PSYC1038

Banner Number: 001135917

PSYC1038

Psychopathology and Clinical Psychology

Assessment: PSYC1038 Essay

Coursework title: Discuss and Evaluate Treatment Strategies for BPD, MDD and Schizophrenia (+ CV)

Coursework Deadline: 15 Desember 2022 (23:30 UK Time)

Module Leader: Dr Michele Britel (BSC)

Word Count: 2000

Introduction

Treatment strategies are used to help patients recover from their mental health condition. Maintaing the highest standards of quality care for patients with mental health conditions is achieved by ensuring that strategies developed for their treatment are always being evaluated.

This essay will investigate treatment strategies for three mental health conditions and critically review their efficacy based on empirical research evidence underpinned with peer-reviewed journal articles, meta-analyses, and randomized controlled trials.

Borderline Personality Disorder

Thanks to the introduction of Dialectical Behavioral Therapy (DBT) for BPD and drugs used to treat BPD symptoms, there is a lot of hope for the treatment of BPD. DBT is the primary form of therapy for people with BPD, however, there are many other therapies and self-help techniques that can be used to manage symptoms. The prevalence of borderline personality disorder is estimated to be 1.5% worldwide (Nugent et al., 2020). Trauma experienced as a child and a family history of personality problems is usually linked to this disorder. Depending on the person's age and the form of BPD they have, BPD symptoms can be persistent and pervasive and range in intensity. Finding and employing good treatment is essential to having a fulfilling life because this condition is lifelong. Several therapeutic modalities are effective in treating and controlling BPD (Cai, 2018).

Lack of trustworthy, dependable relationships is caused by untreated borderline personality disorder because most BPD friends or family cannot sustain their ongoing emotional instability. Everyone needs social and familial ties; without them, physical and mental health outcomes are diminished, and may suffer long-term effects. Additionally, eating disorders, addiction, incarceration, and suicide rates are higher in people with untreated BPD. Effective care and support systems are crucial for those with BPD (Boku et al., 2018).

The most successful method of treatment for BPD is psychotherapy, which has been developed and researched for many years. The best course of treatment for BPD seems to be long-term therapy combined with medication to control symptoms. Although DBT is frequently regarded as the most successful treatment strategy, people with BPD can benefit from a variety of therapy methods and experience personal development.

Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy (DBT), which Marsha Lineman developed in the 1970s, is frequently the treatment of choice for those with BPD. 10 DBT is a multifaceted therapeutic strategy that was initially developed to stop suicidal thoughts in BPD patients. DBT, which incorporates elements of individual and group therapy, crisis phone calls, and therapy worksheets, is now successfully used to treat a wide range of mental health issues.

People often report progress after six months of therapy, and significant and long-lasting change happens after two years. DBT concentrates on developing abilities in four areas: Mindfulness, tolerance for stress, emotional control, and relationship effectiveness.

Cognitive Behavioral Therapy (CBT)

This method of BPD treatment combines behaviorism, humanism, and mindfulness to promote holistic and long-lasting improvement. CBT components have been used in the treatment of BPD for more than 50 years. Through CBT, a person can assess, keep track of, and modify their thoughts and beliefs that have an impact on their feelings, experiences, and interpersonal interactions. This talk-therapy-based approach helps people become aware of their negative and maladaptive thinking, then challenges them to alter those false beliefs and thoughts.

Schema-Focused Treatment

A person can comprehend the maladaptive schema they established as children with the aid of schema-focused treatment. This method can help people recognize how unfulfilled demands can result in counterproductive patterns in interpersonal interactions and daily life. When we become adults, things that were beneficial to our survival or prosperity as children could turn out to be counterproductive and encourage unfavorable social connections (Hagi et al., 2021). A person can identify these negative interactional patterns and ways of being in the world with the use of schema-focused therapy, which can then help to create lasting adjustments. Schema treatment patients with BPD report enhanced self-knowledge, increased emotional awareness, and improved emotional regulation. Schema-focused therapy is displaying encouraging long-lasting effects, but more research is required to substantiate this method's efficacy (Wall, 2020).

Mindfulness-Based Therapy (MBT)

This method of treating BPD integrates the mentalizing process, which is how we interpret our subjective daily events to make sense of ourselves and one another. A time-limited, highly controlled strategy called mentalization-based treatment uses several interventions to encourage the growth of mentalizing. Its objective is to help people comprehend their own emotions and thoughts so they might adopt a different, healthier viewpoint (Fonseka, 2018).

People with BPD frequently struggle with identity issues. Their values and interests might therefore quickly shift as a result. Additionally, they have the propensity to see things in terms of extremes, such as all good or all negative. Their opinions of others are subject to rapid change. A person who is admired one day could be despised the next. These erratic emotions frequently result in strong and unstable partnerships.

Risk factors

Other BPD signs and symptoms include: severe dread of being left behind, can't stand being alone, experiences frequent emptiness and boredom, frequent, inappropriate anger shows, Impulsivity in drug usage or romantic relationships, for example, crises that recur often, and self-harming behaviors like wrist cutting or overdose.

Schizophrenia Schizophrenia must be ruled out along with other mental illnesses, and its symptoms must not be brought on by substance misuse, medication, or a physical ailment (Day et al., 2018). Making a schizophrenia diagnosis may involve an exam of the body, which could be done to check for any associated consequences and to help rule out any other issues that might be producing symptoms. Tests and examinations, tests that help rule out illnesses with comparable symptoms, and drug and alcohol screenings may be among them. Additionally, the doctor can ask for imaging tests like an MRI or CT scan (Robertson, 2019).

In psychiatric assessment, examining looks and behavior, as well as questioning thoughts, moods, delusions, hallucinations, substance use, and the likelihood of violence or suicide, a doctor or mental health professional determines a person's mental state. A discussion of one's family and personal background is also included. Schizophrenia diagnostic criteria. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) issued by the American Psychiatric Association contains criteria that may be used by a physician or mental health specialist.

Even after the symptoms of schizophrenia have faded, treatment is still necessary for life. The illness can be managed with medical care and psychosocial counseling. Hospitalization may be required in specific situations. Typically, a psychiatrist with experience with schizophrenia directs care. To coordinate care, the treatment team may additionally include a psychologist, social worker, psychiatric nurse, and possibly a case manager. The full-team strategy might be offered in clinics with experience treating schizophrenia (Luedtke, 2019).

Medications

The most frequently given pharmaceuticals are antipsychotics, which constitute the cornerstone of treatment for schizophrenia. They are believed to impact the brain's chemical dopamine, which regulates symptoms. Antipsychotic drug therapy aims to successfully control indications and symptoms at the lowest dose achievable. To get the desired outcome, the psychiatrist may experiment with various medications, doses, or combinations over time. Other medications, such as antidepressants or anxiety meds, may also be beneficial. It may take several weeks before symptoms start to get better (Williams et al., 2018).

People with schizophrenia may be reluctant to take drugs since they can have major negative effects. Drug selection may be influenced by one's willingness to participate in treatment. For instance, a patient who struggles to take their prescription consistently might require injections rather than pills. Inquire with your doctor about the advantages and drawbacks of any prescription drug (Stilo, 2019).

Behavioral and social interventions

Psychosocial therapies are crucial once psychosis has subsided, in addition to keeping up with medication. These may consist of: Individual counseling. Thought patterns may be normalized through psychotherapy. People with schizophrenia can better manage their illness by learning coping mechanisms for stressful situations and recognizing early warning signals of relapse. Socialization instruction. This focuses on enhancing social relationships, communication, and participation in everyday activities. Family counseling. This offers families struggling with schizophrenia support and information. Rehabilitation for the workforce and assisted employment. This focuses on assisting those who have schizophrenia in their job search, employment, and retention.

The majority of people with schizophrenia need assistance with daily tasks. Programs to assist people with schizophrenia with employment, housing, self-help groups, and crisis circumstances are available in many communities. Finding resources can be assisted by a case manager or a member of the treatment team. Most persons with schizophrenia can control their illness with the right care (Mehlum, 2021).

Long-acting antipsychotics for injection

Some antipsychotics can be injected subcutaneously or intramuscularly. Depending on the drug, they are often administered every two to four weeks. Inquire with your doctor for further details on injectable drugs. If a person prefers taking fewer medications, this might be an option and could improve adherence. Typical drugs that can be administered via injection include: Aripiprazole (Abilify Maintena, Aristada), Decanoate of fluphenazine, Decanoate of haloperidol, Paliperidone (Invega Sustenna, Invega Trinza) and Risperidone (Risperdal Consta, Perseris).

Major Depressive Disorder

Clinical depression, often known as major depressive disorder (MDD), is a mood condition that can affect anyone. Its most common symptom is a protracted state of sorrow or irritation. Sadness is a normal emotion that all people experience. When a loved one dies or when they are dealing with a difficult life event like a divorce or a serious illness, people may feel sad or melancholy (Bateman, 2020). These emotions typically pass quickly. Someone may have a mood disorder like major depressive disorder if they consistently and intensely feel depressed for long periods (MDD).

Clinical depression, another name for MDD, is a serious illness that can have an impact on many aspects of your life. It affects a variety of physiological processes, including food and sleep, as well as mood and behavior. One of the most prevalent mental health disorders in the US is MDD. According to data, major depressive episodes were experienced by more than 8.4%Trusted Source of American people in 2020. Some MDD patients never receive treatment. With treatment, the majority of individuals with the illness can learn how to manage and function. People with MDD can manage their symptoms and receive effective treatment through medications, psychotherapy, and other techniques (Mohi et al., 2018).

Based on your symptoms, emotions, and behaviors, a medical or mental health specialist can determine whether you have MDD. For medical specialists to better identify whether you have MDD or another ailment, you will typically be asked particular questions or given a questionnaire (Bai et al., 2020). The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) symptom criteria must be met to receive an MDD diagnosis. This guidebook aids in the mental health disorder diagnosis for medical professionals (Hutsebaut, 2021).

Medication and psychotherapy are frequently used to treat MDD. Certain symptom-relieving changes to one's way of life are also possible. A hospital stay may be required while receiving treatment for those who have severe MDD or suicidal thoughts. Some might also require participation in an outpatient program of care until their symptoms subside (Brain et al., 2018).

Medications

Antidepressant drugs are frequently prescribed as the first step in treating MDD by primary care providers.

Inhibitors of selective serotonin reuptake (SSRIs)

One class of antidepressants that are widely administered is SSRI. SSRIs function by preventing the breakdown of serotonin in the brain, which raises levels of this neurotransmitter. A brain molecule called serotonin is thought to be in charge of mood. It might contribute to mood improvement and promote sound sleep habits. Serotonin levels are frequently assumed to be low in people with MDD. By boosting the amount of serotonin accessible in your brain, an SSRI may help with MDD symptoms.

Well-known medications like fluoxetine (Prozac) and citalopram are examples of SSRIs (Celexa). The majority of people tolerate their relatively rare side effects. Serotonin-norepinephrine reuptake inhibitors (SNRIs), another class of antidepressants that is frequently prescribed, are similar to SSRIs. Serotonin and norepinephrine, which assist in controlling your fight-or-flight response, are impacted by these (Manigsaca, 2020).

Various other medications

When previous medications haven't worked, tricyclic antidepressants and so-called atypical antidepressants, such as bupropion (Wellbutrin), may be utilized. Weight gain and drowsiness are only two of the negative effects that these medications may have. Benefits and adverse effects must be carefully weighed by a healthcare practitioner, as with any medicine. Immediately stopping a medicine can result in withdrawal symptoms. It's crucial to follow the advice of a mental health or healthcare expert before stopping your medication.

Psychotherapy

People with MDD can be successfully treated with psychotherapy, sometimes referred to as psychological therapy or talk therapy. It entails scheduling regular consultations with a mental health professional to discuss your condition and associated problems. Other forms of therapy, such as cognitive behavioral therapy or interpersonal therapy, may also be suggested by a mental health practitioner. The Health Line Find Care feature can help you locate a mental health professional in your region if you don't already have one. Group therapy is an additional option for treatment because it enables you to express your emotions with others who understand what you're going through.

Risk factors

Although the exact origin of schizophrenia is unknown, several variables, such as the following, appear to enhance the chance of schizophrenia development or occurrence: a history of schizophrenia in one's family, several issues that might affect the development of the brain during pregnancy or after delivery, such as malnutrition or exposure to chemicals or viruses.

Using drugs that alter the mind, such as those classified as psychoactive or psychotropic, when a teen or young adult can also contribute to this infection.

Conclusion

In conclusion, mental illnesses can quite affect the behavior and thinking of humankind in different ways. In that way, these mental conditions need to be handled and treated with utmost care and with both therapy and medication treatment strategies. During the analysis, I was able to find out about various psychotherapies deployed by healthcare professionals to cure the three mental infections that we discussed. Not all these psychologycal disorders indeed require admission of drugs or antibiotics to the patients, but some others require behavioral practices that are aimed at changing the way those patients behave and get back to their consciousness. Different authors made their research on the field and came up with different treatment strategies that can be administered to people suffering from the three mental disorders which played a big part in the current medical field. References

Alns, D., Kaufmann, T., van der Meer, D., Crdova-Palomera, A., Rokicki, J., Moberget, T., ... & Karolinska Schizophrenia Project Consortium. (2019). Brain heterogeneity in schizophrenia and its association with polygenic risk.JAMA psychiatry,76(7), 739-748.

Bai, S., Guo, W., Feng, Y., Deng, H., Li, G., Nie, H., ... & Tang, Z. (2020). Efficacy and safety of anti-inflammatory agents for the treatment of major depressive disorder: a systematic review and meta-analysis of randomized controlled trials.Journal of Neurology, Neurosurgery & Psychiatry,91(1), 21-32.

Bateman, A. W. (2020). Psychoanalytically orientated day-hospital treatment for borderline personality disorder: theory, problems, and practice. InResearch on Psychoanalytic Psychotherapy with Adults(pp. 109-132). Routledge.

Boku, S., Nakagawa, S., Toda, H., & Hishimoto, A. (2018). Neural basis of major depressive disorder: beyond monoamine hypothesis.Psychiatry and clinical neurosciences,72(1), 3-12.

Brain, C., Kymes, S., DiBenedetti, D. B., Brevig, T., & Velligan, D. I. (2018). Experiences, attitudes, and perceptions of caregivers of individuals with treatment-resistant schizophrenia: a qualitative study.BMC Psychiatry,18(1), 1-13.

Day, N. J., Hunt, A., CortisJones, L., & Grenyer, B. F. (2018). Clinician attitudes towards borderline personality disorder: A 15year comparison.Personality and Mental Health,12(4), 309-320.

Fonseca, L., Diniz, E., Mendonca, G., Malinowski, F., Mari, J., & Gadelha, A. (2020). Schizophrenia and COVID-19: risks and recommendations.Brazilian Journal of Psychiatry,42, 236-238.

Fonseka, T. M., MacQueen, G. M., & Kennedy, S. H. (2018). Neuroimaging biomarkers as predictors of treatment outcome in Major Depressive Disorder.Journal of affective disorders,233, 21-35.

Hutsebaut, J., & Aleva, A. (2021). The identification of a risk profile for young people with borderline personality pathology: a review of recent literature.Current Opinion in Psychology,37, 13-20.

Kennis, M., Gerritsen, L., van Dalen, M., Williams, A., Cuijpers, P., & Bockting, C. (2020). Prospective biomarkers of major depressive disorder: a systematic review and meta-analysis.Molecular psychiatry,25(2), 321-338.

Luedtke, A., Sadikova, E., & Kessler, R. C. (2019). Sample size requirements for multivariate models to predict between-patient differences in best treatments of major depressive disorder.Clinical Psychological Science,7(3), 445-461.

Manigsaca, A., Glue, P., & OBrien, A. (2020). Advance directives: another gap in services for people with borderline personality disorder.Psychiatric Services,71(5), 528-529.

Mehlum, L. (2021). Mechanisms of change in dialectical behaviour therapy for people with borderline personality disorder.Current Opinion in Psychology,37, 89-93.

Mohi, S. R., Deane, F. P., Bailey, A., Mooney-Reh, D., & Ciaglia, D. (2018). An exploration of values among consumers seeking treatment for borderline personality disorder.Borderline Personality Disorder and Emotion Dysregulation,5(1), 1-10.

Reed, G. M. (2018). Progress in developing a classification of personality disorders for ICD11.World Psychiatry,17(2), 227.

Robertson, I., Cheung, A., & Fan, X. (2019). Insomnia in patients with schizophrenia: current understanding and treatment options.Progress in Neuro-Psychopharmacology and Biological Psychiatry,92, 235-242.

Sanada, K., Nakajima, S., Kurokawa, S., Barcel-Soler, A., Ikuse, D., Hirata, A., ... & Kishimoto, T. (2020). Gut microbiota and major depressive disorder: A systematic review and meta-analysis.Journal of Affective Disorders,266, 1-13.

Wall, K., Kerr, S., & Sharp, C. (2021). Barriers to care for adolescents with borderline personality disorder.Current Opinion in Psychology,37, 54-60.

Williams, A. E. S., Yelland, C., Hollamby, S., Wigley, M., & Aylward, P. (2018). A new therapeutic group to help women with borderline personality disorder and their infants.Journal of Psychiatric Practice,24(5), 331-340.

Winsper, C., Bilgin, A., Thompson, A., Marwaha, S., Chanen, A. M., Singh, S. P., ... & Furtado, V. (2020). The prevalence of personality disorders in the community: a global systematic review and meta-analysis.The British Journal of Psychiatry,216(2), 69-78.

Hagi, K., Nosaka, T., Dickinson, D., Lindenmayer, J. P., Lee, J., Friedman, J., ... & Correll, C. U. (2021). Association between cardiovascular risk factors and cognitive impairment in people with schizophrenia: a systematic review and meta-analysis.JAMA psychiatry,78(5), 510-518.

Stilo, S. A., & Murray, R. M. (2019). Non-genetic factors in schizophrenia.Current psychiatry reports,21(10), 1-10.

Cai, L., & Huang, J. (2018). Schizophrenia and risk of dementia: a meta-analysis study.Neuropsychiatric disease and treatment,14, 2047.

Appendix

Personal Statement

Professional Summary

I am enthusiastic and motivated undergraduate student who is passionate in progressing further in the field of Psychology. My experience as a Crisis support volunteer allowed me to demonstrate an ability to support children, young people and adults who are struggling to cope. I am able to support texters in distress to calmer moment, empowering them to plan and take their next steps towards feeling better. As a volunteer I developed the ability to provide confidential conversations, as well as listening without judgement and providing further resourses and/or tools to help clients receive more expert support. My course work projects have enabled me to gain skills in researching and statistical analysis. I have also been able to expand my knowledge of understanding of various mental health conditions and counselling approaches. I am eager to gain more knowledge and experience in this field and would like to pursue a career in the mental health sector or psychological therapies. I feel as though I would thrive in an environment where I am able to make a positive impact on the quality of life of others. I am non-judgemental of subjective needs, and reliable in providing the best quality of care. I am courteous and would be respectful not only of clients, but of managements expectations of me, which is something I am able to acknowledge and follow feedback from.

Core Skills

Cognitive Behaviour Therapy

Psychological Counselling

Research methods

SPSS and NVivo Statistical Software

Mental Health Support

Member of the BPS

Education & Qualifications

BSc (Hons) Psychology with Counselling, 2020-2025, University of Greenwich

Professional development: CBT Cognitive Brehaviour Therapy Course, DBT Dialectical Behavioural Therapy Course, Shout Mental Health Volunteer Course

Professional Qualifications

providing crisis intervention to clients

Soft skills

listening and interpersonal abilities

communication skills

problem-solving skills

empathy

counseling

crisis intervention

Key Skills

Extensive knowledge of qualitative and quantitative research methods and their application to psychological settings

Expert user of SPSS and NVivo software

Highly competent in data collection and analysis tasks

Excelent written and spoken communication skills