Mental Health Essay PDF

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Case Study Analysis of Mental Illness Cases...

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Assignment title:

Mental Health Case Study

Unit code and Title:

NCS2102 Mental Health & Illness

Lecturer:

Amanda Cole

Student Name:

Elyse Bettini

Student Number:

10478626

Date of Submission:

7/10/19

Word Count:

2005

1 Mental Health Case Study Introduction Mental health makes up a crucial proportion of a person’s entire overall health, mental health affects a person’s cognitive ability to think, behave and navigate their daily life with minimal obstructions. Mental illness however disrupts these basic skills and impedes the person’s capacity to function normally. Multiple causative factors on a biological, social and psychological scale such as physical ailments, the patient’s living environment, poor coping skills for stress or other experiences can be injurious to a patient’s mental health and potentially evolve into mental health disorders (Muir-Cochrane, Barkway & Nizette, 2017). This case study aims to acknowledge the links between a person’s mental health and physical health with regard to their quality of life by identifying what factors may predispose a patient to mental illness. The study also highlights what specific assessments aid in the diagnosis and treatment of mental illness, or to identify any potential comorbidities that may affect or mask symptoms. This study also highlights the importance of health promotion, early detection of mental illnesses and the use of holistic nursing techniques when caring for patients with mental illness. Question One: Mental health promotion is a broad domain that includes the biopsychosocial and spiritual dimensions of the lifespan. Mental health and wellbeing are encompassed in all aspects of an individual’s life and must be addressed at many levels to ensure quality of life (physical and mental health) and social wellbeing. Discuss this statement and provide rationale for your answer. Mental health promotion is an integral aspect of mental health nursing, it aims to improve a person’s mental wellbeing and improve their quality of life through the use of holistic nursing care and individualised interventions, such as patient education to improve their lifestyle to facilitate early treatment or decreasing the patient vulnerability to the mental

2 illness by increasing protective factors, building resilience and decreasing the chances of future relapses (Brown, Learmonth, Mackereth & Ashton, 2014). Holistic nursing is a practice used across nursing that identifies that the whole of a person suffers whether that be mind, body or spirit in comparison to other biomedical care that focuses solely on the person’s physical being. A person’s mental health can be influenced by multiple categories of biological, social and psychological factors of their life termed as the biopsychosocial model (Papadimitriou, 2017). This model usually considers factors including a person’s personality, genetic predispositions or physical illness, social isolation, living conditions or personal experiences in regard to their mental health (Papadimitiriou, 2017). The aims of the particular model are to give clinicians insight into a multitude of potential factors by that can be injurious to one’s mental health, this leads to implementing a high quality individualized, multidisciplinary and holistic approach to the patient’s treatment resulting in the improvement of the patient’s wellbeing and quality of life under their care based upon all aspects of the patient’s being (Babalola, Noel & White, 2017). Patients with mental illnesses are highly susceptible physical ailments due to the higher likelihood of the patients engaging in unhealthy activities such as drug abuse, smoking or drinking, engaging in unsafe sexual practice or poor nutritional intake. This leads to a higher prevalence of physical illnesses such as lung cancer, obesity, diabetes, HIV/AIDS or cardiovascular disease (Muir-Cochrane, Barkway & Nizette, 2014). This population group’s physical health is generally poor overall, their mortality rate is significantly higher than the general population in conjunction with their life expectancy being between 10-32 years less (Torales et al., 2017). Patients with mental illness in many cases don’t possess the notion of self-care due to their altered mental state and are likely to not engage with appropriate medical services provided to them to receive the care required for their illness

3 both mental and physical to make a full recovery and potentially resulting in premature death (Torales, Barrios & Gonzales, 2017). Patients with long term physical illnesses are also susceptible to mental illnesses such depression and anxiety among others, these disorders are especially dangerous to the person’s physical condition as it can lead to non-adherence to treatments and exacerbate the symptoms which can lead to complications related to their condition thus diminishing their quality of life and impeding the patient’s recovery (Muir-Cochrane, Barkway & Nizette, 2014). Question Two: Discuss this statement and outline why a comprehensive mental health assessment is essential for the nurse to undertake when admitting patients in a general hospital ward. Provide rationale to support your answer Physical illness or the medications used to treat the illness can act as a trigger for mental illness and in turn it can exacerbate symptoms of the person’s physical illness such as heightening pain levels, fatigue or lethargy, cause non-adherence to treatment and affect the patient’s social life (Parrish, 2018). When these symptoms interact with the patient’s physical illness it can inhibit a diagnosis of mental illness by mistaking mental illness symptoms with physical illness symptoms (Parrish, 2018). This can affect the treatment provided to the patient if all aspects of the person’s health aren’t assessed, the physician may not effectively treat one of the comorbidities which means the patient may still present with symptoms which can become costly to the healthcare system and the patient may become reluctant to engage with services or adhere to treatment if they believe their symptoms are not improving as such (Parrish, 2018). When a patient presents with physical illness doctors in most cases perform an in-depth mental health screening and obtain a detailed mental health history to assess for mental illness as a comorbidity that may be exacerbating or even mimicking physical illness symptoms and vice versa (Parrish, 2018).

4 This process allows the physician to identify an appropriate holistic treatment according to the presence of both or one of the illnesses to ensure that the treatment is suited to the patient’s individual needs to ensure an unhindered recovery or at the very least some improvement of the patient’s symptoms (Parrish, 2018). The patient’s past treatment of their physical illness should also be addressed and analysed in regard to potential mental illness as certain medications used to treat illnesses can in actuality induce psychiatric symptoms, anti-convulsant drugs used to treat epilepsy have been linked to adverse psychiatric effects of depressive episodes, psychosis and irritability (Chen et al., 2017). Question Three: Provide two (2) possible occasions when a consumer would present with psychiatric symptoms, but may actually have an underlying physical illness that requires treatment. Provide rationale for your answer. Patients with past head injuries have been known to present with psychiatric symptoms such as mood swings, personality changes and other similar symptoms which may not be directly related to mental illness (van Reekum, Cohen & Wong, 2015). Traumatic brain injuries damage the brain’s neurotransmitter systems that excrete norepinephrine, dopamine and serotonin which can lead to neurochemical imbalances and produce symptoms that may be similar to or identical to mental illness symptoms (van Reekum, Cohen & Wong, 2015). Patients with conditions such as Hyperthyroidism/Hypothyroidism can present with symptoms similar or same as mental illness. this condition affects the body’s thyroid that secretes tetraiodothyronine (T4) and triiodothyronine (T3) and how it reacts to the thyroid stimulating hormone that usually alerts the brain of high or low levels of T3 and T4 (Bathla Singh & Relan, 2016). For example, if the thyroid is overactive it can affect the patient’s sleep and cause insomnia but also mood swings, irritability or anxiety which are also symptoms of clinical anxiety or bipolar depression (Bathla, Singh & Relan, 2016). This is why usually doctors usually test a patient’s thyroid levels before making a

5 psychiatric diagnosis to ensure that the patient does not have any thyroid issues before prescribing any anti-depressants or mental health treatment and instead treat the hypothyroidism to alleviate the symptoms (Bathla, Singh & Relan, 2016). Question Four: Given Nicole’s current presentation, outline the priority assessments that Tim would undertake, and discuss how Tim might identify issues affecting Nicole. Provide rationale for your answer. Nicole has presented with suicidal ideation and emotional lability therefore Tim should first and foremost perform full mental health assessment including a mental state examination that assesses their behaviour, appearance, speech, thoughts and their mood and other factors to obtain a preliminary insight into the patient’s mental state (Moxham, 2017). A suicide risk assessment should also be performed especially since Tim has noticed previous self-harm scars on Nicole’s arms, this assessment identifies factors that may lead to potential suicide risk by asking the patient a series of questions to obtain a score that pertains to whether the patient fits within the low, moderate or high risk category and determines what precautions need to be implemented and which areas need to be focused on with regard to Nicole’s treatment (Rudd, 2014). Nicole was also admitted with a drug overdose and was demanding medication which could be indicative of drug seeking behaviour of a patient who has been misusing their medication, substance abuse or misuse increases the risk for relapses, non-compliance with treatment and heightened aggressive or impulsive behaviour in mental illness patients (Giguere & Potvin, 2017). Therefore, a Drug Abuse Screening Test (DAST-10 or DAST-4) should also be performed in which the physician asks the patient four to ten questions related to drugs that are worth zero or one points to obtain a score, this assesses the patient’s degree of drug abuse ranging from no signs of drug abuse to severe drug abuse which can assist in altering a patient’s treatment in accordance with the patient’s condition (Giguere & Potvin, 2017).

6 Tim can also utilise the Health of the Nation Outcome Scale (NoHOS) that assesses twelve items categorised into the four dimensions of behaviour, impairment, symptoms and social that considers the patient’s biopsychosocial dimensions (Muller et al., 2017). Each subcategory is scored 0-4 in severity and then tallied to gain an overall score (Muller et al., 2017). If Nicole scores moderate or high on these assessments Tim can opt to turn the data he has collected from his other assessments over to a medical practitioner or authorised mental health practitioner to suggest that they file a Form 1a for a psychiatric examination under the Mental Health Act 2014 to allow for Nicole to enter an involuntary treatment order if she is a risk to herself and/or others if deemed necessary but also to help her maintain a treatment schedule (Mental Health Act, 2014). Question Five: The early detection and treatment of anxiety and depression is important to promote a person’s wellbeing. Often anxiety and depression will go ‘hand-in- hand’ or one precedes or can mask the other. Discuss this statement and identify how health professionals can assist in the early detection of these diagnoses. Provide your rationale and reasoning to support your answer. Depression is often a comorbidity to anxiety and vice versa, this can lead to symptom overlaps as the two disorders share similar symptoms which can lead to a misdiagnosis of one of the disorders (Wu & Fang, 2014). The under diagnosis of comorbid conditions can cause treatment resistance and decrease the treatment’s effectiveness as anxiety symptoms can be resistant to depression medications and a similar effect occurs when depressive symptoms impede the treatment of anxiety (Wu & Fang, 2014). Therefore, an in depth assessment of the anxiety symptoms within patients who fit the depression criteria and the same for a patient that meets the anxiety criteria to determine if the patient in actuality fits both criteria, this allows for an alteration in treatment options to treat both the disorders (Wu & Fang, 2014).

7 Early detection, identification and treatment of depression is crucial to ensure that the illness doesn’t escalate in severity, there are a few diagnostic questionnaire based assessment tools that are used to determine a depression diagnosis such as the Hamilton Rating Scale for Depression, Beck Depression Inventory-II and the Patient Health Questionnaire that utilises subjective data that is provided by the patient or in some cases from the patient’s family to answer sets of questions that are placed on a scale to determine the risk of/presence of depression (Cacheda, Fernandez, Novoa & Carneiro, 2019). Like depression the early identification and treatment of anxiety is crucial to ensure that the patient’s condition doesn’t deteriorate further through assessment tools similar to the depression scales such as the Generalised Anxiety Disorder-2 questionnaire that begins with two questions that are scored to potentially add up to a total of 3 or more that may indicate a potential anxiety disorder (Byrne & Rosen, 2014). Guidelines state that the use of the Generalised Anxiety Disorder -7 in which they ask four more questions to gain a score of 8 or more to indicate a potential anxiety disorder and treatment can be considered (Byrne & Rosen, 2014). Conclusion Mental health is a crucial aspect of a person’s being and it can be affected by many aspects which can cause ill mental health whether it be the person’s physical condition or other biopsychosocial factors. Thus the usage of mental health promotion to educate patients on a healthy lifestyle and implementing holistic nursing to treat mental illness is important for early detection/treatment or prevention of the illness to ensure that the patient maintains a highly quality of life, and if there is a patient presenting with potential mental illness to utilise appropriate assessments to assess the person’s entire being to make a sufficient diagnosis.

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9 Injury. Oxford, UK: Oxford University Press Incorporated. Retrieved from https://ebookcentral.proquest.com Torales, J., Barrios, I., & González, I. (2017). Oral and dental health issues in people with mental disorders. Medwave, 17(8), e7045. https://doiorg.ezproxy.ecu.edu.au/10.5867/medwave.2017.08.7045 van Reekum, R. (2015). Can Traumatic Brain Injury Cause Psychiatric Disorders?. Journal Of Neuropsychiatry, 12(3), 316-327. Retrieved from http://neuro.psychiatryonline.org/ Wu, Z., & Fang, Y. (2014). Comorbidity of depressive and anxiety disorders: challenges in diagnosis and assessment. Shanghai Archive Of Psychiatry, 26(4), 227-231. doi: 10.3969/j.issn.1002-0829.2014.04.006...