Mental Health Assessment
Name
Institution
Mental Health Assessment
Introduction
John Riley is a 36-year-old man who has visited a psychiatrist due to the concerns raised by his General Physician (GP). John works as a mechanic and lives with his parents. Mental health is a menace to most of the patients. Appropriate healthcare must be undertaken to assist those having such challenges. In several cases, patients are challenged with various problems in their lives. However, whenever they get to visit physicians, they usually get assistance and continue with the usual lifestyle. The essay refers to the diagnostic criteria listed in the DSM-5 (American, 2013) to validate the decision that the client has a psychiatric disorder. The answers provided for the case study would be supported by the evidence from the case study video. The paper contains three major sections.
Part A is the assessment of the client’s psychiatric history and family and social environment. Under this section, the GP would extract more information about the reasons for referral, history presenting the problem, occupational, current treatment, parental status, among other features. Part B deals with the mental state examination of the patient. Under this section, GP would be examining appearance, behavior, mood, speech, thought form, perceptions, cognition or intellectual functioning, insights, and judgment, risk assessment, formulation, provisional diagnosis, and need for referral. The last section of this paper is part C, which deals with various interventions that can be unleashed to bring the patient to normalcy. Here, the GP would explore medical interventions, particularly clinical issues or goals. There would be an exploration of psychological interventions that could be employed in assisting the patient. The GP would make use of nursing interventions such as diagnosis, goals, and interventions. Overall, the essay provides a roadmap of managing mania amongst patients by mental healthcare workers.
Part A: History
Mr. Riley stays with his parents and works as a mechanic. He has been referred to the GP for insomnia. He has not been sleeping for the past week. On his occupation as a mechanic, he meets several people like engineers, top management, among others. He is talkative during the whole period with the pressured speech. When asked how he would prefer to be called, he replies, “name’s a game,” and later agrees to be called John. He is a manic mechanical. The GP informs him that she is a doctor and pulls some jokes by saying, “doctor who, diddly dang, wobbly dang.” From the interview, every moment the lady speaks, the manic mechanic operates much grander as compared to the lady. The lady, in this case, the doctor lost her ego entirely, and the patient develops the feeling that he is the one in control. The patient does not realize the fact that he needs assistance from the doctor. In various cases, experiencing mania is awful, and some people might be scared of the condition. The patient denies no medical history and says that his past medical history is fantastic. For family history, the patient feels that he is cleaver than any person in the family. Riley has not been taking any prescribed medicine concerning any condition. In his career as a mechanic, Mr. John loves talking to dignitaries, and when in the session with the doctor, he requests to speak with the top boss in the medical facility. He is informed that the doctor is the top boss of the facility.
Part B: Mental state examination
From the case study, we may derive that the patient has suffered acute mania. He is very talkative with pressured speech. His attention is easily distracted from one task to the other. In most cases, distractibility happens as a result of the inability to filter out exterior stimuli or rather internal thoughts when attempting to concentrate on a matter. John is deprived of sleep, and this might bring an attention-deficit problem. On his appearance, the patient looks shabbily dressed in a colored top with the unkempt hairstyle. He holds into his perception that he is the most intelligent person in his family. The character on distractibility is presented when he said: “I’m going to get one of those” (University of Nottingham, 2012). Again, he is having false belief concerning his superiority, greatness as well as intelligence. With this, John experiences delusion grandeur. On various occasions, people who are experiencing this form of the mental problem have higher self-esteem on top of believing in their importance and greatness as well as importance even at the times they are facing overwhelming contrary evidence. For the case of the patient, he tells the doctor that “God tells me I’m going an excellent job.” This is an indication that he holds himself higher.
Similarly, the patient has a flight of ideas. From the video, it can be noted that John shifts rapidly between the conversation themes, thus making the discussion to be challenging. He speaks faster but jumps from one topic to the other. The links between his notions are incredibly loose as the rate of his speech augments. For instance, he says, “how old.” He says that “you are only as old as the women feel” ( University of Nottingham, 2012). The way to a man’s heart is through his stomach, food for the soul, a nice bit of sole”. All the works show the tangential nature of the patient. John’s insight and judgment are predetermined. He has been up all week and thinks that his cure is cancer. He says, “I have been up all week.” “This work I have been doing, and it is my cure for cancer” ( University of Nottingham, 2012). From this statement, John Riley is insomnia and has some features of grandiosity. Insomnia is related to lack of sleep for quite a longer duration, as mentioned by the patient. With the grandiose experience, the patient is describing what is more abundant than his life sentiments of superiority as well as invulnerability. This is a sense of one’s importance, which is more exaggerated in terms of knowledge, power, and identity.
The patient needs immediate care to assist in improving his condition. The provisional diagnosis for John is the acceleration of thoughts, pressured speech, and flight of ideas. However, it is possible to say diagnose him with dis-inhibition. This is witnessed when he tells the doctor, “fuck off,” unless he is often vulgar, then the condition does not suit him. He is euphoric. He remarks, “fantastic.” He is not on substance abuse, and the case of hyperthyroidism is ruled out.
Part C: Interventions
From the case study, we may derive that the patient is suffering from acute mania and should be hospitalized for 21 days. At the time of the visit, there is an episode of hypomania commonly associated with bipolar 2 disorders. Concerning a perception of the symptoms to their entirety, one may not conclude the actual type of disorder. Some of the reasons behind this conclusion are that the patient indeed had an episode of acute mania. Despite that, the patient does not show symptoms of insomnia, which are associated with bipolar 1.
Furthermore, hypomanic experience is mostly associated with bipolar 2 disorders. In such a scenario, there are no symptoms that would point the treatment toward a particular condition. The decision, therefore, would be to treat the symptoms and observe the outcomes in the patient, ensuring that the real situation is identified and the patient is treated accordingly.
We, therefore, assume that the patient is indeed suffering from bipolar 1 disorder. Furthermore, while the features of bipolar are not much in the patient, there are chances that the patient might have undergone insomniac episodes. The best approach to the treatment of the patient would seem, therefore, to deal with the conditions that were affecting her usual countenance at the time. Diagnosis of mania is one of the primary methods of keeping the patient calm to enable further treatment (American Psychiatric Association, 2013). The reason for diagnosing mania is to increase the chances of dealing with bipolar disorder, even without identifying the actual condition. We, therefore, handle the mania and the hypomanic reactions on the client. The diagnosis for the manic episode is confined to the outcomes of the presented conditions. Some of the indications that the diagnosis is accurate to include the inability of the client to conduct routine activities and the necessity for hospitalization to avoid harm on the patient or other individuals (American Psychiatric Association, 2013). A peculiar observation is that mania is usually associated with psychotic experiences. However, the patient reports not to have any psychotic experiences, and with the mania reduced the patient’s happiness is only a symptom of bipolar-related hypomania. With the presence of hypomania during the interview sessions, the expectations involved the presence of psychotic experiences.
Furthermore, the patient denied neither any substance abuse ideation nor other depressive symptoms. Therefore the patient’s hypomania would be the only case that would derive clinical interventions from the office. Some of the primary considerations to make, including the genetic factors that would affect the medication provided. According to the American Psychiatric Association (2013), atypical antipsychotic drugs have a practical impact on controlling the mood relapse of the client, especially those with manic reactions. Some of the atypical antipsychotics include risperidone, which is known to be useful, especially for the manic episodes and not for the depressive symptoms. Indeed, the patient did not face any depressive episodes which leave mania and hypomania as the primary symptom affecting the client. Genetics comes in because the CYP2D6*10 allele is responsible for the metabolism of the risperidone compounds. According to Sajatovic, Madhusoodanan & Fuller (2006), a large portion of patients tend to express homozygous for the CYP2D6*10 allele. The implication is that Americans have a higher chance that with antipsychotic medications such as the Risperidone, the patient may take relatively a long time to get the drug out of their system. It, therefore, explains the somnolence of the client even a week after ending medication. After letting the medication wear out for weeks, the client would reduce the level of mania, and the lethargy also decreased due to the risperidone. After drug cessation, the client would be expected to be less lethargic and that the symptoms will have reduced. However, the outcome was that the patient faced an increase in the signs over the next three weeks, which required an administration of lithium for mood stabilization. The expected decision was the use of a different medication other than lithium because the patient had shown no change in the symptoms after the introduction of lithium in the previous medical center. The psychiatrist would use an alternative such as carbamazepine (American Psychiatric Association, 2013). However, the psychiatrist might introduce the patient to an increased dosage of lithium, which may indeed stabilize the mood. Nonetheless, the outcomes of the medication may not be as expected because the patient might fail to show control symptoms after the introduction of the first line of lithium dosages.
For the psychological and nursing interventions, family together with the interpersonal associations assist in shaping the identity of an individual alongside having essential impacts on the mental well-being of the clients along with the recovery and outcome. A fundamental relationship might be deemed to be natural support. That is to say, and there are resources inherent within an individual’s environment that might be employed towards supporting the recovery of an individual with a mental problem (Gilligan et al., 2016). In various situations, the members of a family are never involved in the life of consumers due to abuse or rather violence that happened within a family or rather legal actions taken against them. In such conditions, family involvement within the mental health care of a consumer requires careful deliberation, conferring as well as getting consent from the consumer.
Therefore, family members should take all the measures required to bring John Riley into healthy living. Families are entering into unknown territories wherever they are facing challenges in learning how to cope up with the symptoms of mental illness. This is making them use a lot of their resources in reinstating the patient into normal states. This implies that family members are using resources to seek medical services for their affected members of the family. The family members similarly provide emotional support to the consumers, an issue that is making the work of health professional to be easy. Since various changes are imminent during the treatment process, family members should take appropriate measures in ensuring that patients get emotional support during the treatment process (Shantell, Starr & Thomas, 2007).
Conclusion
By and large, doctors and other persons working in mental care facilities are deemed to be substantially effective when they guard against using their systems in judging the feeling, thoughts, or rather behaviors of clients. For the appropriate recovery model, the care providers should develop judgmental values to know the opinions of the clients genuinely. When a caregiver has judgmental benefits, he or she will not appropriately establish the feelings of a patient. Thus, the therapeutic relationship will be successful.
References
American Psychiatric Association. (2013). Practice guideline for the treatment of patients with bipolar disorder (revision). American Psychiatric Pub
Gilligan, C., James, E. L., Snow, P., Outram, S., Ward, B. M., Powell, M., & Harvey, P. (2016). Interventions for improving medical students’ interpersonal communication in medical consultations. The Cochrane Library.
Sajatovic, M., Madhusoodanan, S., & Fuller, M. A. (2006). Risperidone in the treatment of bipolar mania. Neuropsychiatric disease and treatment, 2(2), 127.
Shantell M., Starr ST. and Thomas S. (2007) Take my hand, help me out’: Mental health service recipients’ experience of the therapeutic relationship. International Journal of Mental Health Nursing. 16, 274–284
University of Nottingham (2012), Psychiatric Interviews for Teaching: Mania. Viewed from: https://www.youtube.com/watch?v=zA-fqvC02oM