Over the years, scientists and mental health professionals have made great strides in the treatment of psychological disorders. For example, advances in psychopharmacology have led to the development of drugs that relieve severe symptoms of mental illness. Clinical psychology is dedicated to the study, diagnosis, and treatment of mental illnesses and other emotional or behavioral disorders. More psychologists work in this field than in any other branch of psychology. In hospitals, community clinics, schools, and in private practice, they use interviews and tests to diagnose depression, anxiety disorders, schizophrenia, and other mental illnesses. People with these psychological disorders often suffer terribly. They experience disturbing symptoms that make it difficult for them to work, relate to others, and cope with the demands of everyday life.
Clinical psychologists usually cannot prescribe drugs, but they often work in collaboration with a patient’s physician. Drug treatment is often combined with psychotherapy, a form of intervention that relies primarily on verbal communication to treat emotional or behavioral problems. Over the years, psychologists have developed many different forms of psychotherapy. Some forms, such as psychoanalysis, focus on resolving internal, unconscious conflicts stemming from childhood and past experiences. Other forms, such as cognitive and behavioral therapies, focus more on the person’s current level of functioning and try to help the individual change distressing thoughts, feelings, or behaviors.
The field of counseling psychology is closely related to clinical psychology. Counseling psychologists may treat mental disorders, but they more commonly treat people with less-severe adjustment problems related to marriage, family, school, or career. Many other types of professionals care for and treat people with psychological disorders, including psychiatrists, psychiatric social workers, and psychiatric nurses.
As a psychiatric health nurse we works closely with other disciplines to arrive at the most appropriate plan of care for the client and the family. The physician’s responsibility is to make a medical diagnosis when there is sufficient support to determine that a psychiatric problem is present. The taxonomy used to make the medical diagnosis is the Diagnostic and Statistical Manual, commonly called the DSM-III-R of the American Psychiatric Association.
The DSM-III-R uses a biopsychosocial perspective but is considered atheoretical, so that it can be readily accepted and used by all who diagnose the psychiatric client. The nurse assists the process by sharing important information about the client from the nursing history, mental status assessment, and daily observations. A working knowledge of the DSM-III-R is important in maximizing the team effort to help the client. Knowledge of the criteria will help the nurse for deciding on a particular medical diagnosis found in the DSM III-R may help the nurse in making a clinical condition about a nursing diagnosis.
The DSM-III-R is a multiaxial system. The diagnostic criteria are inclusive for each diagnosis and allow room for individual differences within a pattern of behavior by including phrases such as “at least one of the following” or ‘for at least 6 months”. Five axes constitute the format for a complete psychiatric diagnosis. A five digit coding system is used for the first three axes. Axis I comprises the major mental disorders such as schizophrenia, bipolar illness, and substance abuse disorders. A disorder of this nature is usually the main reason the client is seeking help. On the other hand, Axis II comprises the personality disorders and developmental disorders such as paranoid personality disorder, schizoid personality disorder, schizotypal personality disorder, borderline personality disorder, and antisocial personality disorder.
This axis separates the patterns of lifestyle and coping that have developed from childhood from the more acute manifestation of behavior in the major mental disorders. Axis III indicates the related physical disorders and conditions that may be influencing the client’s response to the psychiatric problems such fro example, asthma, gastric ulcer, or diabetes. Axis IV indicates the severity of the psychosocial stressors over the past year such as anticipated retirement, natural disaster and change in residence with loss of contact with friends. The Axis V represents the global assessment functioning (GAF) both currently and over the preceding year.
So how does Axis I differ from Axis II? Now let’s try to compare and contrast their similarities as well as their differences. Under Class A Axis II are the personality disorders; paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder.
Personality is vital to defining who we are as individuals. It involves a unique blend of traits—including attitudes, thoughts, behaviors, and moods—as well as how we express these traits in our contacts with other people and the world around us. Some characteristics of an individual’s personality are inherited, and some are shaped by life events and experiences. A personality disorder can develop if certain personality traits become too rigid and inflexible.
People with personality disorders have long-standing patterns of thinking and acting that differ from what society considers usual or normal. The inflexibility of their personality can cause great distress, and can interfere with many areas of life, including social and work functioning. People with personality disorders generally also have poor coping skills and difficulty forming healthy relationships.
Unlike people with anxiety disorders, who know they have a problem but are unable to control it, people with personality disorders generally are not aware that they have a problem and do not believe they have anything to control. Because they do not believe they have a disorder, people with personality disorders often do not seek treatment.
A paranoid personality disorder applies to a person who displays pervasive and long-standing suspiciousness. This suspicious pattern affects perceptual, cognitive, affective and behavioral functions in specific ways. In person’s with paranoid personalities, perception is extremely acute, intense and narrowly focused in search of clues or the real meaning behind other’s behavior or life events in general.
In a cognitive side, the great perceptual distortion is present in paranoid personality. Cognitive disturbances may range from transient ideas of reference, in which a person believe others are giving them special attention or gossiping about them unlike Manic disorder the client is easy going and friendly. The paranoid person’s affective domain reflects a lack of basic trust, extreme suspiciousness, vigilant mistrust, guardedness and hostility.
Typically, paranoid person assume a callous, unsympathetic approach to others in an effort to purge themselves of any tendencies to experience humor or affectionate and tender feelings. For the most part, they remain coldly reserved and on the periphery of events, seldom mixing smoothly with people in social situation, remaining withdrawn, distant and secretive instead. Rarely do they seem relaxed and unguarded.
Unlike with Axis I manic bipolar disorder, Manic clients are self-satisfied, confident and aggressive and feel on top of the world and in control of their destinies, paranoid patient are reserved type while manic is transparent, the manic clients remarks are very similar to free associations, disorganized and incoherent. Manic client is full of ambitious schemes and exaggerations while a paranoid person often engages in verbal interchanges designed to test others honesty. The content of their verbalization usually reflects themes of blame, deceit, control, persecution and self-aggrandizement. Similarities of manic and paranoid personality disorder are that they appear hypervigilant, mobilized and prepared for attack.
Socially detached, shy and introverted persons may be described as having schizoid personality disorder while Schizophrenia is psychotic disorder characterized by disturbances in thought, perception, affect, behavior and communication lasting longer than 6 months. Schizoid refers to persons exhibiting perceptual, cognitive, affective and behavioral patterns that fall within the healthier end of the schizophrenic spectrum. This personality disorder differs from schizotypal personality disorder in that the latter’s symptomatology more closely resembles schizophrenia.
In contrast to both schizotypals and schizophrenics, schizoid personalities do not demonstrate odd or eccentric perceptual, cognitive and behavioral patterns. Persons with schizoid personalities exhibit a distorted pattern of perception, characterized by a reduced ability to attend, select, differentiate and discriminate adequately between and among interpersonal and social sensory inputs while the perception of Depressive disorder clients may be distorted too because of their intense affective states. They perceive the world as strange and unnatural.
For instance, a client with deep guilt feelings may interpret the sound of wind in the trees as reproaching voices (illusion) the severely depressed client may less frequently experience hallucinations. Auditory hallucination may be present such as a client may hear voices blaming her or telling her that she is worthless. Illusion and hallucination do not occur in Schizoid personality disorder. They are able to recognize reality despite their faulty interpersonal or social perception.
Schizotypal personality disorder is one of a group of conditions called eccentric personality disorders. People with these disorders often appear odd or peculiar. They might display unusual thinking patterns, behaviors, or appearances. People with schizotypal personality disorder might have odd beliefs or superstitions. These individuals are unable to form close relationships and tend to distort reality. In this respect, schizotypal personality disorder can seem like a mild form of schizophrenia—a serious brain disorder that distorts the way a person thinks, acts, expresses emotions, perceives reality, and relates to others. In rare cases, people with schizotypal personality disorder can eventually develop schizophrenia.
Additional traits of people with this disorder include the following; dressing, speaking, or acting in an odd or peculiar way, being suspicious and paranoid, being uncomfortable or anxious in social situations because of their distrust of others, having few friends and being extremely uncomfortable with intimacy, tending to misinterpret reality or to have distorted perceptions (for example, mistaking noises for voices), having odd beliefs or magical thinking (for example, being overly superstitious or thinking of themselves as psychic), Being preoccupied with fantasy and daydreaming, tending to be stiff and awkward when relating to others, coming across as emotionally distant, aloof, or cold.
Hallucination, and illusion may not be present in schizotypal personality disorder but it is always present in Schizophrenia. There is lack deterioration of functioning in schizopherenia while their no huge deterioration is schizotypal personality, they are also in touch with reality and they are aware of their eccentricities and their deterioration is occurring within a time frame while Schizophrenia is usually diagnosed in people aged 17-35 years, delusions, false personal beliefs held with conviction in spite of reason or evidence to the contrary, not explained by that person’s cultural context is present.
Their is hallucinations, perceptions (can be sound, sight, touch, smell, or taste) that occur in the absence of an actual external stimulus (Auditory hallucinations, those of voice or other sounds, are the most common type of hallucinations in schizophrenia, disorganized, thoughts and behaviors, disorganized speech, catatonic behavior are also manifested.
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