Question:
Discuss about the Mental Health and Physical Health.
Mental health and physical health have correlation with each other; poor physical health contributes to risk of mental health issues. Similarly, mental health problems negatively influence physical health, personality and overall quality of life of an individual (Kemp and Quintana 2013, pp288-296.). This essay develops the understanding of mental health and its relationship with physical health through the analysis of the case study of Mary, a 41 year old woman, who has been suffering from moments of despair when she feel tearful and tend to develop symptoms of depression. Her feeling of worthlessness and hopelessness has affected her overall appearance, normal sleep time and completion of simple activities in daily life. The purpose of the essay is to give insight regarding understanding of mental illness with support from Mary’s case and find the importance of personal recovery for Mary. The next section discusses about the mental health needs of Mary and proposes the best and treatment options for her recovery. It also gives an insight into the implications of the information for the practice of health professionals.
The examination of the Mary’s case study has mainly revealed the problem of feelings of despair, low motivating in daily activities, and feelings of worthlessness, sleep difficulty and a history of depression. All this symptoms is an indication of major depression in patient. This is because the symptoms are similar to the DSM-IV criteria for major depressive disorder (MDD) (DSM-IV Criteria for Major Depressive Disorder (MDD) 2017). According to the DSM-IV criteria, a person having depressed mood for more than two weeks, impaired social and occupational functioning and presence of at least five specific symptoms every day are regarded as suffering from MDD (DSM-IV Criteria for Major Depressive Disorder (MDD) 2017). These symptoms include depressed mood, little pleasure in activities, weight loss or appetite change, modified sleep and activity patterns, tiredness, feelings of worthlessness, poor concentration and suicidal thoughts (Uher et al. 2015, pp. 459-471) Similar to this specification of DSM-IV, Mary was also found to experience low moods, feelings of worthlessness and hopelessness, little interest in activities like eating and dressing, loss of sleep and poor personal hygiene. Hence, she also had at least five of the nine symptoms of depression and the only symptom that was not present in her included suicidal thoughts (Uher et al. 2015, pp. 459-471).
Based on the frequency or persistence of symptoms in Mary, it is found that Mary developed low moods more frequently and she also experience moments of low mood. However, however her condition can be classified as recurrent MDD because she was admitted to the hospital for depression earlier too and she has started experiencing low mood again. In case of recurrent depression, relapses of depressive symptoms occur in affected individuals after phases of normal moods (van der Velden et al. 2015, pp.26-39). According to the severity of depression, the ICD classified depression into four categories which includes mild depressive episode, moderate depressive episode, severe depressive episode without or without psychotic symptoms (ICD-10 Version: 2016 2017). According to the ICD-10 classification, it can be said that Mary’s depression is under F32.1 category of moderate depression. This is because she has four or more symptoms of depression but she does not develop suicidal thoughts. If she has suicidal thoughts, then her condition would be described as severed depressive disorder. Hence, it is clear that Mary is suffering from moderate depression.
There are numerous links between mental health and physical health conditions and both have an impact on quality of living, health outcomes and demand of care. WHO (2016) has defined that without mental health, overall health and well-being of an individual is not possible. The relation between mental and physical health is particularly more apparent in chronic conditions (WHO 2016). Poor mental health increases the risk of chronic physical illness in patients, whereas people with chronic physical conditions are vulnerable to developing poor mental health. For instance, the study by Kemp and Quintana (2013, pp.1238-1334) showed increased association between depression and cardiovascular disorder. It was found that depression increased the risk for developing CVD by 1.5 fold, whereas patients with both CVD and depression had three fold risk of developing cardiac events. In this case, heart rate variability was found to influence mental and physical well-being. It is recommended that for patients like Mary with mental illness, increasing physical activity, mediation and dietary changes should be considered along with conventional treatment to promote recovery
In case of Mary too, it can be said that presence of depressive mood is likely to affect her physical health too. This is because in the presence of altered mood and lack of motivation, she may not full attention to her nutritional and personal needs. Inability to complete activities like eating and maintain personal hygiene will increase the risk of physical illness in patient. Chronic fatigue and physical aches and pain become common for patients with depression. Secondly, poor personal hygiene and nutritional intake make the susceptible to diseases too (Coventry et al., 2015). Research has explained that individuals with mental illness have shorter life than general population because mental health related factors like unhealthy lifestyles, disparities in health care access and affect of psychotropic medications increases the risk of physical morbidity (Correll et al. 2015). Evidence has proved that antipsychotics increase risk of physical illness such as diabetes, obesity, renal disease and other issues in mentally ill patients (Correll et al. 2015). To find treatment options for people living with either mental illness or physical health conditions, the most critical aspect for the health care professional will be to find the link between body and mind. This understanding will help to develop effective strategies to improve the quality of life of people living with mental illness and physical health conditions (Rogers and Pilgrim 2014). Hence, clinicians can minimize adverse outcome for Mary by analysing the link between treatment and patient specific risk factors.
Personal recovery is defined as the systematic process of modifying an individual’s attitude, values, feelings and goals towards illness and being satisfied and hopeful even within the limitations of illness (Unger 2017). In case of Mary, whose quality of life has been seriously affected by altered moods and feelings of hopelessness in life, focusing on personal recovery is most important. This is because clinical recovery can just address the physical symptoms of patients, however patient’s thoughts and feelings towards illness cannot be changed unless personal recovery related values are developed in them. Hence, recovery can be facilitated in Mary only changing her attitude towards mental illness and developing new purpose in life. This will help her to cope with her current issues as well as find strategies to tackle such issues in life (Drake and Whitley 2014). This will eventually help her to gain back the lost confidence and approach her illness with a positive towards life (Angermeyer et al. 2013).
WHO (2016) has defined that mental health is the state of well-being in which a person is capable of coping with stressors of life and working productivity to contribute to the community. The development of major depression is evident from the symptoms of low mood, feelings of worthlessness, sleep disturbance and history of depression. The presence of these symptoms has affected Mary’s capability to manage life stressors and work productively. Although she has a supportive husband and no history of drug use, she finds it a challenge to manage not just her work but also simple activities in life. In such situation, personal recovery should be facilitated in Mary by providing an environment that supports her in adapting healthy lifestyles. Hope, identity and personal responsibility will be the key elements of personal recovery in patient and this will enable Mary to live a life beyond illness (Lin et al. 2013). This action is related to the recovery model of mental illness because inculcation of personal recovery values in patients supports them to take control in their life as well as on mental illness (Jacob 2015). For Mary, her personal recovery will add a new meaning to her life. It will make her control her moments of despair and develop resilience particular during emotional distress. The role of psychotherapist will be crucial in teaching Mary self-management strategies will help her to develop hope, optimism, control and responsibility towards life (Owen and Hilsenroth, 2014, p. 280).
As Mary is having recurrent symptoms of depression, the main health care priority is to address altered mood in patients and change development of negative thoughts in patient. She would require both pharmacological as well as cognitive behavioural therapies to address the problem of altered moods and low pleasure in daily life activities. The best pharmacological treatment option for Mary includes providing antidepressant medications initially to stabilize her mood (Lara et al. 2013, pp.2111-2117). The initial antidepressant medication that is suitable for Mary includes selective serotonin reuptake inhibitors (SSRIs) as it prevents neurotransmitters form being reabsorbed into the nerve cells (Kemp et al., 2014). However, the limitation of antidepressant treatment is that many side-effects develop in patients which further increases the relapse rate and health risk in patients. Many patients like Mary also develop remission and continue to suffer from residual symptoms (Fishbain et al. 2014, pp.1522-1539). Mary had also taken Citalopram antidepressant in the past, but her depressive symptoms relapsed again. Research evidence shows that such challenges in antidepressant therapy can be addressed by means of optimization of dosage and duration of the therapy and switching strategies like discontinuation of ineffective drugs and initiation of new drugs. In some patients like Mary, addition of a second anti-depressant also addresses symptoms of depression (Al-Harbi 2012).
As pharmacological treatment for depression is associated with many side-effects and risk of disease in patients, focusing on non-drug strategies is particularly important for Mary. The best treatment options for bringing behavioural change in Mary would include antidepressant medications with cognitive therapy to promote recovery in patient. Research on the effect of cognitive therapy with antidepressant medications has proved that such strategies increase the rate of recovery from MDD compared to use of antidepressant medications alone (Hollon et al. 2014, pp. 1157-1164). Cognitive behavioural therapy is based on the assumption that mood of a person has direct relation with thought patterns and the therapist supports the patient to recognize negative thoughts and replace them with valid and positive thought patterns (Yoshimura et al. 2013, pp.487-493). Hence, combining cognitive therapy with antidepressant therapy is likely to enhance treatment response. Another study also suggest that mindfulness based cognitive therapy can reduce risk of relapse in patient compared with conventional treatment (Kuyken et al. 2015) As Mary has mainly recurrent major depression, this intervention would be most useful for her to endure positive outcomes, prevent relapse of depressive symptoms and improve the quality of life (Samaan et al. 2016, p.22).
For a nurse providing care to patients like Mary, knowledge about mental illness and their link with physical health and social determinants of health can have useful practice implications. While prioritising care and recovery of patient like Mary, the main care plan of nurse will be to develop a therapeutic relationship with patients based on trust and promote effective coping skills to empower Mary to overcome negative feelings. The nurse will also play a critical role in promoting positive health behaviour in patients such compliance with medication and healthy lifestyle (Ekers et al. 2013, pp.14-22). Mentally ill patients are most likely to discontinue medications and nurse must observe them and motivate them to adapt healthy lifestyle choices. In many patients with depression, smoking and consumption of alcohol further deteriorates their condition (Braithwaite et al. 2016, pp.566-572). In such situations, nurses also have the responsibility to encourage people to withdraw from alcohol and drugs (Ekers et al. 2013, pp.14-22). However, Mary has no history of smoking, alcohol or drug use. Therefore, the area of lifestyle choices where the nurse needs to closely work with Mary includes increasing physical activity, personal development and diet changes in patient. In short, it can be said that collaborative care by nurse will promote recovery and mental health and well-being in Mary (Zimmermann et al. 2016, pp.101-111).
Conclusion
Thus, from the analysis of Mary’s case scenario, it is understood that mind and body plays a key role in the health and well-being of an individualThe critical evaluation of Mary’s symptoms and issues in life summarized that according to DSM-IV criteria, recurrent major depression was a major health issue for Mary. The essay also established link between mental health and physical health by stating that poor mental health increases the risk of physical illness and in increase in risk of depression in patients with chronic disease. As mind and body are linked together, the essay also highlighted why adapting personal recovery model is important for Mary. To address and treat Mary, the combination of cognitive behaviour therapy as well as antidepressant therapy was proposed as this is likely to address all challenges in treatment too. This knowledge will also have useful implications for nursing practice and delivering effective care to mentally ill patients. The future recommendation to improve nursing skills in caring for mentally ill patient is that nurses must change their attitude towards such patient and engage in empathetic and close relationship with them to understand their social as well physical health needs to treat them
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