Literature Review on Health Interventions

This assignment presents a collection of research articles on diverse health interventions. The papers cover a range of topics including motivational interviewing for addiction treatment, chemotherapy regimens for pancreatic cancer and leukemia, cognitive-behavioral therapy for stress management, targeted therapies for gastric cancer, and the side effects of anti-PD-1 immunotherapy. Students are tasked with analyzing these studies to understand the effectiveness and impact of different interventions in addressing various health challenges.

Case study with application of
MI and a therapy

TABLE OF CONTENTS
INTRODUCTION AND OBJECTIVES.........................................................................................1
CASE STUDY.................................................................................................................................1
CONCLUSION :..............................................................................................................................7
REFERENCES :..............................................................................................................................9

INTRODUCTION AND OBJECTIVES
Motivational interviewing is known as the clinical style which engages patients in
treatment and increases motivation in order to reduce substance use (Elsabahy, Heo & Wooley,
2015). Issues which are faced at the time of treating patients who are suffering mental illness and
concurrent problematic substance use are well recognized. The present research will provide a
case study of Eliza who is suffering from schizophrenia. The main aim is to investigate two
approaches which can be used while working with her and in the development of care plan. The
present research will focus on two approaches that motivational interviewing and cognitive
behaviour therapy. These both will be presented with a review of the literature with a view of
their application in this case (Zimmer, Goldinger & Hassel, 2016). In the entire literature, there
are different terms are used in order to refer the mental illness.
CASE STUDY
Elisa, a 28 year old working women was admitted to an acute psychiatric unit as she was
facing issues with increasing delusions and auditory hallucinations. From the past medical and
diagnosis reports it was identified that she has been suffered from schizophrenia at age of 18 and
has been using a poly-substance drug at age of 14. She oftens develop delusion when she was a
child that her uncle was sexually abusing her whenever she felt unwell. She got experience of
derogatory auditory hallucinations. When she got admitted to the hospital her appearance was
dishevelled, got irritated and infuriated at several times during medication and staff intervention.
She has refused all the staff and medical intervention and prefers to sit alone in isolation. Medics
contends that while giving her medication she often resists and keep shouting that her uncle used
to do same tricks while raping her. Elisa stated that she has been smoking marijuana (THC) daily
after a period of around 6 months of abstinence. From the drug urine analysis it was identified
that what she stated was true as only THC drug was identified. From the interrogation, it was
discovered old friend of her offers her joint at music concert. Since then she got addicted to the
marijuana. As the delusional intensity got decreased in Elisa she was transferred to the Low
Dependency Unit (LDU) after 15 days. After the transfer, her food intake got improved and she
sleep more peacefully. Furthermore, she responds to health care professionals more politely and
efficiently. It was identified that she was participating in co-curricular activities including art and

dance therapy. She prefer to spend large amount of time dancing and singing in her room. After
four weeks at hospital she elucidated that she has been suffering from prolonged mental illness
and medication would not be able to help her. She said that THC was best drug to reduce her
psychological distress and helps her by making more creative and innovative. She further
connotes that the medication given to her (amisulpride) was precise but it gave her less energy.
She like to volunteering at community centres especially at times of abstinence. She reported that
longest period of abstinence of 6 months. During this time she volunteered at different
community centres in order to get rejuvenated. Elisa was found of art and dance and she
expressed her area of interest in dance and desire to study it efficiently. It was identified that she
has participated in various official events and community programmes. Elisa stated that her
desire to study art and dance therapy got demolished due to frequent admissions in hospitals.
Elisa further stated that she had few colleagues as her friends. Her relationship with mother was
efficient and they love to spend time with each other. Due to frequent delusions and auditory
hallucinations, she described that the relationship become stressed. Elisa suffered from
psychological disorder which converts her healthy living life into terrible miserly
Motivational Interviewing
At the time of non-adherence to recommended medicines remains the fundamental driver
of psychotic relapse in service users who are suffering from schizophrenia, THC utilize is related
with expanded recurrence and length of hospitalization and for the most part poorer results.
Rollnick, Miller and Aloia (2008) recommended that motivational interviewing focused on self-
identification of motivation and cognitive behaviour is one of the beneficial counselling
approaches that help in measuring service user with dual diagnosis. Along with this, motivational
interviewing focus on the patients own concerns related to behaviour, their aim, purpose and the
significance of taking responsibility for their own action and choices. Levounis, Arnaout and
Marienfeld, (2017) state that with the help of self identification of these factors a healthcare
professional can easily accomplish its long term results. With the systematic use of MI it can
become easy to determine the process and a key segment of the trans-hypothetical model, that
spotlights on behavioural change forms and also deciding availability and inspiration. However,
all the stages of change do not follow a systematic pattern especially in relation to substance

users and may include moving into one stage as before going back to the last stage in assessment.
But it used to identify intervention, attitudes of the service user and clinical decision making
(Rubak, Sandbæk and Christensen, 2005). It includes six stages of change that are determination,
contemplative, action, ambivalent maintenance and last was is a relapse.
The first stage is a pre-contemplative stage in which an individual who suffers from
schizophrenia do not want any type of changes in their behaviour (Miller, Yahne and Pirritano,
2004). In this situation, a therapist only focusses on raising awareness among patient related to
the current situation. In this stage implementation of the treatment plan is not right of the need of
change. Therefore, in this stage, an individual is aware of the problem and take into
consideration seriously the way it can be overcome within a fixed period of time (Tobacco,
2008). It is contrasted with the decision and preparation stage at the time when an individual has
a goal is to make a goal and intends of changing the behaviour in provided time. The action stage
organize demonstrates a plain change in behaviour among 1 day to a half year and the upkeep
arrange happens at the point when people effectively avert backslide and happens following a
half year (Rollnick, Miller and Aloia, 2008). The last stage is of relapse which shows that a
people started moving back to the cycle. The above-mentioned 1st three stages are appropriate
for Eliza which is based on provided information. However, to carry out further assessment it is
essential to use the motivational interviewing technique (Resnicow, McMaster and Hollinger,
2015).
MI is undertaken by four principles which help in providing effective care to the patient.
The first of these is the establishment of the therapeutic relationship that leads to incorporate
general relationship with which arise from expression of understanding of the situation from
which patient is suffering (Elwyn, Dehlendorf and Frosch, 2014). Changes can be made for them
through active listening and provide them all facility. Hence, with Eliza, a therapist need to the
made relationship as because it is considered as the first principle. Along with this, health care
professional need to adopt open questions, summarising which is a way to promote a healthy
working relationship. Along with this developing a inconsistency aims for helping the service
user in investigating their behaviour and it can conflict their beliefs and ideas.

Certification, as sketched out by Christie and Channon, ( 2014)is an imperative
methodology that would recognize this accomplishment. Elwyn, Dehlendorf and Frosch, (2014)
clarifies that MI procedures empower reasonable, achievable objective setting in connection to
substance utilize. Eliza states that THC makes her vibe more 'creative' regardless she has
moreover perceived strong circumstances where it's use has not been useful and furthermore she
has widely seen that it doesn't 'help' her. Supporting self-ampleness is the rest of the norms and
relates to the patient's own particular sureness that they can achieve changes, their competency to
change, joins recognizing confirmation of sponsorships anticipated that would do thusly and
propels tolerant commitment with respect to their change rather than the consultant. In regard to
achieving the objective, it is vital to centre around building an association with Eliza. She was
effortlessly proficient objectives already. Proof of this is she can without much of a stretch deal
with her charitable effort that aides in advancing self-adequacy (Levounis, Arnaout and
Marienfeld, 2017). Along with this her achievement at the time of admission that her participants
in a group program and song writing need to be provided positive feedback which will help in
building a confidence of Eliza. Hence, motivational interviewing is essential in respect to
develop understanding of problem from which patient is suffering and providing appropriate
treatment.
Cognitive behavioural theory for providing care
Cognitive behaviour therapy is a short term goal theory in which the main purpose is to
solve problem by identifying the behaviour of a person. It goal is to find out difficulties in
change in pattern of behaviour. It is developed for individuals to find out changes in eating
pattern. It includes a range of problems such as depression, anxiety, obsessive compulsive
disorder (OCD), etc. According to (Lee, Yoo & Cheon, 2015), for providing treatment of
dual diagnosis and stress an integrated approach is used. It includes programs such as
implementation of fundamentals for both psychiatric and substance use treatments. (Khera,
Saxena & Nasir, 2018), suggests that during schizophrenia diagnosis the substance can be used
because in schizophrenia negative symptoms are presented. Along with this, avolition and
cognitive impairment is presented in person. So these factors has to be considered while

providing treatment to Eliza. But in Eliza case it is seen that plan is related to issues of substance
and family relationship.
Cognitive behavioural therapy (CBT) is mostly used in approach in providing care. It
helps other to recognise their own pattern and thinking style in a particular situation. This
changes their behaviour and thoughts in a specific situation. It is been elucidated by (Hofmann,
Forschner & Hassel, 2016), that CBT can also be used with MI techniques to provide treatment
in dual diagnosis. In Eliza case MI technique can be used. It will help her to address her won
thoughts in relation to maladaptive thinking. It will help him to identify high risk situations that
can be either related to family or any other thing. Thus, by using MI technique Eliza will be able
to determine her goals. It is said by (Elsabahy, Heo & Wooley, 2015), that feeling of guilt and
failure may be related to relapse. This will lead to reduction in individual motivation and
changing its behaviour. Besides this, it will make them think that doing so it futile. The result of
relapse may lead to suicide or self harm as person is suffering from mental illness. In case of
Eliza open questions can be asked to identify her feelings on what was happening with her. Eliza
is already having attributes of smoking. This will not help her in the future. The feeling of guilt
can be created by making her realise about the consequences of smoking. Moreover, Marlatt and
Gordon social cognitive model of addiction can be used in this (Zimmer, Goldinger & Hassel,
2016) It shows that relapse as temporary lapse, that can be used in positive manner. By this new
learning or perspective can be gained.
In case of Eliza new learning can be related to increasing awareness of high risk
situations. In this new skills can be developed in order to handle high risk situations. If she is
allowed to explore and identify here old friends in music concert than it will be easy for her to
relapse prevention plan. It can be identified as a goal. Eliza describes that her new friends and
mother supports a lot in identifying high risk situations. Although they both are having different
type of relationship with her. As said by (Sandri, De Sanctis & Cesaro, 2017) the involvement
of family in providing dual diagnosis can be beneficial to a person. It helps in better outcomes
and lead to improve motivation among them. But, on the other hand it can lead to conflicts and
stress.

Apart from this, CBT techniques can be used in analysing Eliza relationship with her
mother. By this it will be easy to identify what situations lead Eliza to think that her mother was
over protective. Also, how these situations has a great impact on her behaviour. (Nomoto,
Fukushima & Kishimura, 2016), elucidated that family often argue that when an individual uses
drug. It depends upon individual stage of change and readiness. In this MI may create more
resistance to change. This will increase feeling of anger towards the family. Also, it can lead to
psychotic symptoms and relapse.
Getting in more deep of Eliza and her mother relationship will give better understanding
of change in dynamics between them and how it has created a great impact on Eliza behaviour.
Generally, an acute inpatient unit meeting with family will be limited. But by using CBT
approach meeting with Eliza mother will help in giving realistic expectation. It will be related to
Eliza illness as well as her mother anxiety and guilt (Satoh, Lee & Yamada, 2015) This may
result in change in behaviour of Eliza. With this it will be easy to identify what factors have
created a great impact on her behaviour. Furthermore, by finding out how Eliza reacts or behaves
in different situation, goals and objectives can be identified. These goals can be more expanded
in areas from where support can be provided. Through this Eliza can be motivated in situation in
which she gets nervous. Also, dual diagnosis can be given in proper way. This will make easy for
Eliza to get care in right time. Using or taking of drugs will be specified by identifying the
changes in behaviour of Eliza. This will make it easy to give proper drug to patient according to
his needs. If overall process of CBT goes in right direction and way, patients get recovered
easily.
Implication for future care
Based on the case of Eliza it is analysed that she is at contemplative stage of change. It is
identified by motivation for change and discrepancy (Sadot, Doussot & Kingham, 2015) It will
assist in creating opportunity for further expansion of goals with relation to substance use. It is
expected that the goals will be focused on abstinence. By giving Eliza history and her realistic
nature the aim can be shifted to MI. it will help in easy recovery and providing effective
treatment to her. Along with this, providing support to her after getting discharge from hospital

will help in achieving her goals and objectives. Besides this, drug and alcohol counselling can be
given to her. It will be beneficial in supporting her to overcome from metal illness. Also, it is a
very integrated approached of providing care. Moreover, providing service to Eliza and taking
follow up of that service can be done. This will be useful in completing the overall care. This
will ensure that Eliza is getting specialist support at the time of discharge (Santos-Ruiz, Robles-
Ortega & Peralta-Ramírez, 2017)Cognitive behavioural therapy (CBT) is mostly used in
approach in providing care. It helps other to recognise their own pattern and thinking style in a
particular situation.
Furthermore, one more support can be given to Eliza. Along with her mother, she is
having few friends. They can also support her in giving care. It will be beneficial for her to get
combined care from mother as well as friends.
It is essential that during discharge Eliza gets support from her mother. This will help her
to maintain effective family relationship (Hofmann, Forschner & Hassel, 2016). Moreover, it
will also give better outcomes and goals and objectives can be achieved in proper manner. It will
be helpful for Eliza to improve relation with her mother. Other than this, Eliza friends can help
her in dual diagnosis. It will be great for her to identify what goals needs to be determined. Also,
it will help in supporting Eliza to get involved with community so that mental illness can be
reduced. By this it will be easy to discharge Eliza. Moreover, it will give extra benefit to her
mother for motivating Eliza. Besides this, it will be easy for her family member and relatives to
understand her behaviour and take measures accordingly (Elsabahy, Heo & Wooley, 2015).
This can be done by regularly communicating with her. This will make it easy in providing dual
diagnosis.
CONCLUSION :
From this case study it is concluded that MI and CBT are antonymous approaches. If they
are combined together it can be effective while working with patients in providing dual
diagnosis. In case of Eliza MI application will change the stage and goals in substance use. On
the other hand, using CBT will help in exploring other factors that can be related to psychotic
relapse including family members. From the research results and information collected and

gathered it is cleared that these two approaches will help in giving better outcomes for patients.
But in case of discharge from inpatient psychiatric community support, it will become necessary
to monitor that is patient has received his desired goals and objectives or not. MI is undertaken
by four principles which help in providing effective care to the patient. Cognitive behavioural
therapy (CBT) is mostly used in approach in providing care. It helps other to recognise their own
pattern and thinking style in a particular situation.

REFERENCES :
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