Alan is a 42 yr old white british male, he was diagnosed with schitzophrenia at the age of 21yrs. He is the eldest of two children, his sister resides with her husband and children nearby. Alan resides at home with his parents, who are in their early seventies. Alan has always complied with medication, and agreed to hospitalization when necessary, compulsory admission has not been required.
“ Scitzophrenia is a devastating mental illneess, and probably the most distressing and
disabling of the severe mental disorders. The first signs of schizophrenia typically emerge in
adolescence or young adult. The effects of the illness are confusing and often shocking to
families and friends.”
http://www.psychiatry24x7.com.schizophrenia retreived 19/01/06.
Alan is seen by his psychiatrist, every six months, unless he is unwell, when he will be seen more frequently. He is reviewed through the Care program approach at hospital out-patients. His key worker is a community psychiatric nurse, (CPN).
The psychiatrist plays a central role in the diagnosis of a mental disorder. Diagnosis is made after a mental health examination. The role of the psychiatrist in the mental state examination serves two purposes:
“A detailed history is taken to identify change and characteristic clusters indicative of a
specific psychiatric disorder. Secondly the psychiatrist has to make a comparison of change
against a diagnostic criteria to establish presence or not of a specific psychiatric disorder.” (Holland, 2003, p.1938)
After illiminating organic cause, by physical examination, the psychiatrist makes a diagnosis by classification of the symptoms. In todays psychiatry there are two systems used to more reliably identify a mental disorder. The International Classification of Disease, 10th revision, (ICD10), and the American Classification Diagnostic and Statistical Manual, 4th revision, (DSMIV). European psychiatry are guided by the former.
The ICD10 catogarises schizophrenia under, F.20. using the description of Kurt Schieder’s first rank symptoms, (1959). These are ranked as A – D, other symptoms E-I have also been added. (p.49, ICD10, WHO 1992,). For a diagnosis of Schitzophrenia the person must show at least one of the first rank symptoms A- D and at least two of the symptoms, E- I. Alan experiences;
- Thought withdrawal, insertion and broadcasting, he beleives that someone or something is responsible for this. (First Rank symptom A). - Auditory Hallucinations, he hears a running commentary about him. (First Rank symptom C). These are also known as the positive symptoms of schitzophrenia. Alan also experiences more than two of the symptoms E –I, he has thought disorder, anxiety,depression and poor motivation, referred to as negative symptoms. (Kingdom, cited Bailey, 2000)
The ICD10, goes on to provide subsections for types of schizophrena, and notes; not everyone agrees with the sub-sections, due to the overlapping symptoms that can be present from one type to another. According to Alan’s medical notes and on asking him, he does not appear to have been diagnosed with a specific type of schizophrenia. Given the clusters of symptoms that he has experienced, at various times, it would be difficult to place Alan into one of the sub- sections.
The medical model excepts that the schizoprenic brain has increased ventricles, (spaces in the brain), which leads to an imbalance of chemicals in the brain. Using their main tool pshycopharmoglogy, they prescribe drugs to correct this imbalance. (Leonard,2003). The pathology of the illness considers that the chemical which is imbalanced is dopamine. Drugs used to treat mental disorders are known as; neoroleptics or...