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Young Adults Schizophrenia Bipolar Disorder

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Question:

Discuss About The Young Adults Schizophrenia Bipolar Disorder?

 

Answer:

Introduction

Community plays an important role in occupational programs that encompasses the schizophrenic and bipolar clients for independence and improved quality of life. Therefore, client-cantered programs and a community approach are required to restore and enhance the well-being and functioning of the clients (Craig, 2002). According to World Health Organization (WHO) schizophrenia is a severe and chronic mental disorder that is characterised by many disruptions in perception, thinking and lack of sense of self and affecting language. On the other hand, bipolar disorder is characterised by depressive and mood episodes that are separated by the periods of normal mood. There are irritable or depressive moods, pressure of speech, over-activity, decreased sleep and inflated self-esteem. These cognitive impairments in memory and executive functioning have direct implications on their quality of life in the social domain that leads to social exclusion and as a result, there is inhibition of occupational engagement.

Background and significance

Schizophrenia is a condition that is characterised by failure to distinguish the real and have abnormal social behaviour. The common symptoms are confused or unclear thinking, false beliefs, lack of motivation, hearing voices and reduction of social engagement. The genetic and environmental factors are the causes of schizophrenia. Along with the pharmacological interventions, psychosocial interventions are also required like assertive community engagement and family therapy. This condition is associated with social and psychological factors that have serious implications on their quality of life and social life (Frith, 2014).

On the other hand bipolar disorder is a maniac or depressive illness that causes unusual shifts in the energy, mood and their ability to perform the day to day activities. There are many risk factors that contribute to bipolar disorder like brain structure and functioning, genetics and family history.

There are candidate genes and chromosomal regions that are related to the disorder. Abnormal brain structure and functioning like abnormal modulation in the limbic regions and ventral frontal regions. Other reports indicate that environmental factors also predispose to bipolar disorder like abusive or traumatic childhood experiences that increase the suicidal attempts and onset of stage. The Dopamine hypothesis explains that the dopamine increase results in the down regulation of secondary homeostatic receptors and systems and G-protein couple receptors that are dopamine mediated. The decrease in the volume of the certain areas of the hippocampus that deals with the memory processing is the pathophysiology of bipolar disorder (Dimeff& Linehan, 2001).

 

Literature Review

Bipolar disorder and schizophrenia is a condition that presents a spectrum of challenges when it comes to diagnosis as well as treatment. Studies show that there is need for occupational therapy to supplement as well as optimize the benefits of the medication. However, clinicians and researchers recognise that the quality of life outcome is as essential as clinical result to successful treatment of schizophrenia and bipolar disorder. Also, literature shows that occupational therapist interventions benefit schizophrenia patients as well as have the ability to significantly improve their social functioning plus reduce substantial social costs of the illness. The rationale for this proposal is to provide a safe place for young adults with schizophrenia and mental disorder to express themselves as well as learn new skills and socialize. It explains how the proposal is supposed to be carried out and obtain results.

Societal Issues and Implications Associated with Schizophrenia & Mental Disorder

Schizophrenia and bipolar disorders have associated social and psychological issues that have serious implications on their quality of life. There is dependency of social outcomes in individuals with these conditions on the societal context. The main characteristic of schizophrenia and bipolar disorder is social functioning impairment. There is deterioration in the social relations that leads to social isolation and withdrawal which are the main social problems faced by a schizophrenic or bipolar clients. These social deficits give rise to social consequences like stigma, social isolation and problems in the family relationships. This social exclusion results in unemployment that has an effect on their treatment and social engagement. There are social implications of schizophrenia like poor social judgment in the social situations (Australian & New Zealand College of Bipolar Disorder, 2016).

Alienation; According to Brent et al., (2014) the social impairment and premorbid development is associated with these mental disorders.

Divergent thinking; It is a presentation of psychosis where the individual finds a way to solve problems through many possible solutions in an effort to find the working solution.

Social judgment; It is characterised by the paramount and essential battle that ameliorates the stigma effects and the consequences of the societal attitudes that are the reactions to these mental disorders unintended and hapless nonconformity. The poor social judgment leads to poor negotiations in the social relationships and inability to understand the others viewpoints and lose social contact with the material world.

Psychological Issues

The delusions and hallucinations, disorganised speech, lack of mood and repetition of speech or movement are the cluster of psychological issues that are caused due to these mental disorders. However, gradual progression of these symptoms severely affects the social life and they try to withdraw themselves from the social life due to exhibition of inappropriate mood that makes the social relationships difficult. These consequences lead to joblessness and there is social disengagement and in community participation.  Therefore, there is a need for community participation and programming that is lacking in the system to help these individuals living with the disorder (Niv et al., 2014).

Identification of Needs for the Clients

There are unmet needs of these individuals and need for community based programs that are devoted to the economic and psychosocial needs where they face economic difficulties and lack of community care. Some of the unmet psychosocial needs find their way to the reinforcement of these individuals and in improving their quality of life. Many people are not familiar with these mental health disorders and consider them to be subjects of violence and different from the general population. There is discrimination and stigma that restricts these individuals in availing the healthcare services and options for employment. Therefore, there are many community-based occupational programs and public health initiatives that are being implemented in many regions of the country to include these individuals into the mainstream (Pitschel-Walz et al., 2015).There is less acceptance and lack of awareness and understanding of the prevailing mental disorders in the community.

 

Ongoing Occupational Program in Australia

The Occupational Therapy Practice Framework (OTPF) was developed with an aim to define and guide occupational therapists. There is reference to specific models that articulate occupational programs to improve the quality of life for people living with these mental disorders (Mulligan et al., 2014). For example, Mind, Australia is one of the country’s leading community-based mental health services that support people who are dealing with daily struggles due to the mental illness implications over 40 years. They provide healthcare services and motivational support to these individuals and offer social connection through group activities (Brady et al., 2017).

Methodology

  1. Community-Based Occupational Program Plan

For the development of a community-based occupational plan, the occupational therapists play an important role in selecting activities and occupations that would help to achieve the desired needs of client (Hagedorn, 2000). Firstly, there is interaction between the occupational therapists with the clients to take note of their environmental and social context and decide on occupations that are suited to the client. A program desired to meet a variety of interests to accommodate many clients. Creative Arts for Creative Minds is a performing arts group exclusive to clients with a mental disorder. This step requires understanding of the dynamic and complex client factors, performance patterns, skills and activity demands. The plan would also decide on the aspects that influence the clients and evaluate the performances of the clients that would support their occupational performance.

  1. Service Delivery Models

The service delivery model would help provide direct services to the clients in a community setting. For this, direct contact with the clients is important through meetings, group session and through telehealth systems (Young, Klosko&Weishaar, 2003). Providing a service called Creative Arts for Creative Minds would provide clients with the opportunity to socialise with others diagnosed with a mental illness and schizophrenia. It is a space to express oneself through drama and role playing. There is also opportunity for parents/carers to meet up as a means of support. Next step would be to decide the advocacy that can directly affect the lives of the clients that include transportation required for the people with physical or mental disabilities so that it can support their living and also work in the community.

  1. Finding the Occupational Profile

Using a client-centered approach would be necessary to gather information and understanding of the cultural background along with the identification of the interests and past experiences of the client (Sundsteigen, Eklund & Dahlin-Ivanoff, 2009).   For example, occupational plan helps to identify the individual interests. Creative Arts for Creative Minds as mentioned above offers a variety of opportunities to participate in different areas of theatre. Clients whether extroverts or introverts can choose to be in the limelight or behind the scenes. (E.g. the sound desk for the “tech savvy” as well as props and costumes)

Procedure

  1. Principles of group behaviour change

Some of the principles of group behaviour change would be to create an atmosphere of trust, value the experiential knowledge, belief that change is possible, interactions construct knowledge. Also, the behaviour change proceed from action to reflection and again back to action and in the acquisition of knowledge where people acts as the active participants. Others include democratic decision-making and sharing of life-experiences. Critical thinking has the ability to develop the critical consciousness and then perform actions.

Ideally, the service delivery model mentioned above would be a procedural way to access the client to use Bandura’s self efficacy as a form of measurement for satisfaction as explained below.

Bandura’s self-efficacy

Vicarious experience refers to when a person hear the experiences of others and learn from them. Social persuasion is where a person imitate others reactions. Physiological reactions that includes normalization of the reactions and the physiological response management. Mastery experience includes the positive and successful feedback from the leader and group for reinforcing the belief that a person is able to manage a task successfully.

 

Occupations for the clients with mental illness disorder

Self-Care; Clients need assistance in practicing healthy behaviours such as weight-control and exercise.

Activities of Daily Living (ADL); Functional independence is required for them to perform ADL as it is the foundation of a successful recovery. The activities like brushing, cleaning, bathing require ADL skills that provide them a sense of independence.

Leisure; Taking participation in leisure activities is important for their health, active living and in improving their quality of life.

Work; They require means of employment to live a life of independence and live their life in a meaningful way.

Sleep/Rest; These individuals require proper sleep and rest as there is sleep-rest disruption experienced by the clients.

Social Participation; They have social adaptation issues and require inclusion into the social events in their spheres of life.  

However, these occupations can be linked to Model for Human Occupation (MOHO) domains as it provides client-centered programs that take into account the mind and body that complement the theories of occupational therapy (Jonsson, 2008).

Some of the resources include ADL scales, sensory testing, assistive devices that evaluate the work, ADL and leisure skills, knowledge skills. Also, community resources like park, open spaces and neighbourhood mobility support the individuals.

Experienced and certified staff; Information for the family members and carers regarding the undertaking of the activities, strategies and equipment that promotes independence and support among these individuals

Timing; The activities like physical exercise, group activities can be performed during the daytime. Leisure activities can be performed during the evening time as it would provide them relaxation and promote the life skills. Self-care and ADL activities should be scheduled according to the clients’ preferences and timings to perform the ADL. Creative Arts for Creative Minds would meet once a week for two hours. It could run according to the school terms so goals could be established and achieved within a timeframe. For example, the beginning of each school term would start fresh with new ideas, allowing people to join the group at any time.

Venue; I have chosen Lind Lane Theatre in Nambour due to the location being central on the Sunshine Coast. The website is www.lindlane.com.au. The theatre can be hired out and the price is negotiated as discounts may apply dependent on the organisation. A basic hire gives access to Front of House area, stage, wings, green room, loading dock & SM Desk.

Occupational therapists create goals that assist the individuals in self-care, play and work. Role playing and understanding emotional self-regulation is one of the primary goals. Second is encouraging integration into society. Whilst the group is exclusive to those with a mental illness diagnoses, there is opportunity to participate in mainstream theatre. There are a number of performing art groups on the coast that hold auditions if the clients are confident. Third is to assist clients in learning to perform new tasks according to their desires (Shimada et al., 2016). Depending on client interest, there are several areas in theatre where one could learn new skills and develop confidence and possibly lead to work opportunities. Being able to work in a group, share ideas and thoughts is another program goal where the occupational therapist should accept constructive criticism and be able to change or adapt.

Short term goals; These are designed to help the clients enjoy success and work towards goals to be achieved in few weeks or months.

Long-term goals; They are performed when the clients are able to finally reach the ultimate goals where they would be able to live life independently and learn to live with the disability.

Program Activities; These activities are designed according to the capability and preferences of the clients. They include writing Storylines/plays/poems, acting/role playing, creating props/art & craft, sound & lighting desk/computers and making costumes/sewing

Participant Recruitment; The recruitment of the participants is a challenging task. However, referrals would be the most effective way to gather clients together, either through GP’s or psychologists or psychiatrists.

Model of Human Occupation (MOHO)

It involves human occupation that is being influenced by volition, habituation and performance aspects and the environment. It motivates the person’s values, interests and belief in the skill. Habituation helps a person to understand their role in their lives, pattern of behaviour, routine and rules in life. It provides a framework for holistic and client-centered model where they include the cognitive, motor and emotional skills within the environment that influences their occupation in social and physical forms.

Occupational Performance Model (Australia)

This model establishes the relationship between the human and environment and how the occupations affect their social relationships in their lifetime. There are eight major constructs in the theoretical structure that includes occupational performance, performance roles, occupational roles, space, time and environment. The therapist aims to fulfil these barriers and enablers that the person may face and is greatly guided by the outcomes (Josephine Durkin PhD, 2014).

 

Person-Environment Occupation (PEO) Model

This model has three components that help to describe the activities that a person performs in their daily life, their motivations and the influence of the personal characteristics that combine with the occupations that they undertake and influence their performance. This model states that the people through these occupations can develop their self-identity and a sense of satisfaction and fulfilment so that they understand their identity and have a place in the society and environment (Bass, Baum & Christiansen, 2017).

This model explains the overall strategies, purposes and the interpretation of the client’s circumstances that clarify the aims and occupational therapy application within the cultural and social context of the client (Mattila &Dolhi, 2016).

Client-centered approach to occupational interventions

There is client-centered way of thinking which emphasize on the understanding and active listening and in developing a healthy client-therapist relationship for successful outcomes. This is a partnership between the therapist and client that would help to empower the clients to get engaged in the functional performance and also aid in fulfilling their occupational roles in variety of settings and environment. The clients act as the centre of the interventions that helps to prioritize the goals that are client-centered. This approach also helps the therapists to listen to and respect the values and needs of the clients to make them adaptive to the interventions and in making informed decisions. This would also help to enable the clients to gain control over their situations and progress towards achievement of the goals (Csikszentmihalyi, 2002). This would also help to make the clients have an active participation in the decision-making and negotiation in the making of goals and priority given to the clients for assessment, evaluation and interventions (Gunnarsson& Eklund, 2009).

The therapists provide pertinent information to the clients regarding the intervention goals, perspectives and wishes to assess the knowledge about the program and for its positive outcomes.

Outcomes of occupational programs

Some of the outcomes of occupational programs are; to identify the client-centered occupational goals, to help them assist with ADL’s (Activities of Daily Living), to help them become socially engaged and promote a good quality of life and lastly to assist them maintain a fulfilling life with the disability

Conclusion

Community plays an important role in these occupational programs that encompasses the schizophrenic and bipolar patients to make them independent and improve their quality of life. Schizophrenia and bipolar disorders have associated social and psychological issues that have serious implications on their quality of life. There is dependency of social outcomes in individuals with these conditions on the societal context. Community-based Occupational Program Plan provides understanding of the dynamic and complex client factors, performance patterns, skills and activity demands. The plan would also decide on the aspects that influence the clients and evaluate the performances of the clients that would support their occupational performance. Model of Human Occupation (MOHO) is influenced by volition, habituation and performance aspects and the environment. It motivates the person’s values, interests and belief in the skill. Therefore, community-based occupational based programs are beneficial for the people living with schizophrenia and bipolar disorder to improve their life and enhance social inclusion.

 

References

Australian, R., & New Zealand College of Psychiatrists Clinical Practice Guidelines Team for Bipolar Disorder. (2016). Australian and New Zealand clinical practice guidelines for the treatment of bipolar disorder. Australian & New Zealand Journal of Psychiatry.

Bass, J. D., Baum, C. M., & Christiansen, C. H. (2017). Person-Environment-Occupation-Performance Model. Perspectives on Human Occupations: Theories Underlying Practice, 161.

Boehm, J., Cordier, R., Thomas, Y., Tanner, B., &Salata, K. (2015). The first year experience of occupational therapy students at an Australian regional university: promoting student retention and developing a regional and remote workforce. Australian Journal of Rural Health.

Brady, N. S., Spittal, M. J., Brophy, L. M., & Harvey, C. A. (2017). Patients’ Experiences of Restrictive Interventions in Australia: Findings From the 2010 Australian Survey of Psychosis. Psychiatric Services, appi-ps.

Brent, B. K., Seidman, L. J., Thermenos, H. W., Holt, D. J., &Keshavan, M. S. (2014). Self-disturbances as a possible premorbid indicator of schizophrenia risk: A neurodevelopmental perspective. Schizophrenia research, 152(1), 73-80.

Caddy, L., Crawford, F., & Page, A. C. (2012). ‘Painting a path to wellness’: correlations between participating in a creative activity group and improved measured mental health outcome. Journal of psychiatric and mental health nursing, 19(4), 327-333.

Craig, A. D. (2002). How do you feel? Interoception: the sense of the physiological condition of the body. Nature reviews neuroscience, 3(8), 655-666.

Csikszentmihalyi, M. (2002). Flow: The classic work on how to achieve happiness. Random House.

Dimeff, L., & Linehan, M. (2001). Dialectical behavior therapy in a nutshell. The California Psychologist, 34, 10-13. Psychological Science, 18(3), 233-239.

Frith, C. D. (2014). The cognitive neuropsychology of schizophrenia. Psychology Press.

Gunnarsson, A. B., & Eklund, M. (2009). The Tree Theme Method as an intervention in psychosocial occupational therapy: Client acceptability and outcomes. Australian occupational therapy journal, 56(3), 167-176.

Hagedorn, R. (2000). Tools for practice in occupational therapy: a structured approach to core skills and processes. Churchill Livingstone.

Jonsson, H. (2008). A new direction in the conceptualization and categorization of occupation. Journal of Occupational Science, 15(1), 3-8.

Josephine Durkin PhD, D. (2014). Assessment of learning powered mobility use-Applying grounded theory to occupational performance. Journal of rehabilitation research and development, 51(6), 963.

Martin, P., Kumar, S., Lizarondo, L., &VanErp, A. (2015). Enablers of and barriers to high quality clinical supervision among occupational therapists across Queensland in Australia: findings from a qualitative study. BMC health services research, 15(1), 413.

Mattila, A. M., &Dolhi, C. (2016). Transformative Experience of Master of Occupational Therapy Students in a Non-traditional Fieldwork Setting. Occupational Therapy in Mental Health, 32(1), 16-31.

Mulligan, S., White, B. P., &Arthanat, S. (2014). An examination of occupation-based, client-centered, evidence-based occupational therapy practices in New Hampshire. OTJR: occupation, participation and health, 34(2), 106-116.

Niv, N., Cohen, A. N., Hamilton, A., Reist, C., & Young, A. S. (2014). Effectiveness of a psychosocial weight management program for individuals with schizophrenia. The journal of behavioral health services & research, 41(3), 370-380.

Pitschel-Walz, G., Leucht, S., Bäuml, J., Kissling, W., & Engel, R. R. (2015). The effect of family interventions on relapse and rehospitalization in schizophrenia: a meta-analysis. Focus.

Rouse, J., & Hitch, D. (2014). Occupational therapy led activity based group interventions for young people with mental illness: A literature review. New Zealand Journal of Occupational Therapy, 61(2), 58.

Schwarzer, R. (2014). Self-efficacy: Thought control of action. Taylor & Francis.

Shimada, T., Nishi, A., Yoshida, T., Tanaka, S., & Kobayashi, M. (2016). Development of an Individualized Occupational Therapy Programme and its Effects on the Neurocognition, Symptoms and Social Functioning of Patients with Schizophrenia. Occupational Therapy International, 23(4), 425-435.

Sundsteigen, B., Eklund, K., &Dahlin-Ivanoff, S. (2009). Patients' experience of groups in outpatient mental health services and its significance for daily occupations. Scandinavian Journal of Occupational Therapy, 16(3), 172-180.

Young, J. E., Klosko, J. S., &Weishaar, M. E. (2003). Schema therapy: A practitioner's guide. Guilford Press.

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