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Hi Laxmi! My name is Alexis and I’m the writing coach reviewing your paper today! From what I understand you are to pick a mental disorder within a specific population and talk about treatment and the disorder itself. I think you do a great job of this! Even to me knowing next to nothing about schizophrenia as a disorder, your paper made clear sense and flowed logically. Great job! You indicated that you wanted assistance with understanding the assignment and with editing and proofing strategies, so I hope I’m able to help you out with those things!

You’ll notice a yellow highlight in a few places, and that just means you can delete whatever is highlighted. It’s usually just an unnecessary word or punctuation mark. The rest of my minor concerns at a sentence level are within the comments throughout the paper.

I did notice that your headings weren’t correct in APA format, so I commented on what needs to change for each one that was incorrect. Here is a link, too, to the Purdue OWL page on APA headings: https://owl.english.purdue.edu/owl/resource/560/16/

I don’t have much else to say about your paper, I think it’s really good and you adhere to the rubric really well! I hope the comments and suggestions that I have are helpful to you.

Best, Alexis

Schizophrenia in the Homeless Population

Laxmi Basnet

Regis University

6/17/2018

Schizophrenia in the Homeless Population

The Diagnostic and statistical manual of mental disorders (DSM), is a complete summary of mental disorders published by the American Psychiatric Association. The manual contains a list of mental disorders, the various diagnostic criterion used to identify these disorders, as well as their organization, definition, and classification (Marty & Segal, 2015). The latest edition of the DSM is the fifth edition commonly referred to as the DSM-5. This edition comprises up to 22 different categories under which specific health disorders are included. These disorders include the generalized anxiety disorder, the bipolar disorder, anorexia nervosa, and schizophrenia. The DSM-5 employs the use of dimensional and cross-cutting assessments to provide additional information which can assist medical practitioners in the patients’ assessment as well as the planning and monitoring of the treatment procedure. For instance, according to the DSM-5, in most patients suffering from schizophrenia, the symptoms of psychosis, including hallucinations, distorted speech, delusions, and unusual psychomotor activities, may be categorized through the use of a five-point scale which ranges from 0 (safe from the disorder) to 4 (disorder present and severe) (Marty & Segal, 2015).

Schizophrenia is a brain functioning disorder which affects an individual’s thoughts, feelings and actions. The word schizophrenia was derived from Greek ‘Skhizo’ meaning split and ‘Phren’ meaning mind (Mohr, 2012). Unlike other diseases, schizophrenia is a heterogeneous disease entity with several causes including the combination of genetic predisposition, biochemical dysfunction, psychosocial stress and other physiological factors (Mohr, 2012). Schizophrenia patients usually tend to exhibit suicidal tendencies, and as a result, the disease has been linked to numerous cases of suicides.

According to World Health Organization (WHO, 2018), the global population of people suffering from schizophrenia has been estimated to about twenty-one million. According to studies carried out earlier with regards to the schizophrenia disorder, it has been established that people who suffer from the disorder usually tend to exhibit a wide range of medical symptoms (Adeosun, 2013). These symptoms include unremitting warning signs and an escalating disability which has been recorded in about 20% of the patients with another 35% exhibiting mixed patterns which includes a varying level of disenchantment, depression, and increased suicidal tendencies (WHO, 2018). Before the year 2013, schizophrenia was listed as one of the most severe types of mental disorder affecting about one individual in every one hundred people of the adult population all over the world (Adeosun, 2013). In other words, the schizophrenia disorder affects about 1% of the entire adult population globally (Millier et al. 2014). Nevertheless, a much recent data from the WHO provides an estimate of about 21 million people living with schizophrenia globally (WHO, 2018). This essay tends to put much focus on the prevalence and management of schizophrenia disorder among the less privileged and the homeless people in the community.

Relevant theory for the disorder treatment strategy

Schizophrenia disorder has been primarily associated with the dysfunction of the dopamine; a neurotransmitter which is associated with the learning, attention, body movement, and the brain pleasure and reward system of an infected individual (Yang & Tsai, 2017). Since the discovery of chlorpromazine as the best pharmacological remedy for treating schizophrenia, many studies have been putting much focus on dopamine dysfunction (Yang & Tsai, 2017). According to Yang & Tsai (2017), the focus has been much emphasized on the reward dopamine pathway; a pathway which is sometimes referred to as the reward pathway and is involved in the increase or decrease in dopamine synthesis and production levels. An increase in dopamine synthesis has been linked to the development of psychosis in an individual (Yang & Tsai, 2017).

A variety of studies have in the past suggested that schizophrenia is a disorder of the human dopamine signal system (Yang & Tsai, 2017). Initially, it was believed that dopamine was related to the motor function until further studies of animal behavior revealed that it was rather closely associated with the reward and motivation aspect of the brain (Yang & Tsai, 2017). The potency of any drug believed to be antipsychotic is usually proportional to the given drug ability to neutralize dopamine receptors. Some central nervous system stimulants have been linked to the increase in dopamine release, and such stimulants may lead to psychotic symptoms or diseases. Since the introduction of chlorpromazine in the 1960s as the best treatment for schizophrenia patients, the development of newer antipsychotics has been dependent on the dopamine theory stating that schizophrenia patients have increased dopamine activities which can be controlled using dopamine suppressants (Yang & Tsai, 2017).

Other treatment strategies

Pharmacological treatment

Currently, there are newer methods of dealing with the schizophrenia disorder. These methods include both pharmacological and psychosocial treatment. The pharmacological treatment involves the use of drugs interventions to suppress the effects of the disease on a patient or completely treat the patient depending with the state or phase of the disorder as stipulated in the DSM-5 infection level assessment criteria. The physiopathology process may extensively vary across different stages of the disease though the current pharmacological interventions do not differ between the different phases of the illness (Yang & Tsai, 2017).

As discussed earlier, the primary pharmacological interventions for treating schizophrenia are solely based on the dopamine theory (Millier et al., 2014). In other words, the medical treatment is usually focused on the dopamine D2 receptor. Several medical studies have also indicated that the heterogeneity of psychosis may be one of the main challenges facing the introduction of new strategies in the development of new medication. Schizophrenia patients usually display variations in symptoms, and this characteristic is also exhibited in the manner in which the patients react to the prescribed treatments.

Psychosocial treatment

Studies are increasingly finding out significant evidence that the psychosocial interventions in the treatment of schizophrenia are very effective in reducing the psychotic symptoms in the victims and improving their performance (Chien, Leung, Yeung, & Wong, 2013). Apart from directly addressing a diverse range of patients’ healthcare needs, including treatment adherence, reduction of the symptoms, and relapse, the psychosocial intervention also provides the patients especially the homeless victims with a more cost-effective treatment as compared to the standard pharmacological intervention for the disease. The psychosocial treatment can be categorized into five distinct categories which have been effective in treating schizophrenia patients. The groupings include; the cognitive therapy (including both the cognitive behavioral therapy and the cognitive remediation therapy), family intervention program, psycho-education programs, social skills learning, training programs, and the case management approach (Chien et al., 2013).

CBT

The Cognitive Behavioral Theory (CBT) was developed in the 1950s, and to date, it is still being considered as one of the most effective non-pharmacological therapy for individuals suffering from mental and depressive disorders (Chien et al., 2013). CBT is a well controlled and standardized treatment that helps patients to cope with their psychotic conditions through the examination and evaluation of their feelings and perceptions of experiences. This approach requires the caregiver to be able to accept the patient’s perception of reality and find ways of using the patient’s misinterpretations to assist them to make correct interpretation and manage their life problems (Chien et al., 2013).

Nursing implications

Nurses should ensure that both the patients and the community are aware of the effects of hallucination, delusion and social withdrawal (Al-Yahya, 2014). This awareness would not only help the patients to understand their condition but also helps the community to be able to tolerate the patients and minimize the incidents of misjudgment of such patients. On several occasions, schizophrenia patients have ended up getting hurt as a result of a misunderstanding between the community and such patients.

Another form of learning which nurses should provide to these patients involves the psycho-education process. Psycho-education involves the provision of guideline intervention that improves a patient’s insight and medication compliance (Al-Yahya, 2014). This form of learning helps the patients to understand their conditions and know when to take their medication to control their symptoms. With regards to the homeless victims of schizophrenia, the procedure becomes quite complicated. External factors like being homeless or lack of assistance may lead to an increased level of depression in patients. Depression is known to have adverse effects on the course of the disease sometimes causing fatalities. Consequently, it is important for the caregivers and families of such patients to ensure that the sick individuals are reintegrated back to the society, and teach the entire community about the importance of reducing stigmatization of such patients.

To enable better healthcare management of these patients, it is important for further research to be carried out on the impacts of social bonding on the treatment of schizophrenia. It has been noted that most of the homeless patients are always experiencing more severe symptoms as compared to those who stay with their families or other appropriate caregivers. The research should study both the homeless and those under proper care and establish the right framework that would encourage the provision of proper care to the homeless individual to reduce their depression levels and subject them to the right treatment.

Ethical and legal implications

Legal issue

In many occasions, people with mental challenges are usually neglected or given a low priority when in need of treatment interventions. Healthcare providers have a special task to respond to anyone in need of medical attention irrespective of their mental health. The professional code of conduct reinforces the duty to provide healthcare service to everyone without discrimination as a legal requirement for every healthcare practitioner. Similarly every individual irrespective of their mental ability is legally bound to the healthcare provision laws and should be given proper health care service without any form of discrimination.

Ethical issues

One of the most prevalent ethical issues in people with mental disorder includes the minimizing of harm, especially during emergencies. In the current society, mental disorders remain to be highly stigmatized resulting in the inhuman treatment of individuals suffering from these disorders. For instance, it has been noted that in the event of an emergency, individuals suffering from mental illness are usually ignored or given the least priority when it comes to aid whereas those who are healthy are given the first priority. This occurrence is considered quite unethical. Therefore it is an ethical requirement to initiate the development of strategies to reduce the harm that people with mental disability might face in the event of an emergency.

Conclusion

The treatment of schizophrenia based on the dopamine theory has been a successful approach for quite a long period. For many decades, quite a good number of scientists and drug manufacturers all over the world have been working to come out with new and better pharmacological treatment for schizophrenia. Despite all the effort, to date, all the clinical treatment strategies are primarily targeted on the dopamine D2 receptor. Studies have also indicated that the heterogeneity of psychosis may be one of the main reasons behind the problems of coming up with new strategies towards the development of new medication. It is evident that patients suffering from the Schizophrenia condition usually display variations in symptoms. Also, it has been established that the biological classification of schizophrenia symptoms is also indistinguishable from the response to different treatment intervention also showing a significant variation.

Finally, with regards to the challenges faced by the homeless victims of the disorder, it is important to note that other external factors like being homeless or lack of assistance may lead to depression in patients. Depression usually has negative effects on the course of the disease which sometimes ends up with fatal consequences. Therefore it is important for the caregivers and families of such patients to ensure that the sick individuals are reintegrated back to the society, and work to reduce stigmatization of such patients while providing them with appropriate healthcare services.

References

Adeosun, I. I. (2013). Correlates of caregiver burden among family members of patients with schizophrenia in Lagos, Nigeria. Schizophrenia research and treatment, 2013, 1-7.

Al-yahya , N. M. (2014). Effects of Psycho Education Intervention in Improving Insight and Medication Compliance of Schizophrenic Clients, Riyadh, Saudi Arabia. World Journal of Medical Sciences, 11(3), 289-300.

Chien, W. T., Leung, S. F., Yeung, F. K., & Wong, W. K. (2013). Current approaches to treatments for schizophrenia spectrum disorders, part II: psychosocial interventions and patient-focused perspectives in psychiatric care. Neuropsychiatric disease and treatment, 9, 1463-1481.

Marty, M., & Segal, D. (2015). DSM-5 (DSM-5). Retrieved from https://www.researchgate.net/profile/Daniel_Segal3/publication/313965868_DSM-5_DSM-5/links/59e4d9740f7e9b0e1aa87a05/DSM-5-DSM-5.pdf?origin=publication_detail

Millier, A., Schmidt, U., Angermeyer, M. C., Chauhan, D., Murthy, V., Toumi, M., & Cadi-Soussi, N. (2014). Humanistic burden in schizophrenia: a literature review. Journal of psychiatric research, 54, 85-93.

Mohr, W. K. (2012). Psychiatric-mental health nursing. Philadelphia, PA: Lippincott Williams & Wilkins.

World Health Organization (2018). Schizophrenia. Retrieved from: http://www.who.int/mental_health/management/schizophrenia/en/

Yang, A. C., & Tsai, S. J. (2017). New Targets for Schizophrenia Treatment beyond the Dopamine Hypothesis. International journal of molecular sciences, 18(8), 1-14.

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