Mental State examination can be defined as one of the most important elements of psychiatric assessment that is in assessing the psychological functions of a patient going through any sort of mental illness with the help of 15 interrelated elements (Cumming et al., 2013). Most notable elements that can be considered as affected of the patient and the consideration includes mood, thought process, thought content, suicidality, and appearance. Considering the mood, Chung appeared to be in a low and sad mood with slouched rounded shoulders indicating that his appearance and his mood both have been affected by the severely depressed state. Considering thought process and thought content, the most of the effect of his mental illness has been identified in his thought process and content as he had disorganized or disconnected thought including phobia of heart attack, impending death, and the health of his wife. Lastly, suicidality is the last assistive elements that can help in assessing the mental health of the patient as he had been repeatedly saying that he wanted to die and his condition was self-imposed and they cannot be any cure for it, which indicates severe hopelessness, lack of self-worth and depression. Hence from the mental state assessment it can be inferred that the patient might be suffering for long term depression and resultant severe anxiety disorder (Drake & Whitley, 2014).
However, as illustrated by Gluhm et al. (2013), mental State examination is only the first or preliminary step of the mental health examination which is needed to be followed by a more definite and extensive assessment procedure such as the DSM 5. This is the fifth revised edition of the Diagnostic and statistical manual of mental disorders published in the year of 2013 as a taxonomic and Diagnostic tool for mental health examination by the American psychiatric Association (American Psychiatric Association, 2013). As mentioned by Hu, Li and Arao, (2015), persistent depression is intricately linked with panic disorders and any individual that has been dealing with persistent depression associated with interpersonal occupational stress can easily fall prey to panic disorders is adequate measures are not taken. The common symptoms of a panic disorder includes intense phobia of year application profuse sweating chest pain shortness of breath and feeling of something terrible happening. As per case study Chung had been depressed due to his occupational stress and not being able to visit his hometown or being detached from his culture which further aggravated when his wife fell ill after the birth of their daughter. His persistent depression gave rise to panic disorders which is validated by the symptoms of random intense fear palpitations sweating chest pain and breathlessness along with feeling something terrible is going to happen which in this case for Chung had been the fear of a heart attack killing him any second. Hence, from the DSM 5 Diagnostic criteria it can be mentioned that he had been suffering from persistent depression and panic disorder (American Psychiatric Association, 2013).
Stressful vulnerability model is a model of co-occurring disorders which provide in-depth understanding of psychiatric disorders and how it can be caused or aggravated by external factors including stress (Zannas & West, 2014). In order to explore and understand the developmental pattern of a mental illness this particular model explores the interaction between the biological vulnerability of a person the impact of stress and the presence of protective factors that are facilitating or restricting the development of the disorder. This model discusses stress as an external element which has a fundamental impact on the biological vulnerability of an individual is can either Trigger or even worse than the course of the development of a mental disorder. Now the stress can be caused by any individual life event, any tense relationships, lack of productive activity and a sense of loss. The patient, Chung, migrated to Australia from his native land China five years ago for occupational purposes, and had been faced with a varied range of stressors ever since. Hence, stress is the sole contributing factors to his mental state. Occupational stress is one of the most fundamental factor that propelled his panic disorder, anxiety attacks and depression. He worked as a doctor in an emergency department which is associated with severe trauma and burnout. Furthermore, due to his further studies the lack of sleep also aggravated the burn out and propelled him to making medication error for which he was penalized. This event had been a significant impact on his career and paved way for his anxiety or panic disorder to develop along with depression (Chidarikire, 2012).
The second key factor that aggravated his mental health had been the personal stress that he had been facing. The loss of touch with his family and culture, ill health of his wife and distance from his daughter contributed considerably higher stress to his already deteriorated condition. It can be mentioned that long term anxiety and occupational stress can have a significant impact on the mental health especially for the ones that living alone in a unknown city amidst a completely new lifestyle and culture (Kossowsky et al., 2013). Furthermore, with the lack of any social support from family and loved ones, depression deteriorated markedly giving way to suicidal thoughts and hopelessness along with his panic disorder. As mentioned by Drake and Whitley, (2014), persistent depression is intricately linked with panic disorders and any individual that has been dealing with persistent depression associated with interpersonal occupational stress can easily fall prey to panic disorders is adequate measures are not taken. Hence, the impact of both stress factors, occupation and his personal life impacted his biological vulnerability and coping skills giving rise to both depression and sever anxiety or panic disorder (American Psychiatric Association, 2013).
There are a varied range of external and internal factors that affect the course of recovery for a patient, especially for those with mental illness. Recovery from mental illness is not just associated with being relieved from the symptoms, recovery from a mental illness is fundamentally linked with be able to regain control of their life and revert back to the original lifestyle (Yuen et al., 2012). Hence, while providing treatment or care to a patient with mental disorder, it is crucial for the mental health professional to take a holistic approach to care so that along with his psychological symptoms being treated the emotional social and spiritual impact of the mental in this on the life of the patient is also addressed helping the patient it again and overall recovery (Chidarikire, 2012). There is considerable stigma associated with mental illness which instils a sense of hopelessness and lack of self-worth in the patients. However, with holistic approach that focuses on hope, support, and help can successfully accelerate the process of recovery for the mental patient. In this case, Chung had been detached from his culture and family for 5 years. Atop of it, his stressful job as a doctor in emergency department and the uncertain personal with an ill wife and newborn with maternal grandparents, all accumulated to become a massive stressor for him. The loss of touch with his family and culture, occupational stress, wife’s ill health and distance from his daughter is acting as a significant stressor affecting his mental health. Hence, lack of emotional and socio-cultural support which could have suffered the impact of the stress if he had contact with his own culture his own family and loved ones.
Health care program designed for him must spiritual and emotional wellbeing and the centre of the entire program so that the core issues with his lifestyle which has facilitated the mental health disorder for him can be addressed adequately (Wu et al., 2013). Culturally safe and appropriate community services and community engagement activities can be of excellent help to Chung regain hope and faith in life. The therapeutic care services arranged for him should also focus on prioritizing the dignity and empowerment so that his lack of self-worth can be replaced with empowerment and self-management; which will eventually accelerate the process of recovery (Townsen & Morgan, 2017). Lastly the ability to control his own recovery process will make a fundamental difference in his mental state. So, providing autonomy and decision making ability to him to choose his own recovery approach will be fundamentally in beneficial in accelerating case recovery so that he can corporate traditional healing concepts from his Chinese culture and also his family members to support him throughout his journey of recovery (Chidarikire, 2012). Mental health professionals and community care providers will also need to acknowledge and respect his Chinese culture and origin along with his beliefs and principles so that his mental illness can be managed in a manner that is culturally appropriate and promoting autonomy empowerment and self-management. Lastly, the aid of therapeutic relationship and mutually respectful communication will be essential between chance and his care providers so that he can freely express his presidencies and disagreements providing him total control over his recovery and his life that will help him hope for a better and healthy future for himself (Thoits, 2013).
References:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
Chidarikire, S. (2012). Spirituality: The neglected dimension of holistic mental health care. Advances in Mental Health, 10(3), 298-302.
Cumming, T. B., Churilov, L., Lindén, T., & Bernhardt, J. (2013). Montreal Cognitive Assessment and Mini–Mental State Examination are both valid cognitive tools in stroke. Acta Neurologica Scandinavica, 128(2), 122-129.
Drake, R. E., & Whitley, R. (2014). Recovery and severe mental illness: description and analysis. The Canadian Journal of Psychiatry, 59(5), 236-242.
Gluhm, S., Goldstein, J., Loc, K., Colt, A., Van Liew, C., & Corey-Bloom, J. (2013). Cognitive performance on the mini-mental state examination and the montreal cognitive assessment across the healthy adult lifespan. Cognitive and behavioral neurology: official journal of the Society for Behavioral and Cognitive Neurology, 26(1), 1.
Hu, H. H., Li, G., & Arao, T. (2015). The association of family social support, depression, anxiety and self-efficacy with specific hypertension self-care behaviours in Chinese local community. Journal of human hypertension, 29(3), 198.
Kossowsky, J., Pfaltz, M. C., Schneider, S., Taeymans, J., Locher, C., & Gaab, J. (2013). The separation anxiety hypothesis of panic disorder revisited: a meta-analysis. American Journal of Psychiatry, 170(7), 768-781.
Thoits, P. A. (2013). Self, identity, stress, and mental health. In Handbook of the sociology of mental health (pp. 357-377). Springer, Dordrecht.
Townsend, M. C., & Morgan, K. I. (2017). Psychiatric mental health nursing: Concepts of care in evidence-based practice. FA Davis.
Wu, H., Liu, L., Wang, Y., Gao, F., Zhao, X., & Wang, L. (2013). Factors associated with burnout among Chinese hospital doctors: a cross-sectional study. BMC public health, 13(1), 786.
Yuen, E. Y., Wei, J., Liu, W., Zhong, P., Li, X., & Yan, Z. (2012). Repeated stress causes cognitive impairment by suppressing glutamate receptor expression and function in prefrontal cortex. Neuron, 73(5), 962-977.
Zannas, A. S., & West, A. E. (2014). Epigenetics and the regulation of stress vulnerability and esilience. Neuroscience, 264, 157-170
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