Caring for the Mentally Ill Client

Dual diagnosis is a state of an individual that has two or more concurring conditions. It is common in most psychiatric patients. These conditions are, thus, termed to be co morbid. Most psychiatric patients are also victims of drug and substance abuse, thus developing symptoms of one condition may be masked by the other ([surname], Zimberg and Shollar 1993, p. 17).

Dual diagnosis is a result of concurrent symptoms and presentations that are not specific to a single condition. Therefore, the management of both conditions is in view that the conditions would be solved in the process of treatment. Schizophrenia has been significantly associated with dual diagnosis. This is often accompanied by use of drugs or may emerge subsequently as a result of substance and drug abuse. It is difficult to distinguish between substance induced mental illness from a pre-existing, thus a further reason for dual diagnosis ([surname] & [surname] 2003, P. 41).

There are several theories that have been forwarded to explain the prevalence of dual diagnosis. The first theory is casualty theory, which states that mental illnesses could easily develop from the use of some types of drugs such as use of cannabis and development of schizophrenia. Though it can easily be noted that there have been increased incidences of psychosis and mental illness with the increased use of cannabis, it would be wise to determine the role of other factors, hence the theory cannot be fully embraced.

The self-medication theory considers the tendency of individuals with psychiatric conditions to use substances in amid. The reason for this is to clear specific side effects of medications and the unwanted side effects of antipsychotics such as sedation. To reverse these side effects, individuals tend to use substances, yet they ignore side effects of these substances.

Previous exposure to psychiatric medications theory is based on the fact that unprecedented exposure to psychiatric medications causes alteration to neural synapses. Consequently, this is causing an imbalance in the neurotransmitters, resulting in increased chances of recurrence on withdrawal of the drug. Therefore, with such exposure, the patient becomes dependent on the medications improving in condition with use and deteriorating on withdrawal. Such medications cause increased sensitivity to effects of alcohol and increased tendency of addiction, thus aggravating the condition.

The multiple risk factor theory suggests that there are several risk factors that may induce mental illness and substance abuse. These factors include violence, exposure to drugs, poverty, social isolation and sexual abuse, misuse of drugs and lack of planned daily activity.

Schizophrenia is a psychiatric condition that is precedent by a breakdown of mental processes and emotional responses. This condition starts exhibiting its symptoms in the late teens in men, while in women it starts in the mid 20s. The patients are characterized by hallucinations, delusions and unnecessary emotional responses and outbursts. The patients lack contact with reality, hence it becomes difficult for them to negotiate and plan daily activities.

Schizophrenia may develop fast or take time before the first serious episode, hence the patient feels the changes but is unable to point it out. The trend progresses from the lack of motivation, lack of emotions, self-isolation and neglect, peculiarity in speech and indifference to life. Thus, the symptoms of schizophrenia are divided into positive and negative symptoms. The positive symptoms include hallucinations, disorganized speech and behavior, and delusions. The negative symptoms include flat affect, alogia, avolition, associality and anhedonia. The negative symptoms tend to respond poorly to medication.

There are several types of schizophrenia, which include paranoid, disorganized and catatonic schizophrenia.

Paranoid schizophrenia is characterized by suspicious ideas and delusions of persecution. This causes people to have difficulty in relationships and social interactions. They are organized in their thinking, hence they respond well to treatment.

Disorganized schizophrenia starts early in life and is precedent by impaired communication, emotional instability, funny mannerisms and expressions, illogical speech and incongruent reactions. They have delusions and hallucinations that are disorganized and inconsistent.

Catatonic schizophrenia is majorly characterized by either hyperactivity of hypoactivity in motor functioning. In stuporous motor case, there is minimal or rigidity in motor activity and childish obedience to commands, while in excited motor phase, there is overexcitement in activities such as shouting, running, unnecessary movements and people may become violent.

Schizophrenia is attributed to several factors; hence no specific factor can be pointed out as the only key cause. Schizophrenia has a substantial genetic link as it is associated with the family record. The notion is such that individuals with a close relative suffering from the condition are highly predisposed to the disorder compared to the general population. This is not a definitive cause of schizophrenia, as genetics is only a factor that influences schizophrenia, so it is not guaranteed, for a predisposed individual, to develop schizophrenia.

The environmental conditions and predispositions manipulate the vulnerabilities in individuals to cause the disorder. These conditions include high level of stress, which causes subsequent increase in production of a cortisol hormone that is a stress reliever. The alteration of hormone release causes imbalance in systemic hormonal release and control, thus schizophrenia is triggered. The stress factors include childhood sexual and physical abuse, parental loss and separation, and neonatal and prenatal viral exposure.

The brain structure that is abnormal results in alteration of the normal brain chemistry, hence, has a role in development of schizophrenia. Abnormality on the structure of the brain could result in deficit in brain volume, hence enlargement of brain ventricles. More so, the symptoms of schizophrenia include inactivity or reduction in activity of certain part of the brain. The lack of inhibition, lack of reasoning, poor planning and poor decision-making is an indication of an affected frontal lobe. Though there may be effects to areas of the brain, it is highly unlikely that schizophrenia is due to a localized effect to a single part in the brain (Evans and Sullivan 1990, p. 148).

The treatment of schizophrenia is promising and continuously improves, and, thus, there is hope for the suffering patients. With social support, the individuals with schizophrenia have continuously been able to control the symptoms and live productive and satisfying lives. Thus, due to the dual diagnosis, it is vital that the interventions put in place are specific to address both the schizophrenia and the substance induced symptoms. The aim is to be able to clear both disorders simultaneously. More so, the disorder that occurred first is a significant consideration before treatment is commenced.

According to Hussein (2002, p. #), the first concern in the care of any individual is to prevent the disorder from progressing and, thus, improve the outcome of the therapy. This being a noble idea, it is generally not advised for schizophrenic patients, since it does not halt the progression of the condition, thus, it is necessary to start the client treatment correctly. With a dual diagnosis, the prevention therapy will be to halt and reverse the progression of the substance induced symptoms.

Counseling session is aimed at highlighting the effect of the substance abuse and the mental condition. This session helps the clients to realize their own mental state, hence, the need to change. It highlights the shift from normal acivity and the current health situation. The session may be difficult to convene and can act as a set back to the specialist.

Group therapy and support is necessary for such clients with co-morbid conditions. The group session provides a safe place for individuals to open up and express their fears and challenges. This is done through the course of the therapy; hence, they are supported and encouraged to persist with the therapy as it will improve their condition and they will eventually live normal lives. It also offers encouragement, as the client is able to meet with other patients whose condition has improved; thus, this is a sign of hope for the client.

Personal time and space for the client is needed to be able to analyze their progress and the challenges they are facing in the process of transforming and adherence to therapy. This gives the client time to plan for adherence strategies and internalize the encouragements and advice received. This enables development of strength and self-consciousness, hence the desire to change. This is generally referred to self-help, where the client should start by getting sober from the drug in order to progress in the therapy.

Through offering stress management therapy and session, the client will be able to minimize the need for drugs to relieve anxiety and stress, thus, cut the use and, subsequently, the effects. Appropriate stress management techniques are necessary as a basic plan for the therapy of schizophrenics and substance abusers.

The client should be encouraged to adhere to the prescription as there is always a tendency to feel they no longer need the therapy and medications, since they feel better, sober and normal. This is the main reason for recurrence of co morbid disorders, thus the need to consult the specialist before making such a decision.

Assisting the client to identify the factors and incidents that trigger the disorder helps in disease management. This is identification of early signs of the illness in order to seek help promptly. The factors that exacerbate the condition or trigger it such as anxiety evoking situations, stressful activities, and poor eating habits and sleep deprivation should also be identified. The client should always have a standby plan to prevent relapse of the disorder and drug use.

It is important to encourage the client to adopt health eating habits such as from when the day breaks to the end of the day. There is a need to ensure that they eat enough since long periods without food cause reduction in blood glucose levels, thus, lowering the stress threshold and provoke easy anxiety.

The specialist should be patient with the client and encourage the family not to be resentful.  In case the client fails to sustain and comply with the therapy, he/she should instead be encouraged to comply with therapy and be motivated, because it is a vital part of the recovery process.

By getting a chance to learn more about the substances they abuse and the psychotic condition they are suffering from, the clients are able to make conscious decisions. They also discover better ways to keep off the drugs and substances of abuse, hence, it eventually hastens the recovery process.

The specialist should offer specific and appropriate medication due to the variation in responses of the different types of schizophrenia, hence, definitive treatment is needed. Thus, the specialist prescribes relevant drugs to treat the condition and minimize the symptoms. The specialist should prepare the clients and advise them that there is no substantial hurry and that the therapy would take time. On this note, they should be patient for the whole process to be covered, as the results will certainly be satisfactory. This is to avoid the rapid short term treatment that is characterized by hastened withdrawal and frequent relapses due to the superficial effects of the therapy. The easy availability of the specialists for consultations and visits by the patients make the whole therapy personalized by the patient, hence they are waiting for even far reaching results and hastened recovery. This is due to the consistent monitoring and social strengthening that enable effective recovery.

Skills’ training is indispensable in such cases and is crucial as it ensures a structured daily cycle, hence, instills the sense of organization. This provides the clients with the need for planning their time and activities, and, hence, it aids in the recovery process. More so, it reduces anxiety about occupation as skills learnt are economically viable.

Family therapy is also significant, as it highlights to the whole family what ought to be done for the care of the client to avoid overwhelming the client with unnecessary attention. An effective family therapy has been noted to reduce the chances of relapse and a further reduction in symptoms.