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HSNS510 Integrated Nursing Practice 3

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HSNS510 Integrated Nursing Practice 3

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Course Code: HSNS510
University: University Of New England is not sponsored or endorsed by this college or university

Country: Australia

This assignment requires you to watch the interview provided in the Case study below titled “Psychiatric interviews for teaching: Psychosis to complete a mental health assessment and intervention report. In your report ensure to: 
Part A is an assessment of the client’s psychiatric history and family/social environment;Part B is a mental state examination;Part C is evidence-based interventions.

About an interaction between Andy who is a 21-year-old university student and a female psychiatrist. The family doctor referred the patient to the specialist for counseling. Judging from the conversation, Andy has Schizophrenia which is a mental disorder. The disease occurs mostly at the onset of adulthood or at the end of the adolescent stage. Therefore, Andy’s age is a risk factor for the complication. The major symptoms of schizophrenia include hallucinations, delusions, and depression (Duhig et al., 2015). The patient admits that he hears the voices of his roommates which are a hallucinating effect of the complication. Andy also feels that his friends have inserted a chip to monitor his activities which is untrue. This report will assess the client’s psychiatric, family history and social environment. The paper will also conduct a mental state examination on the patient. Finally, the write-up will discuss evidence-based interventions for the patient’s schizophrenia.
Part A: History
The family doctor referred Andy to the psychiatrist; since the patient feels that the GP does not understand his condition. The GP feels that the patient is fine as he lacks physical symptoms. Therefore, the patient has a mental disorder that the psychiatrist can assist to solve the problem. The patient lacks a history of schizophrenia or any other mental manifestations. Schizophrenia has a tendency of developing slowly; hence the affected individual can be unaware of the presenting problem. However, the disease is common between the ages of sixteen and thirty years (Millan et al., 2016). Therefore, the patient’s age makes him vulnerable to infection.
The patient lacks a medical history of the disease. Additionally, none of his family members have suffered from the complication in the past. However, a family history of schizophrenia increases the chances of infection. The patient is still a student and still lacks occupational history. However, the development of schizophrenia can occur regardless of medical and family history. The imbalances in the concentration of neurotransmitters and dopamine lead to the development of the complication (Kesby, Eyles, McGrath, & Scott, 2018). Viral infections before the birth of an individual lead to the occurrence of the condition. Additionally, stressful experiences in the school environment can cause the disease.
 There is a lack of sufficient forensic evidence to link the patient with the disease. However, the client admits that he has a history of consuming alcohol and taking drugs. Andy says that he drinks alcohol but not in large quantities. He also admits to being taking bhang “weed”. Drugs and alcohol lead to the relapse of schizophrenia (Ouellet-Plamondon, Abdel-Baki, Salvat, & Potvin, 2017). When asked about his current treatment, Andy says that he does not use medications. However, he has plans of getting pills to solve his problems. The patient feels that he is fit and does not require medications. Andy says that his only problem is the chip that his roommates inserted on his head to monitor his movements.
The patient lacks sufficient functioning and support; since his parents are far away from him. Furthermore, he does not want to go back home. The patient is single and lacks parental status. Therefore, he has no responsibilities as he is still a university student. Andy lacks any details of dependants at the moment. He depends on his parents for financial support when he is in school. The lack of proper support can escalate the symptoms of schizophrenia (McNamara, Same, Rosenwax, & Kelly, 2018). Additionally, stressful jobs can make an individual to develop the complication.
Part B: Mental State Examination
Appearance, Behavior, and Affect
 The patient is fairly groomed but has shaggy hair. Schizophrenia preoccupies the minds of clients with psychotic ideations; hence the clients pay little attention to hygiene. Andy also behaves in a childish way; since it is only children that can believe that they have a chip on their brain. The disease alters the motor behavior of clients (Phillips, Hewedi, Eissa, & Moustafa, 2015). The affect of Andy is blunt as he fails to maintain eye-to-eye contact with the psychiatrist. Additionally, he hesitates in responding to the questions. The complication makes an individual have a blunt or a flat affect.
Mood, Speech, and Though Form
The facial expression of Andy indicates that he has a flat and sad mood. The brain’s automatic abnormalities and neurochemical alterations affect the mood of patients (Hui et al., 2018). The patient has a disturbed speech as he takes a long time to answer the questions. His speech is also childish due to the infection. Schizophrenia interferes with the normal speech patterns of the clients. Andy also has an unclear thought form as the psychiatrist has to clarify question to obtain a conclusive response. The manifestation of the disease disorders the thought form of the patient.
Thought Content, Perception, and Intellectual Functioning
The thoughts of Andy are filled with delusions and hallucinations. He thinks that his housemates want to poison his food. Andy also thinks that the roommates are monitoring his activities through the chip inserted into his brain. Therefore, he has a wrong perception of his roommates. He also feels that taking alcohol and smoking cannabis sativa is not related to his mental complication. His thoughts and perceptions indicate an altered intellectual functioning due to schizophrenia. The complication interferes with thought content, perception, and the intellectual function of an individual (Allott et al., 2015).
Insight and Judgment
Andy has a poor insight and judgment capacities. He says that he is not ill despite the evident symptoms of schizophrenia. He feels that the smoking of cannabis sativa and drinking of alcohol are not related to the mental disorder. Schizophrenia impairs the insight and judgment of patients (Weickert et al., 2014).
Risk Assessment
 The state of Andy’s condition is severe and he requires urgent assistance. He says that he has to wait for his housemates to go out before he goes out. He also feels that the roommates want to poison his food. His delusionary life has made him have a knife and a baseball butt for self-defense. Therefore, Andy requires nursing interventions to correct his disorder. 
Andy feels that the roommates have inserted a chip to monitor his activities. He also admits to hearing voices of his roommates talking about him. The evidence from the video indicates that the patient is having schizophrenia. The psychiatrist should refer Andy to mental health specialists to assist him.
Part C: Interventions
Medical Intervention
 The psychiatrist can recommend several medications to manage the patient’s condition. The first drug is Risperidone which is an antipsychotic that assists to clear the delusionary thoughts of the patient. Olanzapine decreases the severity of negative symptoms of schizophrenia such as the sad mood and affect (Larsen ET AL., 2017). The patient also harbors a knife in his room that he uses for self-defense. However, he reluctantly admits that he has suicidal thoughts. Therefore, the mental health specialist should prescribe Clozapine to reduce the suicidal behaviors and thoughts. Drugs like Ziprasidone and Quetiapine also reduce the hallucinations, delusions, and imaginary voices of his housemates. Injectable medications such as chlorpromazine have a longer time of action that the oral drugs. Therefore, drugs are the first line of recovery from schizophrenia.
Psychosocial Interventions
Training in social skills is the first psychosocial remedy for schizophrenia. The training involves exposing the patients to behaviors that breed social interaction success. Recent research has indicated that social skills education has a high efficacy in treating the mental illness. Family psycho-education is also efficient in dealing with the symptoms of the complication (Sin et al., 2017). The participation of family members in the rehabilitation of the patient ensures a quick recovery. Cognitive therapy is also effective in the management of the disease. The therapy involves techniques like rational analysis and self-talk that decreases the levels of stress in the patient. Cognitive rehabilitation also assists to correct the mental disorder. The rehabilitation repairs the neurocognitive impairments due to schizophrenia. Proper rehabilitation improves the attention and memory capacity of the patient.
Nursing Interventions
The nurse should establish rapport and trust with the patient to speed up the recovery process. The caregiver should use unambiguous and clear language when interacting with the patient. The nurse should also assure the patient that he can recover from the complication. The care provider should promote the social skills of the patients by teaching them the relevant skills (Turner et al., 2017). The healthcare professionals should also ensure that the patient’s environment is safe for the recovery process. The psychiatrist should ensure that the patent takes the drugs according to the prescription. Andy says that the roommates have poisoned his food. Therefore, the psychiatrist should allow him to prepare his food. The psychiatrist asks the patient to allow the mother to join the conversation which is an efficient remedy.
The video is about the interaction between the female psychiatrist and Andy who is a schizophrenia patient. The patient presents symptoms such as hallucinations, delusions, and hearing the voices of his roommates. Andy lacks a medical or family history of the disease; however, his alcohol consumption and smoking of cannabis induce the occurrence of the complication. The mental state examination further proves that he has the mental disorder due to factors like flat and sad affect. Relevant medication, psychosocial, and nursing interventions help in the management of the condition. Therefore, the psychiatrist should prescribe the relevant medication and train the patient on social skills to reduce the symptoms of the disease.
Allott, K. A., Rapado-Castro, M., Proffitt, T. M., Bendall, S., Garner, B., Butselaar, F., … & Cotton, S. M. (2015). The impact of neuropsychological functioning and coping style on perceived stress in individuals with first-episode psychosis and healthy controls. Psychiatry research, 226(1), 128-135.
Duhig, M., Patterson, S., Connell, M., Foley, S., Capra, C., Dark, F., … & Scott, J. (2015). The prevalence and correlates of childhood trauma in patients with early psychosis. Australian & New Zealand Journal of Psychiatry, 49(7), 651-659.
Hui, C. W., St-Pierre, A., El Hajj, H., Remy, Y., Hébert, S. S., Luheshi, G. N., … & Tremblay, M. È. (2018). The prenatal immune challenge in mice leads to partly sex-dependent behavioral, microglial, and molecular abnormalities associated with schizophrenia. Frontiers in molecular neuroscience, 11, 13.
Kesby, J. P., Eyles, D. W., McGrath, J. J., & Scott, J. G. (2018). Dopamine, psychosis, and schizophrenia: the widening gap between basic and clinical neuroscience. Translational Psychiatry, 8(1), 30.
Larsen, J. R., Vedtofte, L., Jakobsen, M. S., Jespersen, H. R., Jakobsen, M. I., Svensson, C. K., … & Nielsen, J. (2017). Effect of liraglutide treatment on prediabetes and overweight or obesity in clozapine-or olanzapine-treated patients with schizophrenia spectrum disorder: a randomized clinical trial. Jama Psychiatry, 74(7), 719-728.
McNamara, B., Same, A., Rosenwax, L., & Kelly, B. (2018). Palliative care for people with schizophrenia: a qualitative study of an under-serviced group in need. BMC palliative care, 17(1), 53.
Millan, M. J., Andrieux, A., Bartzokis, G., Cadenhead, K., Dazzan, P., Fusar-Poli, P., … & Kahn, R. (2016). Altering the course of schizophrenia: progress and perspectives. Nature Reviews Drug Discovery, 15(7), 485.
Ouellet-Plamondon, C., Abdel-Baki, A., Salvat, É., & Potvin, S. (2017). The specific impact of stimulant, alcohol, and cannabis use disorders on first-episode psychosis: 2-year functional and symptomatic outcomes. Psychological medicine, 47(14), 2461-2471.
Phillips, J. R., Hewedi, D. H., Eissa, A. M., & Moustafa, A. A. (2015). The cerebellum and psychiatric disorders. Frontiers in public health, 3, 66.
Sin, J., Gillard, S., Spain, D., Cornelius, V., Chen, T., & Henderson, C. (2017). The effectiveness of psychoeducational interventions for family carers of people with psychosis: A systematic review and meta-analysis. Clinical psychology review, 56, 13-24.
Turner, D. T., McGlanaghy, E., Cuijpers, P., van der Gaag, M., Karyotaki, E., & MacBeth, A. (2017). A Meta-Analysis of Social Skills Training and Related Interventions for Psychosis. Schizophrenia Bulletin, 44(3), 475-491.
Weickert, T. W., Terrazas, A., Bigelow, L. B., Apud, J. A., Egan, M. F., & Weinberger, D. R. (2014). Perceptual category judgment deficits are related to prefrontal decision-making abnormalities in schizophrenia. Frontiers in Psychiatry, 4, 184.

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