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Description in the DSM 5

Discuss about the Assessment and Intervention in Therapy.

Research shows that the onset of post-traumatic stress disorder abbreviated as PTSD diagnosis has seen several scholars primarily focusing on defining the causal agents as well as the relationship between the trauma and non-psychotic illness CBecky and Van Der Kolk, 2016). As such, the shift in attention has led to limited research done on the relationship between psychosis and schizophrenia. Further, studies indicate that the main reason for such behavior amid health professionals and patients includes but is not limited to tension of being accused of family blaming, avoidance of stigmatization, unwillingness to adopt a biological paradigm for combating the condition, and side effects associated with the diagnosis of the condition (Briere et al., 2017). Moreover, several social factors such as child sexual abuse and child physical abuse do affect the mental well-being of most adults. For instance, Orthorexia, depression, sexual dysfunction, personality disorder and dissociative complications, as well as cases of suicide are among the side effects associated with people with lived experience of schizophrenia (Bushnell et al., 2012).

Again, patients with schizophrenia record longer length of hospitalization due to the demanding medical attention of the disorder. Also, studies on the mental state of humans reveal that bipolar disorder is a side effect of schizophrenia amid children who have been physically and sexually abused (Christoffersen et al., 2013). To that end, schizophrenia is defined as a constant psychological turmoil that distorts a person social links through interference with the emotional and behavioral states hence rendering the patient faulty with an inferiority complex; mainly characterized by mental destruction withdrawal from public gatherings (Fergusson et al., 2016). As such, ideas in this paper seek to explore and critically evaluate four aspects underpinning schizophrenia. First, the article will describe the condition in the DSM 5. Secondly, a discussion will on psychodynamic diagnostic manual be outlined. Thirdly, the disorder is described from the psychotherapy perspective. Finally, the paper compares the assessment criteria and instruments used to elucidate the meaning of the health condition. Notably, the essay is structured into six sections with four being the body. The sixth section is a succinct summary of the discussed ideas with a reference regarding the thesis statement as shown below.

The discussion on schizophrenia sees a hot debate on matters definitions, Pathophysiology, and the boundaries. However, the DSM-IV schizophrenia proves to be of significance value within a clinical setting as it is easily diagnosed and posit useful information. As such, to define the DSM-5, it is considered wise first to analyze the DSM-IV. The DSM schizophrenia finds meaning in explaining the dispersion of the condition in a population. For instance, the works of Garno et al., 2015 calls for an assessment of psychosis in schizophrenia population of children with different ethnic backgrounds. Moreover, the DSM-5 is implemented in the study to ensure the credibility of the data collected from the participants; regarding their social life, economic, and political affiliation. Notably, the DSM-5 model is a justification for identifying the shortcomings in a research deign and provide new information on the psychopathology of the disease. The interventions by the DSM-5 seek to improve the service delivery by health professionals within a mental health setting; improving the health status of the people with lived experience of schizophrenia; and facilitate evidence-based treatment (Grilio and Mashedb, 2012).

Description in the Psychodynamic Diagnostic Manual

The DSM-5 requires that schizophrenia diagnosis is provided when the psychotic criteria of the disorder are not met. Further, the diagnosis model is applied to patients when there is limited and contradictory information regarding an individual's signs and symptoms; such that the clinician cannot assign any other diagnosis. For instance, "psychotic disorder not otherwise specified" can be diagnosed if the patient presents with symptoms that are substance-induced or related to the psychological condition. The increased adoption of the DSM-5 model in most psychiatric units has had the likelihood of equipping physicians with the best alternatives on ways to combat schizophrenia and related symptoms. Also, the works of Hyun et al., 2015 support the fact that the DSM-model as much as it has reduced the increased cases of schizophrenia it has also managed to identify the pathological causes and categorize the psychotic disorders as humans are susceptible. The sufficient clinical information also explains the procedural process taken by clinicians to formulate interventions and implement within an acute mental health setting; the conventional approaches to assessing and evaluating psychosis as a model to treat patients.

PDM integration in a clinical setting calls for a classification of disorder and understanding of the normal processes. Also, mental health comprises of more than analyzing absence or presence of symptoms; it pays attention to details on family ties, emotional state, coping ability, and self-management (Kendler et al., 2013). Notably, just the same way normal cardiac functioning cannot be defined as the absence of chest pain is the same way healthy mental functioning is more than the absence of visible symptoms of psychopathology. Therefore, the PDM involves assessment of the human cognitive ability, emotional, and behavioral patterns. Conceptualization of health is the basis for defining schizophrenia; where the psychopathology entails understanding the trivial features of human functioning including but not limited to tolerance ability, regulatory measures, coping strategies, defense mechanisms, and the type of relationships. Recent studies indicate that "Allen Frances, the chair of the DSM-IV American Psychiatric Association Task Force is of the opinion that there is a growing need for the clinicians to deviate from focusing on the causal agent of the disorder and assess the factors that underpin the well-being of the patient; such as the cognitive ability, behavioral patterns, and emotional status" (Lange et al., 2013). As such, it is possible to discern that description of naturally existing patterns of mental health guide critical study on etiology, development of research questions, prevention, and treatment of the condition. The American Psychological Association also posits that the establishment of scientific knowledge aimed towards defining the disorder and provides solutions constitute evidence–based approach (Lipschitz et al., 2016).

Impact of Social Factors on Schizophrenia

However, the manual treatment therapy on selected symptoms of schizophrenia without addressing the multifaceted person who experiences the symptoms renders the treatment ineffective due to the failure to adherence to therapeutic relationships underpinning the disorder. Moreover, studies on a meta-analysis of results of manual treatment for targeted symptoms showed that asymptomatic advancement did not carry on and that mental ability involving the depth and range of relationships, emotional state, coping strategies had no long-term goals (Hyun et al., 2015). On the other hand, process-oriented research indicated that characteristics of the psychotherapeutic relationship as conceptualized by psychodynamic models are predictive of the results than any manual therapy approach. This is because most dynamically-centered physicians pay attention to details regarding therapeutic relationships, identifying emotional and behavioral patterns, and the coping ability of the patient. What is more is that there has been limited research and published literature on psychodynamically-centered treatments with meta-analysis and reviews showing evidence-based approaches. For instance, "the Adverse Childhood Experience Study in Atlanta found that exposure to developmentally undermining emotional experiences in childhood was associated with increased likelihood of physical and mental health outcomes as adults" (Mullen et al., 2013). Again, the study indicated that physical and mental health disorders were related to feelings and thought patterns; involved in dealing with the adverse childhood experiences.

As much as the PDM is rendered a success in combating mental health complications, there are several factors which hinder its experiences in "theories and metaphors" that have over time resulted in controversial agreement (Spataro et al., 2014). Then there has been a traditional psychoanalytic approach that made it difficult to distinguish between speculative constructs and observable traits. Subsequently, over the years establishment of empirical methods that quantify and assess the complex mental phenomena and psychology has been able to provide clear operational criteria for a comprehensive understanding of the range of human social and behavioral traits (Bushnell et al., 2012). As such, a psychodynamically-oriented system identifies and evaluates procedural processes that constitute emotional and relationship. Further, the APA stipulates that psychodynamic model seeks to understand psychopathologies with expectations that such measures will lead to the identification of etiological patterns. In light of the discusses ideas, the PDM, therefore, addresses in-depth functioning of the mental health; as it uses a multifaceted approach to defining a patient's overall morphological functioning and ways of engaging clinicians and patients to achieve a therapeutic relationship.

The model is of significant value in defining the roles of the PDM in managing schizophrenia; as it advocates for the understanding a patient beyond the clinical location. For instance, the social life and behavioral patterns are assessed to determine the best interventions for the patients.  Also, the model posits that as a clinician it will be faulty to pay attention to one psychopathological finding as a measure of the patient's condition. As such, the model takes into account two factors that treat schizophrenia namely: patient's general location ranging from healthier-poor state and functioning. The next aspect is the characteristic patterns through which an individual organizes the mental functioning and perceives the world.

Comparison of Assessment Criteria and Instruments

The second model of the PDM is a narrative approach that pays attention to the emotional state of a patient; including but not limited to self-management, psychological health, coping ability, and tolerance. The model also presents the condition with finer details that underpin the defense strategies relevant in combating schizophrenia.

The multifaceted dimension starts by integrating the DSM-IV-TR categories and proceed to describe the patient's cognitive abilities: how the patient's "personal experiences" affect the ability t overcome the disorder and how s/he perceives condition. Further, the model offers a platform for assessing patient's degree of severity and supports the implementation of clinical-based interventions.

Recently, medical advancements have sought to provide newer paradigm and biomedical mindful psychiatric interventions in treating schizophrenia therapeutically (Read, 2013). The model is driven by the past literature on contemporary psychotherapy models or schizophrenia; that lacked understanding of the different social, emotional, and behavioral patterns of a patient. Therefore, newer models rely on "integrative and supportive psychotherapy interventions to define schizophrenia as a biological-based condition that can be treated in part by learned and shared coping strategies. Also, research indicates that creating awareness on adjustments and adoption of practical strategies establish a long-term treatment plan. As such, the section supports the implementation of a patient-centered staff to identify, assess, and evaluate therapeutic relationships established by the PDM.

The information on psychotherapy perspectives appraises literature on cognitive-behavioral therapy and group treatment to manage schizophrenia. Cognitive therapy: the model aim at identifying and treating cognitive delusions in patients with lived experiences of schizophrenia (Read, 2014). The therapy uses cognitive strategies such as normalization techniques and reality testing to assess the degree of patient's condition. On the other hand, literature on group treatment focuses on auditory hallucinations. The model uses psychoeducation to create awareness, analyze coping strategies of a group, and their perceptions of the world around to determine the auditory hallucinations. Moreover, group treatment model employs providing intensive care units and/or private wards for patients presenting with schizophrenia to undergo therapy and reduce disruption caused by noise (Goff et al., 2014).

To that end, it is possible to compare the assessment criteria and instruments used by the discussed models in making sense of the schizophrenia. First, the DSM-5 models, the PDM, and the psychotherapy perspective have the same criteria for assessing a patient beyond the morphological spectrum so as to formulate interventions that can effectively treat the condition. For instance, the analysis of a patient's emotional, behavioral, and social patterns provide relevant information regarding past medical history. Further, the common tool for assessing patients with lived experiences of schizophrenia is therapeutic interventions. The tool goes beyond the manual treatment and allows for assessment of a patient's cognitive strategies and assesses the relationships. It is to such evidence that the study finds meaning and helps to treat the ever-increasing rate of mental health disorder schizophrenia being the point of focus. Notably, promoting recovery and well-being of patients within an acute mental health setting calls for effective interactions amid clinicians and patients; through sharing of information and creating awareness through psychoeducation. However, the APA and the World Health Organization should encourage scholars and other organizations to conduct research on matters psychological health to provide supportive evidence to the general public.

Reference

Beck J, Van Der Kolk B. Reports of childhood incest and current behavior of chronically hospitalized psychotic women. Am J Psychiatry 2016;144:1474–1476.

Briere J, Woo R, Mcrae B, Foltz J, Sitzman R. Lifetime victimization history, demographics, and clinical status in Childhood trauma and psychosis 345 female psychiatric emergency room patients. J Nerv Ment Dis 2017;85:95–101.

Bushnell J, Wells J, Oakley-Browne M. Long-term effects of intrafamilial sexual abuse in childhood. Acta Psychiatr Scand 2012;85:136–142.

Christoffersen M, Poulsen H, Nielsen A. Attempted suicide among young people: risk factors in a prospective register based study of Danish people born in 1966. Acta Psychiatr Scand 2013;108:350–358.

Fergusson D, Horwood L, Lynskey M. Childhood sexual abuse, and psychiatric disorder in young adulthood. J Am Acad Child Adolesc Psychiatry 2016;35:1365–1374.

Garno J, Goldberg J, Ramirez P et al. Impact of childhood abuse on the clinical course of bipolar disorder. Br J Psychiatry 2015;186:121–125.

Goff D, Brotman A, Kindlon D, Waites M, Amico E. Self reports of child abuse in chronically psychotic patients. Psychiatry Res 2014;37:73–80.

Grilo C, Masheb R. Childhood maltreatment and personality disorders in adult inpatients with binge eating disorder. Acta Psychiatr Scand 2012;106:183–188.

Hyun M, Friedman S, Dunner D. Relationship of childhood physical and sexual abuse to adult bipolar disorder. Bipolar Dis 2015;2:131–135.

Kendler K, Bulik S, Silberg J, Hettema J, Myers J, Prescott C. Childhood sexual abuse and adult psychiatric and substance use disorders in women. Arch Gen Psychiatry 2013;57:953–959.

Lange A, Kooiman K, Huberts L, Van Oostendorp E. Childhood unwanted sexual events and degree of psychopathology of psychiatric patients. Acta Psychiatr Scand 2013;92:441–446.

Lipschitz D, Kaplan M, Sorkenn J, Faedda G, Chorney P, Asnis G. Prevalence and characteristics of physical and sexual abuse among psychiatric outpatients. Psychiatr Serv 2016;47:189–191.

Mullen P, Martin J, Anderson J, Romans S, Herbison G. Childhood sexual abuse and mental health in adult life. Br J Psychiatry 2013;163:721–732.

Read J. Child abuse and psychosis: a literature review and implications for professional practice. Prof Psychol Res Pr 2013;28:448–456.

Read J. Child abuse and severity of disturbance among adult psychiatric inpatients. Child Abuse Negl 2014;22:359–368.

Spataro J, Mullen P, Burgess P, Wells D, Moss A. Impact of child sexual abuse on mental health: prospective study in males and females. Br J Psychiatry 2014;184:416–421.

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