The MSE guidelines serve as a unique diagnostic tool that efficiently helps in accessing the extent to which the mental health of a patient is affected (“Clinical Practice Guidelines: Mental state examination“, 2018). In close association to the two evaluative MSE components that is the ‘mood’ and ‘thought content’ of Chung it is clearly evident that he is at a high risk of developing prolong depression and stress disorder.
It can be clearly stated that the recurring stress events have led to the deterioration of his stable mental health. Studies reveal that stress events elicits a deterioration in the performance output (Tiller, 2013). The case study reports Chung to be in a constant depressive mood and feeling frustrated. It has also been stated that the client has been feeling low for the past six to seven weeks. He has also been reported to feel extremely anxious and restless as he is not being able to spend quality time with his family. Further, the case study also states that, the client is unable to rest appropriately and because of the stress elicited by his work pressure and has been working for more than 24 hours without sleep. Studies have revealed that professional stress often lead to the development of fatigue and depression (Desrosiers et al., 2013)
The case study mentions certain elements of Chung’s thought process which can be linked to the MSE guidelines. It states that Chung has been harboring suicidal thoughts. It has also been stated that he is constantly occupied with thoughts of incapability and worthlessness based on his personal and professional front which serve as major contributors in the development of depression (Fried et al., 2015). In order to deal with the stress, the client has been reported to consume higher doses of lethal drugs and has been stated to have thoughts of cardiac arrest and die. The constant consumption of high dose of drugs have been linked to the symptoms of self-destruction (Dixon et al., 2016).
The DSM-V guidelines provide a supportive frame work to devise medication and appropriate dosage of medication to diagnosed individuals on the basis of their MSE evaluation score. On correlating the severity of the manifestation of the symptoms in accordance with the MSE guidelines it can be stated that Chung is at a high risk of developing acute anxiety and depression disorders. The DSM-V guidelines are build on the MSE assessment and predict the risk of developing mental health disorders in an individual. On account of the disruptive eating and sleeping habits, Chung is also vulnerable to develop disorders such as permanent insomnia and Anorexia nervosa. On the basis of the case study acute depression has been chosen as the criteria for diagnosis of the client (APA, 2013).
The major symptoms that have been identified with the development of depression in the client can be stated as harboring suicidal thoughts, insomnia, continually feeling low, work pressure, feeling incapable and worthless and distressed mood. Research studies have revealed that extensive work pressure and insufficient rest can lead to the development of the symptoms of depression (Caruso, 2014). The case study depicts the client to be constantly demotivated based on his experiences of failure in carrying out his professional and personal duties. Feelings of hopelessness, guilt consciousness and self- destruction are correlated with the development of depression as predicted by recent studies (Fried et al., 2015).
The primary concept of the stress vulnerability model was developed in the 1977 by Zubin and Spring. The model states that an individual possesses unique characteristics within their respective personality that helps them to deal with social, biological and psychological elements of stress (Zannas & West, 2014). The stress- vulnerability further explains that an individual has inbuilt mechanisms to combat stress and depression (Franklin, 2017). It further states that there is a possibility of inheriting vulnerable genes that increase the risk of developing stress related disorder and at the same time the depressive episodes of life might also expose the subject to severe mental illness and disorders (Tiller, 2013). The stress vulnerability model serves as a natural inbuilt mechanism to treat depression.
On closely analyzing the case study, the two factors that can be identified to have caused the present condition of Chung are the drug error episode and the course of events that followed and rootlessness or home-sickness led to worsening the quality of his mental health. . The case study states that Chung had committed a severe medical error in an 8 year old boy who was suffering from intense pain. Chung had used an intramuscular medication wrongly by administering it intravenously. This resulted in a disaster and the following course of events subjected Chung to face several rounds of investigations by the human resource unit of the inner-city hospital. Evidences have shown that sleep deprivation often leads to conduction of manual error (Caruso, 2015). He had been sleep deprived and felt extremely tired and had been on call for the entire night which made him feel physically and mentally exhausted. As a result, he lost focus and committed the error. It has been stated that continuous stress leads to the deterioration of mental health and normal physiological condition (Franklin et al., 2017). The error was unjustified and it led to the dearth of several investigation rounds that kept Chung under supervision for almost 12 months. Although, the incident had happened two years ago but the consequent mental stress had led to worsening the quality of Chung’s mental health.
Further, the case study states that Chung has been studying and working in Australia for almost five long years. He had visited his native land only once after shifting to Australia had not got a chance to go back home and visit his loved ones ever since. Scientific studies have revealed that cultural distance can lead to demotivation of morale (Dixon et al., 2016). His parents, older brother and younger sister are still based in China and have not been able to come down to Australia to visit him probably because of heavy financial expenditure. Chung has been staying away from his family for a very long time and that has made him extremely home-sick. On his wedding day, the case study reports him to be feeling emotional as the ceremony lacked Chinese tradition and custom and hence it can be said that he felt lonely on being away from his immediate family. In addition to this, he has not been able to share the joy of having a daughter with his family members as he is away from his family members in an alienated place where he is not in contact with any one belonging to his community. Therefore, the most important events of his life such as his wedding and the birth of his daughter took place in the absence of his dearest family members where in the support of the family members is majorly required in these situations. Research studies have shown prolong distance from family members can elicit anxiety and depressive symptoms (Fried et al., 2015).
The recovery model aims at improving the mental health status of the people. The main aim is not just confined to the reduction of the symptoms but also includes educating the patients so as to improve their quality of life (Jacob, 2015). The education imparts training so as to instil a belief in the patients that life is beyond just existing (Seo et al., 2015). The recovery model makes use of three important aspects that would be used in designing an effective mental health intervention for Chung. The three important elements are empowerment, respect and hope (Tiller, 2013).
The second intervention that would be provided would include a family counselling session, where Chung’s wife Harriett and her parents who are taking care of the new born baby, Charlotte would be counselled. The counselling session would involve explaining Harriett about the over-involvement of her parents in the matters of the baby and depriving Chung of the quality time that he is entitled to in terms of spending time with his wife and his baby. It is important to treat the patient with respect so as to build a positive environment around him that would help in a rapid recovery (Seikulla et al., 2013).
As a midwife the first and foremost intervention that would implemented by me would include educating Chung about the risk factors associated with his poor mental health and at the same time educate his family members about the seriousness of his mental stress based on his critical MSE scores. While educating the subject of the case study and his family members, the critical aspects based on the patient history that has led to the development of mental stress in the patient would be explained and accordingly the serious consequences that could take place would also be placed in front of the family members so as to make them aware about the seriousness of the condition (Desrosiers et al., 2013). The consequences could be as serious as intellectual disability or loss of life.
The third intervention would make use of therapies to empower the patient and instil a belief in him that he is capable of emancipating himself from the emotional turmoil and lead an absolute normal life again. This could be achieved by administering cognitive behavioral therapy, counselling and narrative therapy. Narrative therapy would help in understanding the mental perspective of the patient by letting the subject speak about all the experiences that have led to the deterioration of his mental health (Goncalves et al., 2016). In addition to this, making the subject perform certain activities to make him take the responsibility of his own actions would help in making him feel positive about himself (Johnsen & Friborg, 2013). Additionally, practicing meditation and administration of music therapy could also help in making things better (Lopes et al., 2014). Chung should get to spend ample amount of time with his wife and daughter and visiting his parents with them could help in providing relief to his disturbed mind and at the same time prevent from the dearth of suicidal thoughts in him.
Reference:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
Caruso, C. C. (2014). Negative impacts of shift work and long work hours. Rehabilitation Nursing, 39(1), 16-25.
Clinical Practice Guidelines: Mental state examination. (2018). Retrieved from https://www.rch.org.au/clinicalguide/guideline_index/Mental_state_examination
Desrosiers, A., Vine, V., Klemanski, D. H., & Nolen?Hoeksema, S. (2013). Mindfulness and emotion regulation in depression and anxiety: common and distinct mechanisms of action. Depression and anxiety, 30(7), 654-661.
Dixon, L. B., Holoshitz, Y., & Nossel, I. (2016). Treatment engagement of individuals experiencing mental illness: review and update. World Psychiatry, 15(1), 13-20.
Franklin, J. C., Ribeiro, J. D., Fox, K. R., Bentley, K. H., Kleiman, E. M., Huang, X., … & Nock, M. K. (2017). Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychological Bulletin, 143(2), 187.
Fried, E. I., & Nesse, R. M. (2015). Depression sum-scores don’t add up: why analyzing specific depression symptoms is essential. BMC medicine, 13(1), 72.
Gonçalves, M. M., Ribeiro, A. P., Silva, J. R., Mendes, I., & Sousa, I. (2016). Narrative innovations predict symptom improvement: Studying innovative moments in narrative therapy of depression. Psychotherapy Research, 26(4), 425-435.
Jacob, K. S. (2015). Recovery model of mental illness: A complementary approach to psychiatric care. Indian journal of psychological medicine, 37(2), 117.
Johnsen, T. J., & Friborg, O. (2015). The effects of cognitive behavioral therapy as an anti-depressive treatment is falling: A meta-analysis. Psychological Bulletin, 141(4), 747.
Lopes, R. T., Gonçalves, M. M., Fassnacht, D. B., Machado, P. P., & Sousa, I. (2014). Long-term effects of psychotherapy on moderate depression: A comparative study of narrative therapy and cognitive-behavioral therapy. Journal of affective disorders, 167, 64-73.
Seikkula, J., Aaltonen, J., Kalla, O., Saarinen, P., &Tolvanen, A. (2013). Couple therapy for depression in a naturalistic setting in F inland: a 2?year randomized trial. Journal of Family Therapy, 35(3), 281-302.
Seo, M., Kang, H. S., Lee, Y. J., &Chae, S. M. (2015). Narrative therapy with an emotional approach for people with depression: Improved symptom and cognitive?emotional outcomes. Journal of psychiatric and mental health nursing, 22(6), 379-389.
Tiller, J. W. (2013). Depression and anxiety. The Medical Journal of Australia, 199(6), 28-31.
Zannas, A. S., & West, A. E. (2014). Epigenetics and the regulation of stress vulnerability and resilience. Neuroscience, 264, 157-170.
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