrenia patients, [online] Available at: reuters.com/article/2012/11/14/schizophrenia-britain-care-idUSL5E8MCDDY20121114 [Accessed Nov 23rd 2013] Kinney D, Hintz K, Shearer E, Barch D, Riffin C, Whitley K and Butler R ., 2009. A unifying hypothesis of schizophrenia : Abnormal immune system development may help explain roles of prenatal hazards, post pubertal onset , stress, genes, climate , infections and brain dysfunction, Medical Hypothesis , [online] Available at: http://ccpweb.wustl.edu/pdfs/medhyp09.pdf [Accessed Nov 23rd 2013] Manchanda R,  Chue P,  Malla A,  Tibbo P,  Roy MA,  Williams R,  Iyer S,  Lutgens D,  Banks N., 2013. Long acting injectable antipsychotics : evidence of effectiveness and use, Can J Psychiatry.  58(5 Suppl 1):5S-13S. NAMI., 2013. Mental Illnesses, [online] Available at: nami.org/Template.cfm?Section=By_Illness [Accessed Nov 22nd 2013] NHS ., 2012. Support services, [online]Available at:   nhs.uk/CarersDirect/guide/practicalsupport/Pages/Supportservices.aspx [Accessed Nov 23rd 2013] NIH ,. 2011. The Teen brain: Still under construction, [online] Available at: nimh.nih.gov/health/publications/the-teen-brain-still-under-construction/index.shtml [Accessed Nov 25th 2013] NIH., 2013. What is Schizophrenia, [online] Available at: nimh.nih.gov/health/topics/schizophrenia/index.shtml [Accessed Nov 23rd 2013] Paolicelli RC, Bolasco G, Pagani F, et al., 2011. Synaptic pruning by microglia is necessary for normal brain development. Science.  333:1456–8 Palmer BA, Pankratz VS, Bostwick JM., 2005. The lifetime risk of suicide  in schizophrenia: a reexamination.  Arch Gen Psychiatry.62(3):247–253. Phillips L , McGorry P, Franz CP, Yung A., 2005.   The British Journal of Psychiatry, 187: 33-44. Schizophrenia Commission., 2012. The Abandoned illness : A report by schizophrenia commission, [online] Available at: rethink.org/media/514093/TSC_main_report_14_nov.pdf [Accessed Nov 25th 2013] Turkington D, Dudley R, Warman D, Beck A., 2006. Cognitive behavioural therapy for Schizophrenia: A Review, Focus, vol 4 , no 2 223-233. University of Maryland,. 2013. Schizophrenia, [online] Available at: http://umm.edu/health/medical/reports/articles/schizophrenia [Accessed Nov 25th 2013] WHO., 2013. Mental Health Action Plan,   [online] Available at: http://apps.who.int/iris/bitstream/10665/89966/1/9789241506021_eng.pdf [Accessed Nov 22nd 2013] WHO., 2013. Schizophrenia, [online]   Available at: who.int/mental_health/management/schizophrenia/en/ [Accessed Nov 23rd 2013] WHO., 2004. Prevalence, Severity and Unmet need for treatment of mental disorders in the World Health Organization World mental Health Surveys, JAMA, 291(21):2581-2590