Case Study: Mental Health Problems

Case Study: Mental Health Problems

This article is a case study: mental health problems. Study it to gain knowledge on the subject and its interventions.

 

Introduction

The goal of this assignment is to choose a client with an ongoing mental disease diagnosis and conduct an evaluation based on the patient’s presenting condition and the psychosocial intervention provided throughout his therapy. The issue discovered throughout the evaluation process will be examined, as well as the patient’s coping strategy, stress, medication compliance, and family intervention. The author will also outline interventions that attempt to help the patient recover. The Gibbs (1988) Model of Reflection, as stated by Burns and Bulman (2000), will be used to assess the patient’s treatment.

Case Study: Mental Health Problems

The patient will be assigned the pseudonym John to safeguard confidentiality and anonymity, as per the Nursing and Midwifery Council (NMC) Code of Professional Conduct (2008). John is a 40-year-old African-Caribbean guy who lives alone in the neighborhood. John has unsettling and angry audio hallucinations that mostly describe his actions and ideas. This usually occurs while he is not at home, in public areas, or in stores. He claims to hear these voices while he is alone and idle at home, which he says happens mostly in the evenings and at night. He is furious and terrified as a result of these events.

Other people can read John’s thoughts, something he believes is especially true of several kids in his neighborhood who he believes are trying to get him. Every week, he gets six hours of care from the support workers to help him preserve his mental health and independence, as the organization’s concept is to give this support so that patients may continue to strive toward an average life.

John has been diagnosed with paranoid schizophrenia because he has consistent delusions that are generally accompanied by hearing voices and perceptual disturbances (The Diagnostic and Statistical Manual IV, 1994). Two or more of the aforementioned symptoms must be present for a considerable amount of time within one month for a diagnosis of schizophrenia to be established, according to the DSM IV Mental Health Criteria for Schizophrenia.

John had previously spent eight months in a mental facility. Schizophrenia is a widespread mental illness that has a severe impact on sufferers and their families. Patients with schizophrenia often hear voices in their brains and have strange ideas. Following his release from the ward, John was provided housing where he could live independently while receiving the community help he desired.

John is the second of three sons and daughters born to a single parent. The pregnancy and birth went well, and developmental milestones were met on schedule. The patient’s father has no known medical history. John’s older brother is in jail for robbery, and his younger brother has been sent to a mental facility many times with a diagnosis of schizophrenia.

During the evaluation, John’s mother characterized him as a quiet youngster who had never had any close friends and only knew the street lads he went out with. He’s had a sexual connection with a girl from the neighborhood in the past, but he’s never had a long-term girlfriend. John claims that he disliked school and quit out at a young age. Until his initial admittance to a mental health facility three years ago, he had never worked and lived at home.

His mother, who suffers from depression herself, is his major source of emotional support and caregiver. His medical history and examination revealed that he was healthy since there was no evidence that he had ever been diagnosed with a significant illness; nonetheless, he confessed to using many drugs, including alcohol, cannabis, and crack cocaine. He presently consumes one pack of cigarettes every day. At the time, his overall health is fine.

It was clear from my observations and conversations with John that he suffers from anxiety and depression. According to Davis et al. (2007), anxiety plays a key role in the development and maintenance of dysfunction in schizophrenia, although these symptoms are often disregarded or dismissed in favor of the positive and negative symptoms.

John does not seem to be suffering from any signs of schizophrenia at the moment, however, he does mention low mood and worry as challenges he faces on a daily basis. His anxiety and low mood medicine do not seem to be alleviating his problems, however, the prescriptions are being examined to establish the proper therapeutic amount he needs (Lieberman and Tasman, 2006). He lacks drive and self-esteem, and his anxiousness makes it difficult for him to appreciate the advantages in his neighborhood.

Full evaluation to evaluate John’s mental health requirements, including specialized examinations for his anxiety and poor mood, so that he may be helped to create coping skills that will help him with his everyday activities and participation in activities. Assessment is a continuous process that ensures that all data and treatments are current and accurate.

Other aspects of the nursing process, such as planning, execution, and evaluation, may be used after an accurate and thorough assessment (Callaghan and Waldock, 2006). In order to provide care for John, the author conducted a Krawiecka, Goldberg, and Vanghu (KGV) evaluation and a one-on-one session with John and his primary caregiver.

The Stuartand Lancashire (1998) KGV Manchester Symptom Scale updated version 6.2 is a worldwide assessment instrument that allows nurses to examine a service user to determine the intensity and frequency of symptoms, as well as to suggest further ways ahead in care delivery (Barker et al. 2003). The author was able to complete the nursing process and evaluate to identify a broad overview of John’s demands, which aimed to specify explicitly explain his difficulties, and aid in the nursing response aimed at promoting and enabling recovery, by using this tool.

According to Keke and Blashki (2006), mental health evaluation encompasses symptoms, features, and psychological state, as well as psychosocial elements relevant to the patient; as a result, the KGV is considered an important component of mental health assessment.

This KGV test is a global assessment tool that is used to examine a variety of mental health disorders within a few weeks, including the intensity, severity, and duration of symptoms. The first six parts are based on a subjective account of their state during the last several weeks and are targeted at identifying sadness, anxiety, hallucinations, delusions, suicide, and high mood. The next eight components are dependent on the patient’s behavior during the evaluation.

This was mostly used as a beginning point for evaluating John’s mental health issues. Although it was felt that at this stage in the evaluation, all aspects of John’s mental health needed to be addressed, the author was already aware of the concerns connected to anxiety and depression; hence, the use of KGV was an excellent instrument to achieve the work.

The author was able to recognize what symptoms John was having and identify particular areas of need that needed to be addressed in order to explain the depth of the client’s discomfort and symptoms using this method. The KGV assessment tool has one drawback: it takes time. While this time was spent forming a therapeutic relationship with the patient, this is something that should be done over several interviews, taking into account the patient’s individuality and how long he can maintain interest and attention to the questions being asked.

During an evaluation, engaging with a patient who is having a psychotic episode may be exceedingly difficult due to abnormalities in cognition, perception, mood, and behavior (Rigby, 2008). Screening methods were utilized to evaluate and quantify the severity of the detected symptoms after conducting a full examination (Stein, 2002).

The author decided to use the Beck Anxiety Inventory [BAI] by Beck (1987) to measure both psychological and cognitive components of anxiety (University of Pennsylvania, 2008), as well as the Beck Depression Inventory (BDI -1) by Beck (1961) to determine the severity of depression (University of Pennsylvania, 2008). Both the BDI-1 and the BAI are 21-item self-rating scales on which patients assess the presence and severity of their presenting symptoms (Norman and Ryrie, 2005).

The patient scores themselves on a scale of 0-3, which best characterizes how they’ve been feeling over the last several weeks, and is then totaled up between 0-63. The author opted to use these scales on John in order to determine the intensity of his anxiety and depression, and he completed them himself; the goal is to promote him as a participant in his own treatment (NMC, 2008).

Both techniques were also thought to allow the author to explore difficult parts of John’s life rather than merely participate in general conservation, as well as provide opportunities for appropriate action (Barker, 2003). Going through these evaluation tools once the proper time period has passed will provide him and the rest of the nursing team with a report on the progress made and any improvements that can be made.

The results of the screening instruments utilized indicate that there is a moderate level of anxiety and sadness. The engagement of the staff and the support he gets from his mother were thought to be meeting John’s immediate needs in connection with these issues during the time spent with him (carer). His caregiver’s negative attitude about John’s diagnosis might be due to a lack of information, expertise, or judgment (Duffin, 2003).

This was not a problem for the professionals who assisted him, as they all performed to high quality, empowering him and allowing him to make educated decisions, assuring best practices in care delivery throughout John’s life (Department of Health, 2006). Psychosis has a huge influence on the sufferer’s family and caregivers, especially in the early stages (Reed, 2008). Families are often worried, perplexed, frightened, and afraid of the patient’s behavior and what the future may hold for them.

According to the author, John was troubled and stigmatized by his family, their members’ appearance and behavior, as well as other people’s opinions of him and the family as a whole. The physical and emotional responsibility of care is constantly placed on the family, which may cause further stress and anxiety as they try to cope with their own thoughts of mental illness (Patterson et al, 2005).

Families may feel guilty for not recognizing their loved one’s symptoms and anguish sooner, while also acknowledging that the sickness may result in financial hardship for the whole family. They also have to cope with the stigma of mental illness, according to Patterson (2005), who believes that families sometimes misinterpret the patient’s unusual behavior on purpose and hence become less compassionate and feel powerless in the situation.

The Department of Health recognized the importance of caring for carers in 1999, and the National Strategy aimed to support people who chose to be carers. The National Service Framework (NSF) for mental health reported levels of services to involve service users and their carers in the planning and delivery of care.

By examining this patient in his own words throughout the care planning process, he was able to come to grips with his psychotic experience by pledging to take his meds and make appointments with the specialists, and he started to comprehend and identify strategies to cope with it. This is consistent with evidence-based practice, which places the patient at the center of all treatment plans, with personalized care plans and interdisciplinary cooperation at the forefront of care delivery (DoH, 1999 and NICE, 2002).

The National Institute of Clinical Excellence (NICE, 2002) emphasizes the need of having family intervention accessible to relatives of schizophrenia patients. Families are a vital resource for persons with symptoms, according to Norman and Ryrie (2005); however, if the family responds to symptoms by being critical or doing too much for the patient, this may have a detrimental impact on the individual.

Both John and his caregiver received education on his sickness and medicines. This was done at his house in an interactive, question-and-answer manner over the course of many days. At regular intervals, they were provided information updates and summaries, and they were urged to bring up any challenges, questions, or concerns that emerged. It was a participatory session since John was allowed to provide his permission for treatment and offer his own perspective.

The goal of educating a schizophrenia patient’s family/caregivers is to decrease the patient’s expectations and maybe minimize the presenting symptoms. One of the key contributions of stress to a psychiatric condition, according to Leff (1994) and McDonagh (2005), is expressed emotion from families. Having a mental disease may restrict a patient’s life; nevertheless, it is other people’s negative views, not the mental illness itself, that may help impair persons with mental illness (Seggie, 2007).

Formal caregivers’ expressed emotions, such as that of support workers and nurses, may have an equal impact on patients, since both high and low expressed emotions can exist in the interaction between nursing staff and patients, potentially affecting the patient’s outcome (Tattan and Tainer, 2000). Carers’ critical, aggressive, and emotionally over-involved attitude toward patients is known as expressed emotion. Negative statements and nonverbal acts by the caregiver may have an impact on the diagnosis outcome. This negative attitude on the part of caregivers does not always assist the patient in improving his health.

In psychiatric diseases like schizophrenia, caregivers with “strong expressed emotion” are considered to generate stress. Negative judgment and sympathy cause stress to the individual with a condition, and they may relapse. Expressed emotion may have a direct role in a patient’s relapse after being diagnosed with schizophrenia (Leff and Vaughn, 1985).

Patients are more prone to relapse when their living environment contains a lot of expressed emotion, as John discovered (Lopez et al. 1985). When the sufferer can no longer cope with the burden of pity, he or she may relapse into their condition, utilizing drugs as a coping mechanism. The stress caused by the caregiver’s statements, attitudes, and behavior may be too much for her to bear, as she may believe she is the source of the difficulties. The patient may develop unhealthy behaviors, leading to a cycle of relapse and recovery.

One method to break out from this cycle of behavior is for the caregiver to participate in behavior family therapy with the patient, which tries to enhance the family’s health while reducing stress and aggravation. Family therapy allows the caregiver to recognize that John has an illness and that he may need her assistance to recover and stay stable. One strategy to reduce expressed emotion and make it no longer a problem is to educate the caregiver and the patient about mental illness (McDonagh, 2005).

When contemplating family involvement in John’s care, it’s critical to remember that there are many people who are significant in his life (Berke et al., 2002). A multidisciplinary conference was arranged for all those engaged in John’s care to learn how a crisis may be a turning point and the start of something new. Patients and caretakers were provided information on the devastation that mental illness can bring, as well as exacerbations of symptoms and remissions. All of this was done in the hopes of improving the family’s environment by boosting awareness, coping skills, and support for the caregiver and John.

The majority of the therapeutic therapies supplied to John’s caregiver focused on communication, including training, problem-solving skills, and knowledge. The treatment focuses on the positive features of the family’s coping mechanism and avoids making judgmental or blaming comments. The objective is for the caregiver and the nursing team to work together on change goals and to place a greater focus on John’s needs.

Fadden (1998), on the other hand, criticized the limited emphasis on relapse prevention at the cost of the caregiver’s broader needs. Some family therapists have shifted away from a stance of seeking to diminish expressed emotion by delivering a message that stress exacerbates psychosis rather than causing it, in response to significant critiques of family intervention based on views that it blames families for schizophrenia (Harris et al, 2002).

There is a conflict in teaching families that decreasing criticism reduces the risk of recurrence while also informing them that schizophrenia is a disease that is not caused by them. The presence of a family member has been shown to enhance a variety of characteristics of this patient’s social well-being, including participation in activities.

Case Study: Mental Health Problems
Symptoms of schizophrenia

John feels the whispers from individuals strolling nearby were preparing an impending assault on him. He feels that by becoming enraged and yelling back at them, he has avoided a possible assault. Distraction was unlikely to work in this scenario unless the notion was questioned in a calm and courteous manner. John and the author decided to put this theory to the test, and he subsequently came to believe that it was a contributing factor in his condition. John was urged to clear his mind of the thoughts and beliefs that he was being spoken about.

One of John’s major challenges in life is a lack of drive; he recognizes that spending more time doing things to occupy his thoughts will improve his mood. He finds it difficult to push himself to do anything, but he has agreed to see his caretaker (mother) most weekends and to attend the community center on a regular basis. These will allow him to focus less on his hallucinations.

Reflection, according to Hogston and Simpson (2002), is the process of examining a practice experience in order to better define, analyze, and evaluate it, and therefore to inform practice learning. This is an important process for all nurses who want to improve their practice, according to Wolverson (2000). The Gibbs (1988) model of reflection will be used to investigate this.

Evaluation using Gibb’s Reflective Model

When considering John’s care and interventions, a person-centered approach appears to be the most important. He was at the center of his care. His personal feelings, beliefs, and values were respected, and he was able to make informed decisions at all times. Engaging John in a dialogue about his disease and care, and how to best deal with it, was highly valued by him and his caregiver, and it resulted in greater capacity to cope, improved compliance, and better results.

John was taught relaxation methods as a coping strategy for his anxiety; however, although relaxation may be successful, Frisch and Frisch (1998) recognize that it is ineffective on its own and that it should be used in conjunction with other therapies.

Kirby et al. (2004) recognize the importance of a diverse workforce, which complements the Essence of Care Document. The Essence of Care Document is an organized way of benchmarking components of care. It establishes a method for discussing and comparing practices, allowing nurses to discover best practices or form action plans to correct habits that need to be improved.

John was aided by a team of professionals with a wide range of experience and expertise, as well as training in family interventions and cognitive behavioral therapy. CBT is a problem-solving-based, short-term psychological therapy targeted at finding answers to everyday difficulties. Clients’ mental health needs should be identified and effective treatment supplied if necessary, according to Standard 2 of the National Service Framework for Mental Health (1999). John is expected to benefit from CBT in the future, as well as continued family intervention.

Conclusion

Case Study: Mental Health Problems
A nurse caring for a mental health patient

The relationship between the author, the patient, and the carer was critical and recognized as an aspect of service effectiveness throughout the care of my chosen patient (DoH, 2001a), and active collaboration with the family is a requirement rather than an optional extra when providing care to people with enduring mental health problems. John and his caregiver were pleased with the author’s assistance, support, and service when they most needed it.

Frequently Asked Questions (FAQs)

1. What is the KGV assessment tool?

The Stuartand Lancashire (1998) KGV Manchester Symptom Scale updated version 6.2 is a worldwide assessment instrument that allows nurses to examine a service user to determine the intensity and frequency of symptoms, as well as to suggest further ways ahead in care delivery (Barker et al. 2003).

2. What is the purpose of the Beck Depression Inventory?

The author decided to use the Beck Anxiety Inventory [BAI] by Beck (1987) to measure both psychological and cognitive components of anxiety (University of Pennsylvania, 2008), as well as the Beck Depression Inventory (BDI -1) by Beck (1961) to determine the severity of depression (University of Pennsylvania, 2008). Both the BDI-1 and the BAI are 21-item self-rating scales on which patients assess the presence and severity of their presenting symptoms (Norman and Ryrie, 2005).

3. What is the Essence of Care Document?

The Essence of Care Document is an organized way of benchmarking components of care. It establishes a method for discussing and comparing practices, allowing nurses to discover best practices or form action plans to correct habits that need to be improved.

4. What does reflection mean in health?

Reflection, according to Hogston and Simpson (2002), is the process of examining a practice experience in order to better define, analyze, and evaluate it, and therefore to inform practice learning. This is an important process for all nurses who want to improve their practice, according to Wolverson (2000).

References

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Beck, A.T. (1961) Beck Depression Inventory (BDI-1).

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Berke, J.H., Fagan, M., Mak-Pearce, G. and Pierides-Muller, S. (2002) Beyond Madness: Psychosocial Interventions in Psychosis. London: Jessica Kingsley Publishers

Burns, S. and Bulman, C. (2000) Reflective Practice in Nursing: The growth of the Professional Practitioner. 2nd ed., Oxford: Blackwell Science

Callaghan, P, and Waldock, H. (2006) Oxford Handbook of Mental Health Nursing. Oxford: Oxford University Press.

Davis, L.W., Strasburger, A.M. and Brown, L.F. (2007) ‘Mindfulness: An Intervention for Anxiety in Schizophrenia’, Journal of Psychological Nursing & Mental Health Services, 45(11), pp. 23-30

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DSM-IV (1994) Diagnostic and Statistical Manual of Mental Disorders. Washington DC: American Psychiatric Association

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Lopez, S.R., Hipke, K.N., Polo, A.J., Jenkins, J.H., Karno, M., Vaughn, C. and Snyder, K.S. (2004) Ethnicity, Expressed Emotion, Attributions, and course of Schizophrenia: Family warmth matters. Journal of Abnormal Psychiatry. 113. pp. 428-439

Keke, N., and Blashki (2006) The acutely psychotic patient: assessment and initial management. Australian Family Physician. 35(3) pp.90-94

Kirby, S.D., Hart, D.A., Cross, D. and Mitchell, G. (2004) Mental Health Nursing: Competencies for Practice. London: Plgrave MacMillan

Lancashire, S. (1998) Manchester Symptom Scale, modified version 6.2.

McDonagh, L.A. (2005) Expressed Emotion as a participant of relapse in psychosocial disorders. Available at www.personalityresearch.org/papers/mcdonagh.html Accessed on [28 Nov, 2009]

National Institute for Clinical Excellence (2002) Schizophrenia: Core Interventions in the Treatment and Management of Schizophrenia in Primary and Secondary Care. London: NICE

Normal, I. and Ryrie, L. (2005) The Art and Science of Mental Health Nursing. A Textbook of Principles and Practice. Berkshire: Open University Press

Nursing and Midwifery Council (2008) The NMC Code of Professional Conduct: Standards for Conduct, Performance and Ethics. London: Nursing and Midwifery Council

Patterson, P., Birchwood, M. and Cochrane, R. (2005) Expressed Emotion as an adaptation to loss. British Medical Journal. 318. p. 149-153

Reed, S.I. (2008) First episode psychosis: A Literature review. International Journal of Mental Health Nursing. 17. pp. 85-91

Rigby, P.A., and Alexander, J. (2008) Understanding Schizophrenia. Nursing Standard. 22 (28) pp. 49-56

Seggie, A. (2007) Isolated by Ignorance. Nursing Standard. 21. p. 29

Stein, D.J. (2002) ‘Obsessive-Compulsive Disorder’, The Lancet, 360(9330), pp. 397-405

Tattan, T. and Tattier, N. (2000) The Expressed Emotion of Case Managers of the Seriously Mentally ill Clients in the Community, their doctors, and their case managers. Journal of Mental Health. 7(6) pp.621-629

Wolverson, M. (2000) On Reflection. Professional Practice. 3(2) pp.31-34­

Case Study: Mental Health Problems

 

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