Stages of Developing a Psychiatric Treatment Care Plan

Stages of Developing a Psychiatric Treatment Care Plan A patient had been admitted to an A E unit after committing ‘deliberate self-harm’. He had attempted to commit suicide by overdosing on some headache tablets. When that hadn’t worked he slashed himself in several places using a kitchen knife. He arrived at the A E unit in an extremely distressed state. Why the psychologist was called in Although the patient clearly had very severe physical injuries a comprehensive psychosocial assessment revealed he was suffering from severe psychological problems. His symptoms seemed to suggest clinical depression that was so deep-rooted and severe it necessitated intensive and sustained psychotherapy. Thus, it was decided to immediately refer him to a clinical psychologist. This is consistent with professional guidelines, which recommend that self-harm patients are referred for psychological intervention if an initial psychosocial assessment reveals an underlying psychological problem (NICE, 2004, p.32). A clinical psychologist is formally trained to deal with various forms of psychopathology, including clinical depression, based on psychological theories and research (Davey, 2004, pp.713-714). In addition to carrying out in-depth psychological evaluations, to identify underlying psychopathology (using a wide variety of personality and neuropsychological tests, and clinical observ ation), the psychologist is trained to make a formal diagnosis, using set criteria. Clinical psychologists and psychiatrists have very similar training. However a clinical psychologist rather than psychiatrist was called in to deal with this case because the latter are primarily medical doctors, and hence typically use the ‘medical model’ for dealing with psychological disorders. Psychosocial assessment suggested that this patient primarily required intensive psychotherapy rather than medication. Theoretical concepts The clinical psychologist relied upon Sigmund Freud’s psychoanalytic theory in formulating a treatment plan (McMillan, 2001, pp.599-600). Freud’s conceptualisations have had a massive impact on popular culture, and psychology and psychiatry in particular. Psychoanalytic theory posits that unconscious conflict, often emanating from childhood, and involving forbidden sexual and aggressive desires causes psychopathology. A distinction is made between the conscious (awareness), preconscious (memories that are readily accessible), and unconscious (repressed memories of which a person may not even be aware). Superimposed against these levels of consciousness are three components of human personality: the id (basic biological drives), the ego (restrictions imposed by external reality), and superego (conscience). The id operates at the subconscious level, while the ego and superego function at the preconscious and conscious levels. Perpetual and intense conflicts between the id and the other two components can generate considerable anxiety and, if unresolved, mental health problems. Psychoanalysis places considerable emphasis on the sex drive, or ‘libido’. Humans are thought to progress through several stages of psychosexual development. Fixation at any one stage results in various emotional problems. What the psychologist did During the initial session with the patient the clinical psychologist immediately set up a good rapport with the patient. The priority was to assess the patients’ problem, and develop a comprehensive treatment plan with clear goals for recovery. After an initial session the patient underwent numerous sessions involving free association, a therapeutic form of psychoanalysis (McMillan, 2001, pp.167-168). During this procedure, the psychologist encouraged the patient to verbalise whatever came to mind. Free association is considered to yield clues about the subconscious roots of a patients’ problem. The patient spoke a lot about his childhood. From time to time the therapist probed with searching questions encouraging the patient to elaborate on particular statements made. During each session the psychotherapist maintained an empathic and non-judgemental demeanour, in order to facilitate a high degree of trust between himself and the patient. The patient attended weekly se ssions over a six-month period. During the final month of therapy the clinician engaged in dream analysis, whereby the patient was asked to describe recent dreams in as much detail and with as much accuracy as possible. How the psychologists’ input was assessed By the end of therapy it had gradually become clear that the patient had been experiencing intense homosexual desires ever since puberty. These urges had been repressed for years, in order to conform to social norms and his parents’ wishes for him to get married and have children. The patient wasn’t conscious of these forbidden desires. The realisation made him feel much better, going a long way to explain why he had been feeling pathologically depressed, even suicidal. The impact of psychoanalytic therapy on this patient was assessed using a pre- and post-test experimental analysis (Coolican, 1994, pp.82-88). During his initial assessment of the patient the psychologist obtained baseline measures of psychiatric symptoms using the SCL-90-R (Derogatis, 1983), social functioning using the Social Adjustment Scale (Weissman, 1975), general adjustment in life, using the Global Assessment Scale (Endicott et al, 1976), and episodes of self-harm, using the Suicide and Self-Harm Inventory (Sansone et al, 1998) during the previous six months. At the end of therapy the therapist administered the same battery of tests to gauge any improvements in the patients’ mental health. Statistical analysis comparing pre- and post-test data, using a t-tested for repeated measures (Coolican, 1994, pp.281-286) showed significant improvements on all criteria: psychiatric functioning, and social/global adjustment, and frequency of self-harm. Bibliography Coolican, H. (1994) Research Methods and Statistics in Psychology, London, Hodder Davey, G. (ed) (2004) Complete Psychology . London: Hodder and Stoughton Derogatis, L.R. (1983) SCL-90-R: Administration, Scoring, and Procedures Manual,  II. Towson, Md, Clinical Psychometric Research. Endicott, J., Spitzer, R.L., Fleiss, J.L. Cohen, J. (1976) The Global Assessment  Scale: a procedure for measuring overall severity of psychiatric disturbance.  Archives of General Psychiatry, 33, pp.766–771. NICE (2004) Self-Harm: The Short-Term Physical and Psychological Management  and Secondary Prevention of Self-Harm in Primary and Secondary Care:  Clinical Guideline 16. London: National Institute for Clinical Excellence. McMillan, M. (2001) The reliability and validity of Freud’s methods of free  association and interpretation. Psychological Inquiry, 3, pp. 167-175. Sansone, R.A., Wiederman, M.W. Sansone, L.A. (1998) The Self-Harm Inventory  (SHI): development of a scale for identifying self-destructive behaviors and  borderline personality disorder. Journal of Clinical Psychology, 54, pp.973-983. Weissman, M.M. (1975) The assessment of social adjustment. Archives of General  Psychiatry, 32, pp.357–365.

No Link Between Autism and Vaccination

According to the World Health Organization and the American Psychological Association, autism is a developmental disability, manifesting itself before the age of three, and resulting from a disorder of the central nervous system.   The developmental disability is diagnosed with the use of specific criteria for impairments in the areas of communication, basic social interaction, the interests of affected individuals, and their imagination as well as activities.   Autistic children are known to be slow at basic processes like language acquisition that healthy children are known to learn quickly (â€Å"Autism†). The causes of autism are controversial, which is why it is possible for people to formulate a host of theories on the causes of this developmental disability (â€Å"Autism†).   A British study published in February 1998 was misinterpreted by countless people who believed that the data provided proof that the measles, mumps, rubella (MMR) vaccine was responsible for autism in children.   The study was conducted by a team of thirteen scientists with Dr. Andrew Wakefield of Oxford University as the team leader. After it was discovered that parents had begun to fear the MMR vaccine because a debate had been waged with regards to the data presented in their study, ten of the thirteen authors of the study report made the following statement which was published on the BBC website: â€Å"We wish to make it clear that in this paper no causal link was established between MMR vaccine and autism, as the data were insufficient† (Jackson). The demand for vaccination fell in the United Kingdom after the data in the above mentioned study had been misunderstood, and the misinterpreted information had been publicized.   This meant that children could no longer be protected from measles, mumps, and rubella.   In point of  fact, it was found that a significant number of families had entirely given up on the idea of vaccination for their children. Some parents had opted for single vaccines rather than the MMR at the time, but health organizations and the UK government warned that even single vaccines put children at risk (Burke).   What is more, even some doctors in the United States had begun to believe that the MMR vaccination was responsible for autism.   Globalization had spread the rumor overseas.   According to Dr. Mary Megson from Virginia, The segment of children with â€Å"regressive autism,† the form where children develop normally for a period of time then lose skills and sink into autism, most commonly at 18-24 months of age, is increasing at a phenomenal rate.   I am seeing several children in the same family affected, including in the last week four cases of â€Å"autistic regression† developing in four-year-old children after their MMR and DPT vaccination.   In the past, this was unheard of. The doctor from Virginia advised that the implementation of safe vaccine policies should become a first priority, seeing that vaccination cannot be kept away from children (Megson).   The doctor had believed that there was definitely a link between autism and vaccination.   As a matter of fact, many doctors believed what Dr. Megson had believed.   This is because the link between MMR vaccination and autism was that of â€Å"coincidental-timing.†Ã‚   In other words, the symptoms of autism began to occur around the same time as the vaccination. Hence, parents began to falsely believe that the vaccine was indeed responsible for autism.   Dr. Ken Haller, who works as a primary care pediatrician with the Cardinal Glennon Children’s Hospital explained  the false belief thus: â€Å"When something terrible happens to a child, everyone wants a reason for it†¦Ã‚   As a physician, it's very difficult for me, when I see a kid who's diagnosed with autism or a seizure disorder, to say we have no idea why this happened.   But people want to grasp onto something; that's human nature. (Jackson)† The â€Å"insufficient† data in the study conducted by Dr. Wakefield and his colleagues could not find a link between autism and vaccination.   So, two different groups of investigators in the United States attempted to find out whether there was truly a link between autism and vaccination.   Dr. James A. Kaye and his colleagues at the Boston University used the United Kingdom General Practice Research Database to find out whether 254 boys suffering from autism in their study were actually suffering because of MMR vaccination. Dr. Loring Dales and her colleagues at the California Department of Health Services in Berkeley performed a similar study during the same time.   Both of these studies eventually showed that there is no link whatsoever between autism and vaccination.   The results of both of these studies actually showed that while the use of vaccination remained constant over time, the cases of autism increased dramatically among children without vaccination being responsible for the increase (Kubetin). Although it had already been clearly proven that there is definitely no link between autism and vaccination, the developed world where the debate on autism and vaccination had been waged was seeking a truly comprehensive study to show whether there really is a link between autism and vaccination, or not.   K. Madsen, A. Hvii, and M. Vestergaard report on exactly the kind of study that was being sought and finally conducted on Danish children: This is the most direct evaluation of whether MMR causes autism published to date. Though all epidemiological studies conducted in recent years have found no association between the MMR vaccine and onset of autism, design limitations have left some doubt about this issue.   This historical cohort included all Danish children born between 1991 and 1998 when prevalence rates for autism and autistic spectrum disorders were increasing.   Because of the thoroughness of the Danish system of registration, ascertainment of vaccination status and health problems was remarkably accurate and complete.   Since the cohort was composed of the entire population, both vaccinated and unvaccinated children had the same risk of autism prior to exposure to the vaccine.   Nearly all children were accounted for at the end of the study period.   Specialists using the same diagnostic classification system made the diagnosis of autism in a uniform manner. No doubt, this was the comprehensive study with ‘sufficient data’ that parents were seeking the results of.   The design of the study was virtually immaculate.   Most importantly, the study showed once again that there was no difference in the risk of autism in the children that were vaccinated verses those that were not vaccinated.   Moreover, the cases considered as part of the study were not clustered at any point after the immunization.   Madsen et al. report that the registry data that was used did not contain information on children that were suffering from developmental regression.   Hence, the issue that there might be children who show vulnerability to vaccination, could not be ruled out.   If there is a group of such children, the risk for vaccinated  children would be greater than 1.   However, the opposite turned out to be true – that is, there is definitely no risk of autism in children especially because of vaccination. Because the size of the sample of children studied was extraordinarily large, and there was no evidence to show that there is a link between autism and vaccination, Madsen et al. concluded that parents should fearlessly continue to vaccinate their children in order to avoid future outbreaks of disease.   Given that parents had previously only trusted false interpretations of the British study that had seemed to show a link between autism and vaccination, it is now time to give up the false belief entirely.   Science is based on real facts, which is why we all trust scientific information. We have been shown through several studies that there is certainly no link between autism and vaccination.   There have been more studies of the same kind with the same results that we have not discussed.   Future studies may similarly show that there is no link between autism and vaccination.   Even so, parents cannot keep their children from immunization waiting for future studies of the same kind, churning out the same results.   The future of children is at stake without vaccination.   The scientific evidence that has been found thus far is sufficient. Works Cited â€Å"Autism.† (2007). Wikipedia. Retrieved from http://en.wikipedia.org/wiki/Autism. (4 April 2007). Burke, Maria. â€Å"Every parent's choice? Autism and vaccination — the jury's out.† Chemistry and Industry (2002, February 18). Jackson, Harry Jr. â€Å"Debate on autism and vaccination started after British medical study.† St. Louis Post-Dispatch (2004, May 28). Kubetin, Sally Koch. â€Å"MMR Vaccination Not Tied to Rise in Autism Rate.† Clinical Psychiatry News (2001, July 1). Madson, K., A. Hvii, and M. Vestergaard. â€Å"There is little evidence that combined vaccination against measles, mumps, and rubella is associated with autism.† Evidence-Based Mental Health (2003, May 1). Megson, Mary. â€Å"Autism and Vaccinations.† The Weston A. Price Foundation (2004, March 16). Retrieved from http://www.westonaprice.org/children/index.html. (3 April 2007).         

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