Week Due Week 10, Sunday at 11.55 pm (AEST/AEDT)*

Assessment 2 Information

Week Due Week 10, Sunday at 11.55 pm (AEST/AEDT)*

Assessment Type Case Study

Weighting

50%

Learning Outcomes

a) Critically review, interpret, integrate, synthesise knowledge and skills necessary to develop mental health literacy and culturally located meanings of mental health and wellbeing.

b) Exercise adaptability and judgment when critically when identifying and examining important characteristics of major mental health and wellbeing conditions.

c) Critically apply self-awareness and self-reflexivity when developing their understanding of mental health conditions.

d) Effectively demonstrate professional knowledge and integrated understanding to communicate ideas at an advanced academic level, using contemporary communication approaches.

Length 2500 words

*Australian Eastern Standard Time (AEST)/Australian Eastern Daylight Savings Time (AEDT).Check yourtime zoneto ensure that you submit your assessment on time. If required, use atime zone converter.

Assessment Details and Instructions

Purpose:

The purpose of a case study is to present an intensive, systematic investigation of an individual, group, community or some other unit. In this assessment, students will select one of the mental health conditions studied in this unit to demonstrate professional knowledge and understanding of a person living with this condition.

Students will provide an analysis of a low-prevalence mental health condition covered in this unit comprising presenting problems that the person may bring to counselling, and demonstrate knowledge and skills in case conceptualization, assessment and development of an evidence-based intervention plan. Ethical issues and potential challenges will be critically analyzed.

Process:

Students select one of the case scenarios of selected low-prevalence mental health conditions: obsessive-compulsive disorder (OCD), hoarding disorder, bipolar disorder I, schizophrenia, or borderline personality disorder.

Provide a general overview of the selected mental health condition (not specific to the case scenario), including key symptoms, risk factors, and prevalence in Australia. Provide a tentative diagnosis based on the DSM-5-TR criteria for the selected mental health condition

Develop a case conceptualization based on the 5-P model, including presenting issues, predisposing factors, precipitating factors, perpetuating/maintaining factors, and protective factors. Elements from the case study need to be drawn upon here to support the case conceptualization

Suggest validated diagnostic tools that could be used to support diagnosis and suggest an intervention plan based on relevant and highly evidence-informed practice.

Identify and critically evaluate ethical and professional challenges.

The paper needs to include an introduction and a summary/conclusion, and needs to be referenced in APA style (7thed.)

Information on how to present a case study can be found athttps://sls.navitas-professional.edu.au/case-study-0

Introduction

Schizophrenia is a psychotic disease that affects around 24 million people, globally (Schizophrenia, 2022). It amounts to 0.45% of the adult population of the world (GBD Results, n.d.). It is a mental illness that is not very common, yet its incidences are not low as well. Late adolescence and the onset of twenties are the common occurrence period of this disease in the individuals with men being affected more than the women of the same age group. Considerable distress along with impairment in academic, personal, social and professional areas of life is linked to schizophrenia (Arango et al., 2018). Human rights abuses occur in the schizophrenic people, either inside the facilities or outside places that are open to public as well. Pervasive and severe stigma is oriented towards these people, which leads to their exclusion socially and affects their connections negatively with others, especially with friends and family (McGorry, 2019). This adds on to prejudice, which leads to the deprivation and restriction of access to basic services like job, education and housing. Schizophrenia is a complex condition of the mental health that is associated with different symptoms and risk factors.

General overview

Schizophrenia is a rigorous condition of the brain that effects the actions, thoughts and feelings of the sufferer. They lose all sense of reality, which can be distressing and disturbing in their niche. It becomes challenging even to participate in everyday activities for them, availability of effective therapies aids in the mitigation of these challenges. Effective therapies have reported to aid in the recovery of such individuals to become independent and symptoms free (Kotov, 2019). The identification of the symptoms of schizophrenia is critical for its early treatment and care. The disease occurs generally in the age range of 16-30 after the first psychotic episode. Therapy should be started at the earliest so that the recovery is speedy in the patients. However, it is reported that prior to the onset of psychosis, mood alterations gradually occur, along with the patterns of thought and social functioning. However, younger children are rarely reported to grow schizophrenia.

Although the symptoms of schizophrenia might vary person-wise, they can be categorized into three groups: psychotic, negative, and cognitive. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) states that these dysfunctions are present in schizophrenia (Table 3.22, DSM-IV to DSM-5 Schizophrenia Comparison - Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health - NCBI Bookshelf, n.d.). So that a positive diagnosis is made, symptoms that link decrease in functioning of the individual that is both occupational and social is imperative. Varied associated characteristics may occur in the diagnosed individuals with the disease. Changes in thoughts, behaviours, and worldview of a person are instances of psychotic symptoms. The presence of the psychotic symptoms leads to the estrangement of the patients along with the occurrence of perceptions of reality that are distorted. The symptoms may be momentary or permanent on the patients. However, gradual stabilization of the symptoms occur (Longden et al., 2020). Hallucinations is one of the symptom of the disease which is characterized by perceiving of sensations like taste and smell that are absent in reality. Hearing voices is a common phenomenon in schizophrenia (Tsang et al., 2021). It occurs in the patients early and later becomes known to the others. The next symptom is delusions that are convictions that are false, unreasonable and strong. Delusional people, as an exemplar, have thoughts that people imaginary people are communicating messages that are important or they are under constant surveillance or in danger (Darrell-Berry et al., 2016). A thought disorder is another symptom which occurs when the thinking method of the sufferer is strange or illogical. It makes people disoriented in their process of thoughts and difficulties arise for in the organization of ideas and words. Abrupt switching of topics, cut off in the middle of a thought, switch topics abruptly, or usage of phrases that are meaningless occurs. Movement disorder is another symptom associated with the disease which can lead to abnormal body movements in the patient (Pearce et al., 2017). Lack of interest and motivation, withdrawal from social living, complexity in expression of feelings, and difficulties regular functioning are some symptoms that are negative. Sometimes, these signs are confused with those of sadness or other mental diseases. Additionally, concentration, attention and memory difficulties are cognitive symptoms. As a result it becomes difficult to be attentive in a conversation or interaction, fulfill commitments and harvest new information (Tsang et al., 2021). Degree of cognitive functioning is an efficient method for the judgment of performance. Evaluation of cognitive functioning is done through tests. According to DSM-5, schizophrenic patients must demonstrate at least one of the above mentioned characteristics. Additionally, these symptoms or disturbing must be occurring for more than a period of 6 months and must not be due to substance abuse.

Risk factors

Various factors may increase a person's risk of getting schizophrenia. Schizophrenia can run in families, according to genetics. However, just because one member of the family has schizophrenia does not automatically imply that it may be in others as well. Numerous genes may enhance a person's risk of schizophrenia, according to studies, but no single gene appears to be responsible for the condition on its own (Fusar-Poli et al., 2019). Also, according to research, a person's experiences of life and the environment, together with variables that are genetic, contribute to the schizophrenia development. Poverty, exposure to pathogens, distressful environment and malnutrition, post and prenatal are the environmental variables. Multiple lines of evidence suggest that schizophrenia's pathophysiology starts early in neurodevelopment, despite the fact that it often manifests in early adulthood (Cicero et al., 2019). Enhancement in the rates of in utero adversity, such as maternal illnesses and malnutrition throughout pregnancy, as well as obstetric difficulties including preterm birth and preeclampsia are among this evidence's supporting factors (Davies et al., 2018). Additionally, there is evidence that points to early neurodevelopment being affected, such as skin indicators of altered development of the ectodermal layer and modest motor and cognitive abnormalities in children (Davies et al., 2020).

Twin studies have repeatedly demonstrated that schizophrenia has a significant genetic component, with heritability estimated to be over 80%. 13 Heritability is the variation in a trait due to genetic variation between individuals and does not allow for the calculation of risk at the individual level or the discovery of any particular genetic loci linked to a disorder. Genome-wide association studies (GWAS), which enable an impartial, data-driven method to find loci associated with schizophrenia, have become more affordable and feasible in recent years (McCutcheon et al., 2020). According to GWAS, schizophrenia is linked to several common variations, each of which has a negligible influence. There are more than 100 loci that are significantly related with schizophrenia after accounting for the number of tests (McCutcheon et al., 2020). Consequently, it was determined that schizophrenia is a common polygenic condition. Pairwise concordance for schizophrenia is only about 50%, even among identical twins. This demonstrates the significance of environmental factors and how they affect genetic factors to raise the chance of schizophrenia. The risk for schizophrenia described by polygenic risk scores, for instance, was recently shown by Ursini et al., (2018) to be 5 times higher in people who had experienced prenatal difficulties, demonstrating an interplay between genetic and obstetric risk factors. The risk score also failed to distinguish between patients and control participants in those who did not have any obstetric difficulties. These results were interestingly explained by genes heavily expressed in the placenta, which shows that some schizophrenia risk variations act by increasing the outcomes (or maybe the likelihood) of environmental dangers, such maternal difficulties, which may then interfere with the development of the brain. According to research, schizophrenic people may be more prone to have variations in the size of specific brain regions and in the connections between those regions. Some of these changes in the brain may form before birth (Di Carlo et al., 2019). The relationship between brain shape and function and schizophrenia is still a topic of research.

Case Conceptualization

A clinical case conceptualization resulted from an examination of the developmental attributions of schizophrenia, including history in the family, biological components, environment, drugs, and other psychosocial mediating factors. Since schizophrenia is one of the most severe and persistent major mental illnesses, these elements all have implicit roles in its onset and maintenance (Bighelli et al., 2018a). People who have the condition may encounter difficulties with tasks of the daily life, particularly when their perception and interpretation of reality are affected by disordered thinking. As a mitigating element to further support and push the underlying psychotic process, disturbances in thinking and perception frequently result in reliance on cognitive distortions influenced by unhelpful and/or inaccurate instinctive ideas. Maladaptive cognitions misalign false basic ideas about oneself, others, the world, or the future, and this can have an impact on how one functions in daily life (Bighelli et al., 2018b). This may have a noticeable or even extreme negative impact on one's interpersonal, professional, intellectual, or other relationships. In the most extreme situations, people are unable to function on their own and need rigorous and stringent treatment. If they are unable to receive it for one cause or another (such as insurance, family, or resources), as is frequently the case, they may become homeless. Schizophrenia is a persistent thought disease that can be effectively treated and maintained with the right intervention and treatment approaches.

Although there are many potential contributing factors to the development of schizophrenia, genetic, chemical, and neurological abnormalities are frequently thought to be the disease's primary cause. Schizophrenia can affect people of any age, race, or cultural background. Social isolation, depersonalization, anxiety, lack of appetite, poor hygiene, delusions, auditory or visual hallucinations, or a sense of being under the influence of an outside force are just a few symptoms that might occur. These symptoms typically result in paranoia (DSM-5). Presentation can range from an individual's ability to function to more strange behaviours. These manifestations are frequently classified as positive or negative symptomatology, with age of onset playing a large mitigating role in terms of the severity and course of the condition.

Schizophrenia symptoms are thought to be a result of cognitive and neurocognitive deficits in social cognition. In order to assess the needs and results of appropriate care, accurate evaluation is crucial (Thomas, 2017). Treatment combines cognitive-behavioral and psychopharmacological modalities; co-occurring drug misuse difficulties are also likely, typically common, and frequently necessitate a comprehensive team approach. Deficits in social skills can also be widespread and have a detrimental effect on many important facets of functioning. Measures of basic neurocognition and social cognitive have been linked to social skills, according to studies (Hudak & Rasmussen, 2022). Internal attributions that support paranoia are fundamental to social-skill deficiencies. It's been hypothesised that the development of such may be caused by an increased self-serving bias (Monfort-Escrig & Pena-Garijo, 2021). Nevertheless, poor treatment compliance is adversely correlated with poor symptom understanding, which is frequently significantly hindered (Cheng et al., 2022). Therefore, there is a need for multimodal care because rehabilitation efforts have only had limited impact on cognitive, without parallel improvement in brain components of behaviour and adjustment (Roelfs et al., 2021).

Intervention

The objectives of treatment are to lessen the severity of the condition, decrease the quantity of relapses, and remove or lessen symptoms (Swanson et al., 2006). Additionally crucial are better social function and the strengthening of relationships. Cognitive behavioural therapy (CBT) is one of the most researched, well-known, and effective forms of psychotherapy (CBT). It is a specialist form of psychotherapy with a focus on thinking, emotion, and behaviour recognition and management. Structured treatment plans are the best way to use CBT intervention techniques. These Plans include quantifiable action activities that apply CBT principles. Each action is intended to aid in stabilising and managing symptomatology. Typical plans include three to six distinct therapy phases. Each stage is combined to create a treatment objective that is appropriate and determined by medical necessity. Clinical supervisors who are qualified and credentialed create and approve each plan on an individual basis. Because there may be clinical morbidity associated with substance abuse, clinical assessment must make sure treatment plans accurately and measurably reflect clinical outcomes.

A successful intervention plan would start with the betterment of the social skills and the daily living activities along with psychoeducation. This will aid in the gaining of confidence for their daily lives. This is followed by the testing for the reality. This will help in the encounter with the reality and the discussion of the hallucinations and the delusions. This will be followed by identification of the thoughts that are negative in nature. This step is the important step towards fundamental change in the patient. The fourth step is the identification of the concerns and requirements which will unmask the feelings of worthlessness and incompetence. This will be followed by information on the past experiences that may have been detrimental on the patient. The last step is the interaction with the support group and the society that will make the patient ready to face the crowd.

Ethical and Professional challenges

The main challenge is the adherence to treatment. It is often found that the patients are reluctant to adhere to treatment. This not only staggers their recovery but also increases the chances of relapse. Another factor would be unfavourable signs, a lack of motivation, and antisocial behaviour. There are no effective cures for it. Negative symptoms make it harder to get individuals moving and doing. For cognitive impairment, there are no known treatments. Attention, memory, planning, and judgement problems are common. There are no treatments for this at this time.

The likelihood for relapse and the difficulty to maintain good functioning with a reduction in judgement, insight, and consciousness are some of the treatment's drawbacks. The flawed fundamental beliefs that persist and frequently start psychotic episodes may not totally improve as a result of the negative and paranoid thought processes. Although this is not always likely and depends on the person's level of psychosis and/or willingness to change via awareness, the concentration on the therapeutic relationship with ongoing psychoeducation and counseling can offer the essential framework to assure limits will be minimised. For the best level of care to be provided, interdisciplinary communication plays a crucial role.

Conclusion

The mental health subject, schizophrenia, which is regarded as a serious and enduring mental disorder frequently require care that is thorough and intricate. People who have the condition may have challenges and difficulties with daily tasks (van der Meer et al., 2020). Among other fundamental symptoms, it is a thinking illness that affects how people view and interpret reality. Psychopharmacological medicine and psychotherapy are used in the treatment of schizophrenia to lower the risk of psychotic episodes, enhance interpersonal interactions, and get a better understanding of the disease [18]. Due to the lack of a clear explanation for schizophrenia, treatment interventions instead try to lessen or relieve symptom experience.

Future study is essential because no underlying cause of schizophrenia has yet been identified by science. Such medical research is necessary to comprehend genetics, epidemiological attributions, (possible) causes, and prospective ways to slow the evolution of diseases. In order to better understand the difficulties entailed by schizophrenia, additional clinical psychology research on social skill deficits and internal cognitive distortions may be able to offer extra helpful information.

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