MHRT/C Portfolio Lesson

Etiology and Treatment of Mental Illness and Co-occurring Medical Conditions

Attention

Individuals with Mental Illness are challenged with the fact that the course of treatment of these conditions is not always linear, that different treatments will not work for different people, and that they can be complicated by co-occurring medical (or other mental) conditions. This adds a tremendous level of complexity to the treatment of mental illness that case managers often need to explain and manage with their clients.

Learning Outcomes

Upon completion of this lesson's material, students will be able to:

• Knowledge about etiology, progression, and treatment of major disabling conditions.
• Understands interaction of co-occurring medical issues.
• Understands role of medication in symptom management.

Teaching

With the Supreme Court in a 6 to 3 vote, the Affordable Care Act remains in effect. From its inception several years ago, the Federally Affordable Health Care Act (FAHCA) was a political flashpoint on many levels. Without knowing directly, it was estimated that when it became fully effective, i.e., people who were required to enrolled, it could save some 15 to 18 billion dollars in health expenditures over the next 5 to 10 years. Those were hypothesized to be savings based on screening for and active management of health risks before they became catastrophic personally and financially.

When I think about disabling conditions, poverty and economics always cross paths. Whether disease is physical, or, psychological, impaired function follows. The model that has dominated the field in based on a disease assumption. Illness starts with some toxic exposure, Ebola for example, or, behavioral risk, smoking tobacco products or use of alcoholic beverages.

Medical Model of Disorders

In considering this model, etiology begins with a causal factor. However, many illnesses have no clear or known onset mechanism. My question to you is then how to implement a plan for prevention, or, ongoing care without knowing the disease trigger. The etiology continues with the client seeking medical intervention and diagnosis. This implies that an outcome, or, progression is predictable. Treatment would then address the biology, physiology, and genetics of the disease. Treatment would either cure, or, maintain client health to the degree possible.

Here is a TED talk about how we need to reframe Mental Disorder as "Brain Disorder"

The disease model also assumes client recognition of a symptom will result in seeking intervention and treatment. The question however is what would be a symptom for someone who has never really known good health and its management. Poverty and mental health challenges create a cycle of physical illness, whether based on inability to travel for diagnostic consultation, fulfilling a prescription for medication, or even enlisting the client's willingness or ability to translate disabling conditions into correctable outcomes.

The Role of Medication

Psychiatry has mercifully stopped some procedures in terms of symptom management that were fairly widespread until only 40 or fifty years age. The prefrontal lobotomy has all but ceased to exist. However, in its heyday, it was the go procedure for managing serious psychiatric disorder. Then, in the 1950's, the phenothiazines, or major tranquilizers came along. These were designed not so much to cure, but, to manage the positive, i.e., acting out aspects of psychosis. Fill in what you wish here. Could be schizophrenia, could be anti-social personality disorder, and, sometimes was the management of choice by parents for children who seemed "out of control." With virtually no controlled study to speak of, thousands of people were lobotomized in the United State. It even became on office procedure. No need for hospitalization, and so on. Even electro-convulsive therapy was widely used for symptoms that today would NOT qualify for such intervention.

What you may not know is that from inception of a potential medication, be it psychiatric of otherwise physical medicine, it routinely takes 9 to 12 years to achieve Food and Drug Administration approval. Compassionate reasons also exist to fast-track a drug IF it seems gains might outweigh the losses substantially, thus foregoing some of the hoops pharmaceutical companies have to jump through. However, you need to know that there is more than ample evidence that psychiatric medication can injure, or kill a client. While tardive dyskinesia was thought to resolve itself on drug cessation, that has not proven to be true. The symptoms looks strikingly like Parkinsonism. Dopamine was thought to be the culprit in schizophrenia, therefore, damp down its activity, and voila, cure. When I taught for many, many years in New York State at psychiatric hospitals, students taking various basic psychology courses, I was frequently asked about what I thought or knew about psychiatric medication. Many students noticed a degradation of some behavior when patients were medicated. True, some of the positive symptoms declined, but the negative ones were apparent.

A medication of choice for schizophrenia, Clozaril, trade name, clozapine chemical designation, can trigger seizures, and, a deterioration of immune system function. If the physician's motto is "Do No Harm," there is a conflict of interest here. Help or harm who, and, under what circumstances. In 1974, posthumously, Alan Turing was pardoned by the British government for his sexual orientation. Never mind that he committed suicide because his medication was designed to "reduce" his libido. It impacted on his sense of self and identity. His life quality was diminished. Absolutely terrifying. While we can look on in retrospect and say we now know better, is that really true?

Assessment

Assignment

In order to demonstrate understanding of these issues, select a significant disabling mental health condition. Be aware that symptoms can be both positive and negative. "Positive Symptoms" are qualities or behaviors that support the diagnosis when they are PRESENT (such as the presence of hallucinations supporting the diagnosis of schizophrenia). "Negative Symptoms" are qualities or behaviors that support the diagnosis when they are ABSENT (such as motivation or good personal hygiene supporting the diagnosis of depression).

Utilize the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) to gather this information on the diagnosis. In addition, locate at least one peer reviewed article that discusses the treatment of the specific diagnosis.

Tell a story here about a significant disabling condition from onset and origin, to progression, to treatment. Even though the outcome may be disabling, it is still an outcome. Even if treated, some disease processes will not go away.

In your paper cover the following points:

• Identify the etiology, progression, and treatment of your selected mental illness.
• Identify the potential impact of a co-occurring medical issue (diabetes, high blood pressure, cancer, etc.) on the course of treatment.
• Identify any medications and their use in managing the symptoms of the selected mental illness.

Your paper must be submitted electronically to the drop box and should have a title page.

Organize your paper according to the bullet point outline above with bold title headings so that you ensure that you cover all the required elements.