Mental health problems can range from the worries that one experiences as a part of the everyday life to serous long term conditions. Early help can help the people to deal with mental health problems and get back to the normal pace of life. There are a wide and a classified range of mental health problem. It is very important to diagnose each of the types to decide a proper treatment regimen. The different ranges of the mental health problems that can be seen are clinical depression, anxiety disorder, dementia, hyperactivity disorder, schizophrenia, obsessive compulsive disorder, post traumatic stress disorder and there are several others (Barrentes-Vidal et al., 2013)
This case study provides us with the information of a 21 years old Caucasian fellow, who has been showing some mental ailments lately, which has become a matter of concern for his family as he is showing signs of acute depression and is exhibiting signs of self destruction like suicide. This report will throw light in the case study; critically analyze the condition of Scott. Depending upon the case study, the following report will be focusing on the potential risks that Scott can pose on himself and others if he is kept in the hospital ward. The following report will also provide with a template discussing the mental health examination and will also provide with the possible ways for assessing the mental health of a person. Finally the later part of the discussion will be provided with a formulation and hypothesis regarding the case study with a succinct conclusion.
Scott is a 21 years old male who live with his parents. Over the last few months, Scott has been suffering from personality disorder. His mood, appearance and behavior has changed which had ultimately led to social withdrawal. His duration for the sleep has increased than before. His personal hygiene has also got compromised as it has been reported that he has not been showering for several days and is also not changing clothes. The most abnormal and creepy thing is that he is often found to be talking o himself. All these problems have also affected his long term relationship and his professional life. It is to be noted that his friends circle has changed; nowadays he was seen with older groups of people. It is a matter of concern as his parents are of the idea that he had become the victims of drugs. Although there are no such valid evidences that a mental illness is hereditary, but chances remain, as Scott’s grandfather also had a mental illness. It has been reported that Scott had started skipping meals due to which his weights have reduced substantially. Scot is reported to have been showing irritation and agitation on being inquired about his concern. The final event reportedly says that when his parents have persuaded him to take him to GP he had shouted at them and ran out of the house. Later on, on notifying the police, scot has been brought to the mental health clinic for the assessment. It was also reported that Scott had injured himself with a deep cut. Scott is found to deny any medication and therapies and he thinks that he is perfectly alright.
Risk assessment: according to the information provided in the case study and going through the MSE, one come across three potential risks that Scott might encounter.
From the signs and symptoms shown by Scott, it can be estimated that he had been taking drugs or alcohol, although it can only be confirmed after certain tests. If Scott is been addicted to any drug, then he would try to access them under any circumstances, for that reason he might try to escape from the hospital (Bleiberg, Rossouw & Fonagy, 2012). Scott might refuse medications that would help to stop the effect of the drug.
Another risk associated to this is that Scott can show violence and other forms of irritation and agitation which can harm the other patients of the ward. It can potentially harm the staffs of the mental health clinic.
The second potential risk associated with Scott is that he is acutely depressed and is of a misconception that he is being harmed by his peers and his family. It is unknown what led him to think this, but he is having trust issues and therefore cannot rely on the medications provided to him (Bleiberg, Rossouw & Fonagy, 2012). The case study suggests that he might be possibly suffering from paranoid personality disorder, which is characterized by a long standing pattern of suspiciousness and pervasive distrust to others. This kind of a patient thinks that other people will harm, exploit or deceive them. This is a dangerous thing as the patient would refuse any kind of treatment from the doctors out of distrust and thus the treatment will not progress (Burke & Stepp, 2012).
Another potential risks includes that he is having thoughts of self destruction and have tried to injure himself by cutting himself. This thing can be dangerous and he should not be kept alone for a minute to avoid the risks related to suicide. So these are the 3 potential risk concerning Scott, while he is in the hospital ward.
Researches suggest that efficient nursing interventions can bring about desirable changes in patients having mental health issues. They tend to reduce the risk factors, reduce the psychiatric symptoms, enhance the protective factors and prevent new cases of mental disorders (Bateman, Gunderson & Mulder, 2015). The general policies related to mental health involves improvement of the food habits, housing, and reduction of the economic insecurity. In case of mental disorders, as seen in Scott the nursing interventions have to be specific.
If the patient is susceptible to drugs and alcohols then care should be taken that Scott is kept away from alcohols and drugs under any circumstances. A nurse or a midwife can provide medications like Methadone and Acamprosate to facilitate withdrawal of the drug (Chanen, & Kaess, 2012). A registered nurse can provide talking therapies to deviate their mind from the drugs. Main aim would be to provide a conducive environment for the patient (Bateman, Gunderson & Mulder, 2015). The patient should be imparted knowledge about the ill effects of the drug. Supervisors have to be appointed so that the patient cannot escape from the hospital wards. Despite of all these care should be taken to exert less restraint and provide a holistic care of approach. It has to be kept in mind that there are certain withdrawal effects that a patient encounters due to the sudden withdrawal of drugs (Bateman, Gunderson & Mulder, 2015). If Scott is addicted to drug then care should be taken regarding the adverse withdrawal effects, which may lead to life threatening conditions.
The case study throws light upon the fact Scott is having issue of distrust on his family members as well as the hospital staffs and he thinks that he would be harmed either by his family members or the hospital staffs and therefore have stopped taking food. The nursing rationale for treating the paranoid personality disorder in Scott, a registered nurse should try to create a friendly and a non harming environment for him, which would help him to open up his thoughts and the grievances. There are no such short term therapies or medications to treat paranoid personality disorder and generally involve long term psychotherapies (Chanen & Kaess, 2012). An RN might develop talk therapies like talking to the patient about his or her childhood, work, schools, and relationships. A proper psychotherapy would help in the individual to cope up with the disorder. He should be learnt how to communicate with the people, which would help to reduce the feeling of Paranoia. Some medications can be administered like antidepressants, benzodiapines and antipsychotics (Hollon et al., 2013). It has to be kept in mind that a Scott is having trust issues and cannot accept his own disorder, so an RN should try to impart him with the knowledge of his own condition. It is believed that a combination of medication and talk therapy or psychotherapy can help to reduce the risks in the patient (Norman & Ryrie, 2013).
As per the information got from his parents, Scott has been having active thoughts of finishing himself, as he thinks that someone wants to kill him and therefore he wants to accomplish this on his own beforehand. This can be a matter of concern to the registered nurse as such a person needs continuous supervision (Townsend, 2014). From the case study it is already evident the Scott had already tried to harm himself. Therefore a bit of negligence from the nurse’s part can cost Scott’s life. In acute situations, the first priority of the nurse would be to stabilize the patient and to ensure his or her safety. Once it has been accomplished it is required to assess the history and the circumstances of the suicidal attempts and the likelihood of the recurrence of the attempts should also be assessed. For treating Scott, it is necessary to make a collaborative plan involving the family and the nursing staffs. The nurse should be non judgmental and should be able to create a conducive environment that would help the patient to become distracted. A therapeutic milieu should be provided to the patient so that he feels emotionally safe (Townsend, 2014). It is necessary to educate the patient about suicidal minds, the signs and the symptoms and the self management strategies. The registered nurse should be able to convey hope and connection during the recognition of the patient’s state of mind. A registered nurse should be acquainted with the warning signs of acute risks (Pompili eta l., 2012). The factors that trigger the suicidal thoughts should be assessed and controlled. Collaborative care can also be arranged by involving the other staffs and the families.
In order to treat a patient like Scott it is necessary to build an interpersonal relationship with the patient in order to provide spiritual support to the patient to bring him back to the original pace of life (Norman & Ryrie, 2013).
Finally as it is evident from the case study, Scott have refused to take any therapies and medications, alternative ways of feeding or application of medications has to be taken up. Early assessment and techniques can bring about changes in the lifestyle of a mental patient (Townsend, 2014).
This case refers to 21 years old Caucasian fellow, who is suffering from serious anxiety, depression and paranoid personality disorder. The actual reason for his abnormal behavior is still unknown. His parents are of the conception that Scott has become the victim of drugs and alcohols due to the influence of some unknown older group of people.
The predisposing factors related to the symptoms of the patient is that Scott has got a family history of mental illness, as his grandfather also suffered from this type of a mental illness, so hereditary factor might have been providing the triggering factor for Scott’s illness. Furthermore it has also been reported that he did not have any sibling. It can be estimated that the presence of a sibling might have helped in reducing his distress (Chanen & McCutcheon, 2013). It is evident from the case study that he has probably created a hypothetical friend as he had been found talking to himself. It has been reported that his long term relationship had ended, his career has been doomed, and which can be the perpetuating factor for his illness. His avoidance of being in contact with the past friends circle can be another perpetuating factor. His distant relationship with his parents can again add up to the perpetuating factors (Chanen & McCutcheon, 2013).
The core symptoms which are of major concern are the increasing distrust of Scott for his loved ones and his tendency to finish himself. The signs and the symptoms exhibited by Scott are similar to the general signs and the symptoms of a person having personality disorder (Butcher, Mineka & Hooley, 2013). Further to confirm about drug addictions, the screening tests can be done. It is evident from the conversation with Scott, and with his suicidal tendency, that he might be also exhibiting some symptoms of the borderline personality disorder as people like Scott always feel empty or alone in spite of the family and the community support. His building distrust for his family shows some symptoms of paranoia (Butcher, Mineka & Hooley, 2013).
People having personality disorder have hard time to get along with the people surrounding him. They believe that the way of thinking is normal and does not require any treatment just as seen in Scott. The causes of the personality behavior are not known and can be triggered by genetic, as well as the environmental factors.
Conclusion
In order to provide a better life to Scott this, the RN should be able to establish trust with the patients. This trust would enable a patient to confide in the professional and believe that they have problem which has to be cured. Dialectical behavioral therapy has to be applied, where people are imparted with the knowledge to cope up with stress and improve relationships (Townsend, 2014). Certain cognitive behavioral therapies can be applied to alter the negative thinking pattern in the patient so that they are able to cope up with the everyday challenges. Finally love and care can bring back anyone to the original pace of life.
References
Barrantes-Vidal, N., Gross, G. M., Sheinbaum, T., Mitjavila, M., Ballespí, S., & Kwapil, T. R. (2013). Positive and negative schizotypy are associated with prodromal and schizophrenia-spectrum symptoms. Schizophrenia Research, 145(1), 50-55.
Bateman, A. W., Gunderson, J., & Mulder, R. (2015). Treatment of personality disorder. The Lancet, 385(9969), 735-743.
Bleiberg, E., Rossouw, T., & Fonagy, P. (2012). Adolescent breakdown and emerging borderline personality disorder. American Psychiatric Publishing.
Burke, J. D., & Stepp, S. D. (2012). Adolescent disruptive behavior and borderline personality disorder symptoms in young adult men. Journal of abnormal child psychology, 40(1), 35-44.
Butcher, J. N., Mineka, S., & Hooley, J. M. (2013). Abnormal psychology. Pearson Education India.
Chanen, A. M., & Kaess, M. (2012). Developmental pathways to borderline personality disorder. Current psychiatry reports, 14(1), 45-53.
Chanen, A. M., & McCutcheon, L. (2013). Prevention and early intervention for borderline personality disorder: current status and recent evidence. The British Journal of Psychiatry, 202(s54), s24-s29.
Hollon, Steven D., et al. “Effect of cognitive therapy with antidepressant medications vs antidepressants alone on the rate of recovery in major depressive disorder: a randomized clinical trial.” JAMA psychiatry 71.10 (2014): 1157-1164.
Norman, I., & Ryrie, I. (2013). The art and science of mental health nursing: Principles and practice: A textbook of principles and practice. McGraw-Hill Education (UK).
Pompili, M., Serafini, G., Innamorati, M., Biondi, M., Siracusano, A., Di Giannantonio, M., … & Möller-Leimkühler, A. M. (2012). Substance abuse and suicide risk among adolescents. European archives of psychiatry and clinical neuroscience, 262(6), 469-485.
Sharp, C., Ha, C., Michonski, J., Venta, A., & Carbone, C. (2012). Borderline personality disorder in adolescents: evidence in support of the Childhood Interview for DSM-IV Borderline Personality Disorder in a sample of adolescent inpatients. Comprehensive psychiatry, 53(6), 765-774.
Townsend, M. C. (2014). Psychiatric mental health nursing: Concepts of care in evidence-based practice. FA Davis.
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