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General appearance |
The general appearance of the patient was normal, and he looked properly dressed. However, the patient did not had any interest in his appearance as it was observed that he did not brush his hair and was least interested hoisin making his outer appearance appealing and appropriate for social interaction. |
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Behavior |
It was observed in the scenario that the patient failed to make or avoided eye-contact with the health professional. He was not concerned about the ongoing conversation and from his behavior and actions, it was clearly visible that the patient was preoccupied with other thoughts. His speech was fragmented with long pauses and a lack of focus. He also displayed signs of anxiety with inappropriate and uncomfortable sitting posture in this clinical scenario. The patient was evidently anxious to leave the interview session. |
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Speech |
The patient was speaking in a monotonous tone and did not utilise any proper speech patterns while talking with rapid and fragmented speech evident. Replies to questions were typically short; only 2 or 3 sentences. At times, the conversation seemed forced, with the patient’s utterances seeming irrelevant the question being aksed |
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Mood and affect |
Harry accepted the fact that he felt happy whenever he was invisible to the people around and also seemed to reject the people who were planning to improve his health condition. However, while determining the thoughts and actions of people as per the case study, it should be said that to the patient’s belief in his superpower of invisibility did not affect his mood during the interview. |
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Thought process |
The patient had several thoughts of superpowers and presented all these details in less coherent speech and manner. In addition, as the patient was thinking about too many aspects in his mind, he was unable to think logically. |
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Thought content |
The thought content of the patient was involved with no suicidal ideation and no hallucination related effects being observed. However, the patient had overvalued thought content as he displayed thought patterns related to superhuman capabilities and paranoia. Furthermore, he expressed homicidal ideation as he admitted that he could kill his brother as he interfered with his superpower. |
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Perception |
The perception of the patient includes derealisation and illusion. The patient accepted as fact that he has supernatural powers which other people are not aware of. In addition, he also thought that the superpowers helped him go invisible anytime and that he will be able to live alone and invisible most of the time. These perceptions about the world, universe and life indicated that the patient was living in an alternative world. |
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Cognition |
The cognition level of the patient was degrading as he lacked the concentration and was preloaded with his superpower and delusion related thoughts. During the interview, the patient accepted the fact that he does not think school is an important part of his life as he is invisible. The interviewer had to probe the patient with specific questions so that they could provide his thoughts. However, by answering the proper date, time and purpose of the interview, it was evident that the patient still has some ties to reality. |
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Judgement |
When the interviewer asked the patient about his aggression and its reason, the patient mentioned the name of his brother and said that he wanted to kill him and was developing an action plan to harm his brother. He did not want anybody to prevent him from being invisible and hence he planned this actions. |
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Insight |
After going through all the responses of the patients, it should be mentioned that the patient is likely suffering from acute substance abuse related syndrome and is the victim of excessive drug use. The diseases he could develop are: substance-induced mood disorder, substance-induced psychotic disorder and substance-induced sleep disorder and substance-induced sexual dysfunction. Therefore, proper healthcare interventions related to mental illness should be implemented on Harry to prevent any serious mental health issue in the patient |
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Symptom |
Intervention |
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Excessive substance abuse and illusions |
· Patient education about drug abuse and its harmful effects · Searching for the agency responsible for patient condition and providing them with the proper treatment, so that the drug can be halted. · Providing the patient with counselling session and the healthcare providers educational strategies to handle the patient (Burrow-Sanchez & Hawken, 2013) |
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Excessive violence and abusive thinking |
· Using diverse methods to increase the patients focus on peace rather than aggression. · Providing the patient with sedatives and other medications so that the patient stays calm and peaceful · Providing counselling to manage the patient’s aggression (Galletly et al., 2016) |
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Poor focus and concertation with hampered sleep pattern |
· Determining the cognitive level of the patient and applying cognitive ability therapy to them in order to enhance their focus or connection (Chapman, 2014). · Providing the patient with proper care and observation to maintain sleep (Sohraby, Attridge & Hughes, 2014). |
Situation: The patient I am caring for is Harry, who is 18-years-old and a high school student. The patient came for emergency assistance due to his extreme substance abuse. The patient has feelings related to delusion, hallucination, and aggressive or destructive thinking due to which he wishes to kill his own brother. Furthermore, the patient thinks he has invisibility related superpowers and delusions in which he is given information from ‘the agency’. It was found that the patient lacks concentration and focus abilities. He also suffers from mild sleeping issues, which he blames on his brother. The patient thinks that his brother does not want him to be invisible and hence, he gases the room. This is why the patient feels tremendous hatred for his brother and shows interest in killing him. All these situations signals that that patient is unable to concentrate on the given situation and requires proper treatment and effective interventions.
Background: The case scenario did not mention any specific medication history, but the patient mentioned that he was involved in a substance abuse in the past week. He was preoccupied with the thought of being invisible all the time and hence, these unrealistic thoughts severely affected the patient condition badly.
Assessment: While determining the mental state evaluation, it was observed that the patient is suffering from vulnerable health condition as he is having delusions destructive thinking and sleeping disorder at the same time. The patient further lacked the proper analytical skills that hampered the ability for him to understand the negative effects of drug or substance abuse. He was also seen to have restlessness and anxiety and was least bothered about his degradation of his health condition and education. Therefore, the intervention applied aimed to control his aggression and violent nature so that his behaviors related to substance abuse and violent nature could be minimised.
Recommendations: The patient must be provided with medications such as tranquilisers and sedatives so that his violent nature can be controlled. Furthermore, this will assure proper sleeping and rest in the patent which will help in the normalization of the hormonal unbalance created by sleeping pattern issues (Bowen et al., 2014). Furthermore, I will assign a counselor for the case of Harry to help modifying his thought processes. Besides, counselling sessions, administration of mindfulness-based therapy should also be applied in the care process to help in the health and mental health improvement of the patient.
References:
Bowen, S., Witkiewitz, K., Clifasefi, S. L., Grow, J., Chawla, N., Hsu, S. H., … & Larimer, M. E. (2014). Relative efficacy of mindfulness-based relapse prevention, standard relapse prevention, and treatment as usual for substance use disorders: a randomized clinical trial. JAMA psychiatry, 71(5), 547-556.
Brand, M., Young, K. S., Laier, C., Wölfling, K., & Potenza, M. N. (2016). Integrating psychological and neurobiological considerations regarding the development and maintenance of specific Internet-use disorders: An Interaction of Person-Affect-Cognition-Execution (I-PACE) model. Neuroscience & Biobehavioral Reviews, 71, 252-266.
Burrow-Sanchez, J. J., & Hawken, L. S. (2013). Helping students overcome substance abuse: Effective practices for prevention and intervention. Guilford Publications.
Chapman, A. (2014). Proposal for patient obligations for access to unapproved medical interventions: both too much and not enough. The American Journal of Bioethics, 14(11), 25-26.
Galletly, C., Castle, D., Dark, F., Humberstone, V., Jablensky, A., Killackey, E., … & Tran, N. (2016). Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Australian & New Zealand Journal of Psychiatry, 50(5), 410-472.
Khoury, B., Lecomte, T., Fortin, G., Masse, M., Therien, P., Bouchard, V., … & Hofmann, S. G. (2013). Mindfulness-based therapy: a comprehensive meta-analysis. Clinical psychology review, 33(6), 763-771.
Sohraby, R., Attridge, R. L., & Hughes, D. W. (2014). Use of propofol-containing versus benzodiazepine regimens for alcohol withdrawal requiring mechanical ventilation. Annals of Pharmacotherapy, 48(4), 456-461.
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