According to the DSM-V, the overall symptoms of Schizophrenia include positive symptoms such as delusions (surreal beliefs), hallucinations (seeing or hearing things which are nonexistent), disorganized speech (impaired communication or answers to questions are unrelated), or catatonic or grossly disorganized behavior (a range of silliness to agitation and may include abnormal motor behavior) (American Psychiatric Association, 2013). Schizophrenia also includes negative symptoms such as avolition which includes diminished emotional expression, lack of eye contact, monotone speech, neglecting personal hygiene, social withdraw, etc.(American Psychiatric Association, 2013). According to the Mayo Clinic website, Schizophrenia occurs in men typically in early to mid twenties, in women in late twenties, but rarely in individuals after age forty-five (2014). Although rare,Schizophrenia has been founded in children as young as five years old (Mayo Clinic, 2014). Often times, it is difficult to diagnose teens because symptoms such as social withdraw, irritability, sleep disturbance, drop in grades, and lock of motivation are typical of development in teens (Mayo Clinic, 2014). The DSM-V declares two or more symptoms must be present for the majority of a one month period and one of the symptoms must be delusions, hallucinations, or disorganized speech (American Psychiatric Association, 2013). Level of functioning in one or more areas of life must have a marked decrease that lasts for at least six months and during one month symptoms must be present (American Psychiatric Association, 2013).
Violent behavior in individuals with Schizophrenia is sometimes witnessed when positive symptoms and depression present concurrently, but this only increases the chance of aggressive behavior (Hodgins, 2008). There tends to be a lack of aggression when the individual presents with singular psychosis, or positive symptoms (Hodgins, 2008). According to Hodgins study, aggressive behavior is associated with interpersonal skills or a lack of psycho-social functioning (2008). In her study, Hodgins found that predictors of aggressive behavior included past substance abuse and level of education as well as lack of anti-psychotic medications, depression, and victimization experiences (2008). In a psychiatric hospital setting individuals committed against their will tend to be more aggressive, however, in society, aggression is associated with thought disorder (Hodgins, 2008). This information leads me to believe that individuals are more likely to experience aggression at times when negative symptoms are present. During negative symptoms, individuals experience catatonia, disorganized behavior, and avolition. Avolition cases the individual to neglect themselves and create isolation from society, but their thoughts are disorganized and the individual may react without thinking because thoughts are all over the place. Popularly, people believe aggressive behavior is most persistent during delusions which is understandable, but only if the delusion is a negative one. For instance, another post referred to the individual acting on the desires of the voices.
Although I sympathize with forcing medication as a violation of rights, I do believe that enforcing medication when it is truly in the best interest of the individual is acceptable. The Answered Patient video claimed that individuals can recover from Schizophrenia after years of medication combined with psychotherapy and group support. Therefore, it is possible for the individual to rehabilitate and live a positive life, however, medication is necessary (2015). The video also claimed that Schizophrenia is controllable with medication (The Answered Patient, 2015). I believe that an individual who is not of a complete and sound mind is not able to decipher what is best for them. Their thoughts should be taken into consideration, but sometimes, someone is better suited to make the call. In a sense, I don’t feel that this is any different than a parent choosing medication for their child. The parent makes the choice because it is perceived as the best interest of the child who cannot make that decision for themselves. The same goes for an individual who is unable to maintain a solid though process based in reality.
Instructor: When you state that it is comparable as to a parent choosing medication for a child this negates that fact that an adult with schizophrenia is their own legal guardian. If we take away their right to choose medication, can we also take away their other rights and treat them as a child or ward of the state?
“If we take away their right to choose medication, can we also take away other rights and treat them as a child or ward of the state?” Forcing medication does not necessarily ensure taking away rights or alter their treatment, per say. According to the “Treatment Advocacy Center”, there are several options for individuals with severe mental illness, all of which have documented improvement in the individuals behavior and compliance with medication (2014). Although the individuals are ward of the state or under some type of guardianship, they maintain their rights as an independent adult. For instance, Assisted Outpatient Treatment court mandates an individual to comply with an outpatient treatment plan such as California’s Laura’s Law and New York’s Kendra’s Law, or the individual is returned to the hospital (“Treatment Advocacy Center”, 2014). Conditional Release court mandates that an individual must take their medication or they return to the hospital (“Treatment Advocacy Center”, 2014). Research conducted on the outcomes of both programs indicates an increase in compliance and a decrease in negative behavior, incarceration, victimization, and violent episodes (“Treatment Advocacy Center”, 2014). Additionally, a study conducted in Australia using the “ward of state” conditional release medication enforcement indicated a 14% reduction in the death rate of those on conditional release (“Treatment Advocacy Center”, 2014). Everything above proves that forcing medication and rehabilitation services has the potential to produce a positive outcome for the individual without stripping the individual of their other rights. However, from what I gather, these options are implemented once and individual commits a crime, becomes a threat to themselves or others and after hospitalization, and minors. It seems as if these options (and there are several others listed on the website) were developed to ensure independent living and recovery from and “error” made while not medicated. I also believe it is a way to keep the individual from having to serve a jail sentence when acting “abnormally” due to a mental health issue. The infamous Stanford Prison Experiment, although unethical (personal opinion) exposed how rapidly incarceration could alter an individuals way of thinking in a short period (this just seemed appropriate here, but not trying to debate the experiment). If an individual suffers from a mental health issue/ illness/ disorder, the potential to heighten the symptoms is greatly increased especially in confinement. If the individual is sentenced to a jail / prison term, wouldn’t that set them up for failure or the potential of symptoms worsening throughout the course of confinement also setting them up to be forced medication because chances of them being sent to psych are probably high as well? If the individual is forced to medicate, chances of incarceration and hospitalization is greatly decreased and the individual has opportunity to complete an outpatient treatment program that holds promise for the future of the individual. A child who is ward of the state (at least in California) has the medications paid for by the state, even medications atypical of the child’s age and development group if deemed medically necessary to ensure “normal” functioning in education, social aspects, familial aspects, and work. Although it is difficult to get the medications and the process of filling is prolonged because the pharmacy has to jump through loops and work with the psychiatrist to have exact coding and diagnosis which is difficult when the psychiatrist is avoiding a definitive diagnosis. Although the examples are of individuals who are ward of the state, I found an article on the APA website which explains new hope for Schizophrenia which integrates psychosocial rehabilitation, or a model consisting of the combination of medication, maintenance, and stabilization , to teach those with schizophrenia self-sufficiency via work skills, social integration via coping techniques that lead them to rehabilitation in their illness (MacGuire, 2000). There is so much research I came across that claims the importance of medication in rehabilitation of Schizophrenia, it kind of seems as if all those who suffer should be forced the treatment programs because the outcome is so great versus no medications. That it just my though. Another thing tht stood out to me was that researchers found that many suffering do not have the knowledge necessary to understand Schizophrenia and perceive the illness as a doom or never ending battle (MacGuire, 2000) making me wonder.. if the knowledge is not there, how can the individual decide on a medication regimen?
Instructor: I agree that treatment can be beneficial, but I also recognize that the end can not always justify the means. I do not know if you are familiar with the clubhouse model?
MacGuire, P. A. (2000, February). New hope for people with schizophrenia. American Psychological Association, 31(2), 24. http://www.apa.org/monitor/feb00/schizophrenia.aspx
Treatment Advocacy Center. (2014). Retrieved from http://www.treatmentadvocacycenter.org/about-us/reports-studies-backgrounders/2530
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Hodgins, S. (2008, August 12). Violent behaviour among people with schizophrenia: a framework for investigations of causes, and effective treatment, and prevention. The Royal Society Publishing, 363(1503), 2505-2518. doi:10.1098/rstb.2008.0034
Mayo Clinic. (2014). Retrieved from http://www.mayoclinic.org/diseases-conditions/schizophrenia/basics/symptoms/con-20021077
The Answered Patient (2015 ). Schizophrenia overview [Video file]. Retrieved from BehaveNet.com website: http://behavenet.com/schizophrenia