Mental status examination or mental state examination (MSE) is an important clinical assessment in psychiatric practice. It is an ordered manner of describing and observing the psychological functioning of patient’s. The main parameters which are taken into consideration include appearance, attitude, mood, behaviour, thought process, thought content, perception, insight, cognition, judgement and mood. The assessment helps in comprehensive cross-sectional description of the mental state of the patient and helps the clinician to ascertain the proper diagnosis and formulation for coherent treatment planning (Mitchell, 2013). The mental state examination of Chung from the perspective of the community nurse who visited the house of Chung is laid down as follows. Appearance: Chung is showcasing flat mood and is tearful. This indicated that he is mentally depressed and is suffering from extremely sorrow and grief (Zimmerman et al., 2013). His mood is sad and restrictive. Here restrictive further highlighted his attitude that he is unwilling to open up his sorrows or reason for despair in front of others. Another reason might be, he is so hopeless that he is not encouraging any discussion for further recovery. His limited eye contact, slowed and purposeful speech indicates that has pre-occupied with certain thoughts and is sharing zero interests in indulging into effective communication. The lack of eye contact further is acting as a determining step indicating that Chung is severely depressed (Alghowinem et al., 2013). His overall thought content is also negative as showed via worthlessness. He is also having a negative perception about himself like thought of getting heart attack and a fleeting mood of committing suicide. This constant disturbed mood, negative cognition or perception of oneself and a escapist attitude via committing suicide indicated that Chung is suffering from severe depression or major depressive disorder (Zimmerman et al., 2013).
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM V) is a 2013 updated for of Diagnostic and Statistical Manual of Mental Disorders, a special taxonomic tool that is published by the American Psychiatric Association (APA). According to DSM V, the there are five simplified form of the personality types apart from the previous one (DSM IV) which has 10 different personality types. These five different personality include avoidant, borderline, obsessive-compulsive, schizotypal and antisocial/psychopathic. The condition of Chung is somewhat related to the psychopathic personality trait which is related to the major depressive disorder (American Psychiatric Association, 2013). The main diagnostic criteria of major depressive disorder as indicated b y DSM IV which coincides with the condition of Chung is continuous depressed mood, a feeling of hopelessness, diminished interest in daily living activity (in case of Chung is loss of appetite) insomnia, recurrent thoughts of death and reluctance in making eye contact and zero interest in conversation. However, problem is pyshcomotor skills is not prominently reflected in the case of Chung however, his delusional or near delusional guilt is making evident that he is suffering from major depressive disorder. The delusional guilt includes hopelessness in job field, guilt in not performing well for the family (American Psychiatric Association, 2013).
Stress Vulnerability Model (SVM) is a helpful model that is used for the identification and treatment of the frequent relapses in the mental illness. According to this model, the synchronisation of the intrinsic vulnerability and psychological stressors lead to the development of the mental illness (Fleming & Martin, 2014). Under this model the main factors which are included in intrinsic vulnerability include abnormal brain organisation. The psychological stressors mainly include crisis in life, substance abuse interpersonal stress factor and the occupational stress. The mental health outcomes from the amalgamation of these two factors (intrinsic vulnerability and psychological stress) include psychosis, or depression, or bipolar disorder, post traumatic stress disorder (PTSD) and other anxiety related disorders (Fleming & Martin, 2014). From the case study, it is difficult for a community health nurse to figure out the intrinsic vulnerability of Chung behind the development of the mental illness. However, as a community health nurses, is can be easily identified the main psychological stressors which is influencing the development major depressive disorder in Chung. According to Townsend and Morgan (2017), SVM highlights life-crisis as the main factor behind the development of mental illness.
One life crisis factor in case of Chung’s life is personal crisis in Chung’s life. Chung is struggling with his career progress and is making constant efforts for getting promoted as an emergency medical consultant. However, in the middle of this professional turmoil, he gets married and his life crisis is further increase. The birth of his daughter Charlotte further increases the crisis further. According to Thompson, Amatea and Thompson (2014), birth of child increases financial crisis in the family that is still struggling for professional stability. Chung is away from his native land and from his close family members for the past five years. The lack of interventions and caring attitude coming from his family members has further increased his problems. Giorgi et al. (2015) have highlighted that staying abroad away from the family increases the life crisis during turmoil situation. The birth of Charlotte also made Harriet unwell. Harriet had caesarean section dur to birth complications and this has lead to the development of infection at the site of operation resulting in increase in pain and restricted mobility. It is due to the ill-health of Harriet, that the financial burden of Chung has increased and he was also compelled to take a leave from his work to manage his home. However, taking his promotion and professional advancement into consideration he has again joined his work but does over-time and does is unable to spent adequate time at home.
Another factor is professional stress in Chung’s life. His professional life is also undergoing crisis, occupational stressors due to one medication error committed by him. Lack of proper rest while at home, and personal crisis has increased anxiety in Chung. This anxiety and lack of proper sleep or rest might have resulted in delusional mind state resulting in the drug error. Chernomas and Shapiro (2013) is of the opinion the stress and lack of rest increases the chances of getting affected with the occupational stress, which in turn increases the chances of developing mental health complications. This amalgamation of both professional and personal crisis has lead to the development of extreme psychological stressors leading to the development of the metal health complications.
Recovery oriented mental health practice ensures that the mental health service is procured in such a manner that it supports the faster recovery of the mental health consumers (The Department of Health Australia, 2018).
Respect is the first parameter of the mental health recovery. Providing proper respect and importance of the decisions of the mental health service consumer ensures quality outcome. This is because, showing respect to their needs or wishes or opinion make them feel concerned or involved in the life process or the care plan. This in turn increases the sense of their own personal value and thereby helping in faster recovery (Slade et al., 2014). In case of Chung, the respect must come from his family members. Like Chung has highlighted that how he felt emotionally unstable in his wedding as it had less reference to Chinese culture and he also felt sorry and guilty about it. This is because, he make himself responsible for this. He thinks that just because he failed to provide proper opinion in wedding planning dur to his high work-pressure, the weeding become a complete Australian couture altogether. Thus keeping this reference into consideration, Chung’s in-laws must consider seeking decisions from Chung when taking any step in the day-to-day life process of his daughter Charlotte. No matter how busy is Chung they must take an initiative in acknowledging his decision in every aspect of family decision. According to Slade et al. (2014) informed decision making helps in the quality improvement in the overall health outcome. It is also the duty of the mental health nurse to listen attentively to the concerns shared by Chung. Slade et al. (2014) highlighted that active listening via eye-contact helps to showcase respect to the client and thereby improving his mental health state. Chung must also be encouraged to take part in the community health programs where he will get to interact with his native members. Communicating with them in native language will help him to feel at home and guarded for his native culture and this in turn will help to overcome his anxious and depressed state of mind (Slade et al., 2014).
Empowerment is another important aspect of mental health recovery plan. In case empowerment, the first step must come from his family members via enabling Chung to involve in the decision making process. This will make Chung feel empowered, making his feel like his opinion are valued in the family and his family members look up to him for taking any determining steps in life. According to Chronister, Chou and Liao (2013), the sense of empowerment help to overcome the depressive feeling of worthlessness and thereby helping to again positive energy and fast recovery in mental health. Empowerment in the professional life is however, difficult since he has already committed a drug error however, if Chung has successfully completed 12-month supervision practice then, his employer must come forward to encourage him in progressing in future steps in his career more enthusiastically. Chronister, Chou and Liao (2013) stated that this helps to feel successful and reduces the sense of guilt and thereby promoting mental health recovery
Hope is another important thing in the mental health recovery plan. It is the duty of the family members as well as the community health nurses to positive source of energy so that he can overcome is suicidal thoughts or sudden fear of getting heart attack. Chung should be counselled in the domain of how his presence is important in the life of this wife and his infant daughter how their happiness and future is dependent on him. This sense of realization will increase hope among Chung and he will get new enthusiasm to live his life, if not for him but for his family. Cleary et al. (2013) stated that it is the duty of the community health nurse to site example of how any turmoil in personal or professional life can never bring end to an entire life, this sharing of examples will provide Chung hope and a new ray of living.
References
Alghowinem, S., Goecke, R., Wagner, M., Parker, G., & Breakspear, M. (2013, September). Eye movement analysis for depression detection. In ICIP (pp. 4220-4224).
American Psychiatric Association. (2013). Diagnostic and Statistical Manual Of Mental Disorders. Fifth Edition. Access date: 20th August. Retrieved from: https://www.sciencetheearth.com/uploads/2/4/6/5/24658156/dsm-v-manual_pg490.pdf
Chernomas, W. M., & Shapiro, C. (2013). Stress, depression, and anxiety among undergraduate nursing students. International Journal of Nursing Education Scholarship, 10(1), 255-266.
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.
Cleary, M., Horsfall, J., O’Hara?Aarons, M., & Hunt, G. E. (2013). Mental health nurses’ views of recovery within an acute setting. International Journal of Mental Health Nursing, 22(3), 205-212.
Fleming, M., & Martin, C. R. (2014). Trauma Exposure, Schizophrenia Symptoms and the Stress Vulnerability Model. Comprehensive Guide to Post-Traumatic Stress Disorder, 1-20.
Giorgi, G., Arcangeli, G., Mucci, N., & Cupelli, V. (2015). Economic stress in the workplace: the impact of fear of the crisis on mental health. Work, 51(1), 135-142.
Mitchell, A. J. (2013). The Mini-Mental State Examination (MMSE): an update on its diagnostic validity for cognitive disorders. In Cognitive screening instruments (pp. 15-46). Springer, London.
Slade, M., Amering, M., Farkas, M., Hamilton, B., O’Hagan, M., Panther, G., … & Whitley, R. (2014). Uses and abuses of recovery: implementing recovery?oriented practices in mental health systems. World Psychiatry, 13(1), 12-20.
The Department of Health Australia. (2018). Principles of recovery oriented mental health practice. Access date: 20th August 2018. Retrieved from: https://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-n-servst10-toc~mental-pubs-n-servst10-pri
Thompson, I., Amatea, E., & Thompson, E. (2014). Personal and contextual predictors of mental health counselors’ compassion fatigue and burnout. Journal of Mental Health Counseling, 36(1), 58-77.
Townsend, M. C., & Morgan, K. I. (2017). Psychiatric mental health nursing: Concepts of care in evidence-based practice. FA Davis.
Zimmerman, M., Martinez, J. H., Young, D., Chelminski, I., & Dalrymple, K. (2013). Severity classification on the Hamilton depression rating scale. Journal of affective disorders, 150(2), 384-388.
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