B760 Mental Health Nursing : Assessment Answer

Question

Case Study

Chung is a 35 years-old male who moved to Australia from China ?ve years ago. His parents, older brother and younger sister still live in China. Chung visited his family in China once after a year of moving to Australia. He has notreturnedtoChinasince, becauseofhislongworkinghoursandneedtoundertakeadditionalstudyforpromotion.

Chung is a doctor working in Accident and Emergency in a busy inner-city hospital. He is studying for promotion to ultimately become an emergency medicine consultant. Two years ago, Chung was under investigation by the hospital Human Resources department due to a drug error. He was very tired and had been on-call over-night with frequent call outs to see patients. The drug error resulted in an eight year-old boy being very sick, requiring intensive care admission. Chung used an intra-muscular medication to treat the boy but administered it intravenously. Chung wassubjectedtoseveralwork-placeandmedicalboardinvestigationsandplacedonpracticesupervisionfor12months.

Chung met his wife, Harriett, in Australia four years ago. Harriett is 30 years old. They married two years ago. Unfortunately, Chung’s parents and family could not attend the wedding due to the high costs of travel and his mother has severe arthritis in her hips, making travel very di?cult. Chung found their wedding day emotionally di?cult. He felt the ceremony lacked reference to his Chinese culture. On re?ection, he feels that he wasn’t as involved in the wedding planning as he could have been, due to his long working hours. He simply agreed to the suggestions and plans made by Harriett and her family.

Chung and Harriett now have a three week-old baby girl, Charlotte. Charlotte was born by caesarean section, duetobirthcomplications. Harrietthashadaninfectionintheoperationsitesincethebirth, resultinginlotsofpain, frequent dressings and di?culties moving around. Chung was o? work for one week after the baby’s birth. However, he has now returned to working shifts, often working through the night, where he may go without sleep for 20 - 24 hours. Harriett’s parents are staying with them to support Harriett while Chung is at work. However, he ?nds that Harriett’s parents are very involved with baby care even when he is home. Given this, Chung ?nds he gets very little time and space to be with his new daughter.

You are visiting the family in your capacity as a community nurse supporting Harriett with the caesarean section wound care or as a midwife undertaking a post-natal visit. During your visit to the family, you notice Chung looks ?at in mood and tearful. His a?ect is sad and restrictive. He is slumped in his chair, with rounded shoulders and starring at the ?oor for long periods. You inquire about his health. He has very limited eye to eye contact with you. His speech is slowed and purposeful. On occasions, you need to repeat your question several times to get a reply. However, you do manage to obtain the following information from Chung. He has been feeling increasingly anxious during the past two months, given his continuing long hours, shift work, the high pressure of an Accident and Emergency department, Charlotte’s birth and his wife’s health. He has been having palpitations, chest pains and breathlessness for six to seven weeks. He asked a colleague at work, another doctor, to assess him for cardiac issues several weeks ago as he had been experiencing thoughts that he was going to have a heart attack and die. Chung has been feeling very low in mood for the past six weeks, experiencing sleeplessness, particularly initial insomnia and early morning wakening at 3am. He has lost ?ve kilos in weight during the past month, due to reduced appetite and missing meals. He feels he is worthless and a failure at work within his medical role and he is letting his wife and new daughter down. He has been experiencing ?eeting thoughts of suicide for the last week. He is aware of high lethality medications which he could take to overdose. Currently, he is hopeless and helpless and wants to die. He states he feels his situation is self-imposed and that treatments will not be of help at this time.

Question

1. Using relevant literature critically discuss the mental health status of the client in the case study. Your work should make reference to two (2) components of the Mental State Examination (MSE) related explicitly to the case study and the DSM V. 

2. Critically discuss two (2) factors which have contributed to the development of the client’s current mental health status. You should demonstrate your knowledge of the Stress Vulnerability Model. Your work should clearly identify the contributing factors; make reference to the case study and relevant literature. 

3. Respect, empowerment and hope are three (3) positive aspects of mental health recovery. Using relevant literature and the case study, critically discuss how these three (3) principles could positively contribute to the client’s journey of recovery. You should demonstrate your knowledge of recovery orientated mental health theory and practice. 

Answer

1. Mental disorders or mental illness refer to a set of mental behaviour and patterns, responsible for causing significant impairment or distress in the personal functioning of a person. These mental illnesses are generally remitting, relapsing or persistent. However, they might also occur in the form of a single episode. In order to classify a mental state as a particular disorder, there needs to be some form of dysfunction in the affected individual (Walker, McGee & Druss, 2015). The Mental Status Examination (MSE) forms an important part of clinical assessment in psychiatric practice. It is most commonly referred to as a structured way that helps in providing a description to the psychological functioning of a patient at any given point of time. In other words, the primary purpose of the Mental State Examination is to gather a comprehensive and cross-sectional description of the mental state of an affected person (Trzepacz et al., 2015). When combined with the historical and biographical information of patient’s psychiatric history, MSE assists the clinician in making an accurate diagnosis of the condition that needs treatment. Some of the most common domains that are encompassed in this examination are perception, thought content, combination, thought process, judgement, and insight. Upon analysing the case study it can be suggested that the two most common elements of MSE that are affected in the patient include his thought process and speech (Gluhm et al., 2013).

Thought process is commonly referred to the tempo, quantity and form of thoughts, and cannot be directly observed. These are most commonly described in the form of input from the speech that a patient gives. Presence of a pattern of disorganisation or interruption of thought processes were found in the client that helped in identifying a formal thought disorder, which specifically contributed to tangential thinking and loosening of association (Fox et al., 2015). Chung was found to portray a flat mood and was severely affected by environmental stressors, which resulted in his reluctance to participate in any momentous activity. Speech of the client was also affected, since it was slow and purposeful. Speech is usually observed by assessing spontaneity and with the use of specific language function tests that address standard thought processes. Structured assessment of speech most often encompasses evaluation of the expressive language and form an integral part of the MSE (Luria, 2014).

Although time and again, anxiety has been identified as integral part of human life, some people face long-lasting anxiety that is associated with a persistent worry and fear and overly concern about general matters. These are most commonly associated with major problems in concentration, irritability, restlessness, disturbances in sleep, and muscle tension. An analysis of the case study suggests that the client Chung suffered from anxiety disorder, more specifically panic disorder that is primarily characterized by recurring panic attack. These attacks are defined as sudden periods of severe fear that include shaking, sweating, shortness of breath, palpitation and feeling of something terrible happening (Kossowsky et al., 2013). People suffering from this episode also display a strong wish of escaping from the events that triggered the attack. Similar  symptoms were presented by Chung which helped in diagnosing the condition as panic disorder, based on the DSM-V diagnostic criteria for panic disorder 300.01 (F41.0) (American Psychiatric Association, 2013).

2. The stress vulnerability model is an essential psychological theory that aims to provide an explanation to any mental disorder, as a result of an interaction between stress, due to life experiences and predisposition or vulnerability. The factors that might often contribute to stress in a person exist in the form of psychological, genetic, situational or biological components (McEwen & Morrison, 2013). The predisposition often interacts with subsequent stress response in an individual. In other words, stress is defined as a series of life events that plays an important role in disrupting the psychological equilibrium of a person, and subsequently catalysing development of a mental disorder. Therefore, the stress vulnerability model explores the role of genetic and biological stressors and their interaction with environmental influences, to produce disorder like anxiety or depression (Drake, Pillai & Roth, 2014). Some of the most common stressful events that lead to mental disorders in a person include getting terminated from a job, engaging in conflicts with acquaintances, or death of a beloved person (Zannas & West, 2014).

Chung faced extreme stress in his workplace due to his job at the Emergency Department and the subsequent monitoring and supervision that he had to undergo, as a result of medication error that breached patient safety. These events increased his susceptibility to panic disorder. Owing to the extreme pathological effects of anxiety, it is essential to recognise the role of social support as a major protective factor. Social support from loved ones and family members has often been found to buffer the impact of anxiety, and it is an essential mechanism in boosting the overall mental health of a person (Budge, Adelson & Howard, 2013). The fact that he was not in close contact with his family members acted as a significant stressor for development of panic disorder. 

Most individuals experience anxiety and stress from time to time that occurs in the presence of multiple competing demands. Such forms of stress also trigger events that makes the affected person feel nervous and frustrated. However, when anxiety and stress begin interfering with the daily life of the individual, it indicates the presence of serious mental issues. Some of the other factors that might have contributed to development of the mental illness in Chung include life events that comprised of lack of participation in daily activities, and strained relationship with friends and family. Staying far away from home and failure of his parents to participate in his wedding program created a significant negative impact on his life and made him feel more isolated. Following birth of his child, his wife suffered from an infection and required care in addition, to facing mobility problems. Long working hours at the Emergency Department prevented Chung from actively participating in taking care of his wife and daughter, thereby widening the gap between them. These environmental stressors also made him isolated and he did not participate in any focused activities such as, parenting. The aforementioned factors exacerbated suicidal feelings in Chung.

3. A mental health recovery process refers to the way by which a person can become active and take control of mental health, thereby working towards accomplishing meaningful goals. For most people, the concept of mental illness recovery encompasses having a control in their life, in place of the elusive state of return to certain pre-morbid stages of functioning. Such an approach does not focus on resolution of the complete symptoms, but places an emphasis on control and resilience over life problems. This approach also argues against providing just treatment of the simple management of symptoms (Drake & Whitley, 2014). Instead, it elaborates on building resilience among individuals with mental illness, and providing support to people who are in emotional distress. The recovery process is capable of providing a holistic view of people with mental illness, and postulates that they can successfully lead a meaningful life, and that the entire process is a journey rather than reaching a destination. Recovery processes also calls for commitment from the individual, suffering from mental disorders, their family members, associated mental health professionals, and the community. It is largely influenced by the attitudes and expectations of people residing with them (Drapalski et al., 2013).

Stating that a person suffers from mental illness does not necessarily mean an end of his life. With appropriate help support and hope, the person can achieve his or her life ambitions. Hope generally comes from the inner desire to live and regain optimal health. It is achieved through assurances of key stakeholders and other people, who care about the affected person or through those who have had lived experiences. Instilling a faith of hope in the mentally ill individual will help the latter to gain a better understanding of the mental state, thereby taking responsibility for self-management and reaching out other people for help. Dignity is also imperative in the mental recovery of a person (Chronister, Chou & Liao, 2013). It commonly refers to the inherent values and worth of an individual and is strongly correlated with recognition, respect, and self worth, in addition to the possibility and capability of making choices for self. The fact that many people are denied the opportunity to participate in public affairs or decision making processes often affects them and triggers mental disorders.

Presence of discrimination and stigma in the society regarding prevalence of mental illness aggravates the condition (Moran et al., 2013). Efforts must be taken to provide community based services that encompass recovery approach by inspiring hope and helping Chung to achieve his aspirations and goals. By respecting his autonomy and demonstrating an awareness and knowledge regarding his Chinese culture, will also help in ensuring his access to good care services, whilst respecting his choices preferences and values (Hu, Li & Arao, 2015). This will also be facilitated by adoption of an empowering attitude by engaging in effective communication. This will promote management of ill health and will also provide assistance to Chung to become an active partner in managing the disease. Implementation of the recovery based practice will therefore help him gain a better understanding and the control over his life, to improve health related life circumstances. 

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

Budge, S. L., Adelson, J. L., & Howard, K. A. (2013). Anxiety and depression in transgender individuals: the roles of transition status, loss, social support, and coping. Journal of consulting and clinical psychology, 81(3), 545.

Chronister, J., Chou, C. C., & Liao, H. Y. (2013). The role of stigma coping and social support in mediating the effect of societal stigma on internalized stigma, mental health recovery, and quality of life among people with serious mental illness. Journal of Community Psychology, 41(5), 582-600.

Drake, C. L., Pillai, V., & Roth, T. (2014). Stress and sleep reactivity: a prospective investigation of the stress-diathesis model of insomnia. Sleep, 37(8), 1295-1304.

Drake, R. E., & Whitley, R. (2014). Recovery and severe mental illness: description and analysis. The Canadian Journal of Psychiatry, 59(5), 236-242.

Drapalski, A. L., Lucksted, A., Perrin, P. B., Aakre, J. M., Brown, C. H., DeForge, B. R., & Boyd, J. E. (2013). A model of internalized stigma and its effects on people with mental illness. Psychiatric Services, 64(3), 264-269.

Fox, K. C., Spreng, R. N., Ellamil, M., Andrews-Hanna, J. R., & Christoff, K. (2015). The wandering brain: Meta-analysis of functional neuroimaging studies of mind-wandering and related spontaneous thought processes. Neuroimage, 111, 611-621.

Gluhm, S., Goldstein, J., Loc, K., Colt, A., Van Liew, C., & Corey-Bloom, J. (2013). Cognitive performance on the mini-mental state examination and the montreal cognitive assessment across the healthy adult lifespan. Cognitive and behavioral neurology: official journal of the Society for Behavioral and Cognitive Neurology, 26(1), 1.

Hu, H. H., Li, G., & Arao, T. (2015). The association of family social support, depression, anxiety and self-efficacy with specific hypertension self-care behaviours in Chinese local community. Journal of human hypertension, 29(3), 198.

Kossowsky, J., Pfaltz, M. C., Schneider, S., Taeymans, J., Locher, C., & Gaab, J. (2013). The separation anxiety hypothesis of panic disorder revisited: a meta-analysis. American Journal of Psychiatry, 170(7), 768-781.

Luria, A. R. (2014). The role of speech in the regulation of normal and abnormal behavior. Elsevier.

McEwen, B. S., & Morrison, J. H. (2013). The brain on stress: vulnerability and plasticity of the prefrontal cortex over the life course. Neuron, 79(1), 16-29.

Moran, G. S., Russinova, Z., Gidugu, V., & Gagne, C. (2013). Challenges experienced by paid peer providers in mental health recovery: a qualitative study. Community Mental Health Journal, 49(3), 281-291.

Trzepacz, P. T., Hochstetler, H., Wang, S., Walker, B., & Saykin, A. J. (2015). Relationship between the Montreal Cognitive Assessment and Mini-mental State Examination for assessment of mild cognitive impairment in older adults. BMC geriatrics, 15(1), 107.

Walker, E. R., McGee, R. E., & Druss, B. G. (2015). Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA psychiatry, 72(4), 334-341.

Zannas, A. S., & West, A. E. (2014). Epigenetics and the regulation of stress vulnerability and resilience. Neuroscience, 264, 157-170.