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INTRODUCTION

“Peace is its own reward.”

–Mahatma Gandhi

OBJECTIVES

  • Discover the four most commonly treated mental disorders

  • Find out how to identify patients suffering from schizophrenia, bipolar disorder, major depressive disorder, and panic disorder

  • Explore how to assess patients suffering from schizophrenia, bipolar disorder, major depressive disorder, and panic disorder

  • See how to de-escalate patients suffering from schizophrenia, bipolar disorder, major depressive disorder, and panic disorder

  • Compare identification, assessment, and de-escalation practices for the four disorders

Healthcare facilities frequently treat patients for concerns related to four prominent mental disorders: schizophrenia, bipolar disorder, major depressive disorder, and panic disorder. Although these disorders are mental in nature, individuals who suffer from them are frequently treated on an outpatient basis in clinics, hospitals, and extended care facilities. Often these individuals are hospitalized for physical health issues that exacerbate their mental health condition.

Schizophrenia, bipolar disorder, major depressive disorder, and panic disorder are all very different conditions, with their own unique manifestations. When a patient suffering from one of these disorders seeks treatment, it’s critical to use assessment and interventional techniques that are appropriate for that individual’s disorder to prevent escalation and ensure proper patient-centered care. That’s the focus of this chapter.

ASSESSING AND DE-ESCALATING PATIENTS WITH SCHIZOPHRENIA

Schizophrenia refers to a group of severe disabling psychiatric disorders marked by a withdrawal from reality. Schizophrenia is characterized by severe emotional, behavioral, or intellectual disturbances. Symptoms of schizophrenia include distorted perceptions of reality, diminished ability to think rationally, and impaired emotional experience and social engagement (American Psychiatric Association [APA], 2013; Minzenberg, Yoon, & Carter, 2011). Other signs and symptoms of schizophrenia are disorganized thoughts and behaviors, negative mood states, and behavioral impulsivity. Finally, people who suffer from schizophrenia may at times experience delusions and hallucinations. Auditory hallucinations—hearing “voices”—are common in schizophrenia.

NOTE

Schizophrenia is a serious and pervasive lifelong mental disorder. It is present in 1% of the population and affects males and females in equal numbers. Between 5% and 6% of people with schizophrenia die by suicide (APA, 2013; Harris & Barraclough, 1999).

The treatment of schizophrenia involves a multidimensional and interdisciplinary approach. Treatment options include the following:

  • Psychopharmacology. This includes antipsychotic medications to reduce or eliminate the auditory and visual hallucinations that often occur with schizophrenia.

  • Psychosocial treatment and rehabilitation. This helps reintegrate individuals with schizophrenia into the family setting and broader community for holistic recovery.

  • Vocational counseling. This assists people with schizophrenia by providing job training to gain employment or return to a vocation (Boyd, 2008; Kane, 2003).

  • Electroconvulsive therapy (ECT). ECT involves applying an electric current to the brain through electrodes that are placed on the patient’s temples to produce a grand mal seizure. ECT is used primarily for patients who are resistant to treatment with medication. Some individuals with treatmentresistant schizophrenia may be candidates for ECT.

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