Mental Health Assessment and Intervention - Case Study Example

Title: Mental Health Assessment (Case Study) Name Course Tutor Date Introduction Mr. Bob Smith is 94 years of age with a mental condition known as psychotic depression that was diagnosed two years after the death of his wife. Historically he was once a prisoner of war after which he got married and had a family of two sons. The sons are not close to him and accuse Mr. Smith of having been violent to them and their mother. Because of this, they have rarely stayed in touch with him. He got admitted at the Placid Palms facility for the aged which is a health clinic for people with mental illnesses. Mr. Smith’s condition has resulted in a number of issues. First, he believes that someone is fishing his stomach and that his room at the aged care facility is constantly being searched by unknown persons. He is also concerned that the cleaners who are in charge of his room and the nurses responsible for the medications are giving him the wrong type of medications. Even recently, he was given a lavender spray for his room but he doesn’t use it because he thinks that it is a poison spray. Furthermore, he complains that someone is abusing his next roommate. The circumstance under which Mr. Smith is under is caused by the mental condition of psychotic depression. Generally, Mr Smith is in good health condition apart from the fact he is suffering from the random mental disorders. He is admitted at my clinic. He is a non-smoker and does not drink. At Placid Palms, he is very popular and very well thought of. In fact he is known to be very polite and humble. He can still the newspaper daily and is always updated with the current affairs. As I approach him he is busy reading a newspaper which he puts aside as a greet him. This is a sign of politeness. He is neat and presentable. I then embark on assessing his condition. The Mental Health Problem An assessment of Mr. Smith’s condition encompasses his whole person, the physical, the biological as well as the psychological being. Psychotic is a word that is related to the word psychosis and is a psychiatric term which is used to explain a mental condition (Garret et al, 2011). It is characterised by experiences such as hearing voices, seeing unusual things and experiencing delusions. Also, the person tends to hold unusual beliefs that any other person cannot experience or share (De Battista & Lembke, 2008, p. 59). Psychotic depression might lead to schizophrenia diagnosis which might be the case for Mr. Smith. For instance, Mr. Smith has an unusual belief that someone is constantly fishing in his stomach. This condition has allegedly made him to stop eating as he also claims that he is experiencing constipation. Thus Mr. Smith’s mental status is not stable. When one experiences psychosis, it is like they are dreaming. Normally when human beings dream, they can experience all sort of strange things. At the same time, they feel that frightening things are happening to them. At some point the psychotic feelings can feel real and intense (Swartz & Shorter, 2000). Psychosis impairs a person’s sense of reality. It changes the thinking of a person as the mind and the thoughts become confused (Swartz & Shorter, 2000, p. 15). Mr. Smith may at times experience difficulties in following a conversation or even trying to recall things. However, my assessment of him is that his mental status is not son in danger. He has a stable mind if he can be able to read a newspaper and be updated with current affairs. His thoughts may tend to slow down at some point which can also affect his thinking. A thorough assessment of Mr. Smith’s psychological status is also needed. Psychotic depression affects the mind in a negative way. When it affects the mind it can lead to severe depression which can even multiply into schizophrenia (Garret et al, 2011, p. 113). Psychological effects include things such as false beliefs and delusions. When a mentally ill person believes that something actually exists when it is not even real, they are said to be experiencing delusions. For delusions, the patient becomes so strongly believes in those things that even a logical argument cannot convince him otherwise (Tohen et al, 2012). For instance, Mr Smith has this strong belief that his room at the aged care facility is being searched. In the actual sense, no one searches his room and no argument whatsoever can convince him that no one actually searches his room. Feelings of being monitored and watched are a sign of mental instability (Barr & Cotteril, 2000). Likewise, the thought of a man fishing from his stomach is very unreal. A normal person can never have things being fished out of their stomach. However, Mr Smith believes so and it has made him not to even eat. He constantly complains of constipation which he may not be experiencing. Another element of mental and psychological instability for psychotic depression patients is hallucinations (Garret et al, 2011, p. 175). In most of the cases, most of them experience feelings of seeing, smelling or hearing things that do not exist. It becomes very distressing and disorienting and can cause major mental disorders (Gorman et al, 2002, p. 239). Mr. Smith hears voices. Particularly, believes that the patient next door who is also his mate in the aged care facility is being mistreated by someone. The belief could be probably from the fact that he hears voices of something like cries of pain or grief. Logically, no one could be abusing a mental patient in an aged care facility. The voices could be negative, positive, ridiculing or threatening. It all depends on the individual patient. There are also other hallucinations that make the patients see images and visions in a distorted manner (Veague, 2003). Constant and stationary things may start to move even when they are not supposed to be moving. According to Womble 2005 at p.17, the patient tends to experience tastes and smells that have no apparent cause. For instance, Mr. Smith is given a lavender spray for his room but he cannot use it. He has this strong belief that it is a poisonous spray. Moreover, he feels that the nurses are giving him the wrong tablets. Such symptoms are normal for psychotic depression as some of the delusional ideas can be very frightening (Veague, 2003, p. 90). Such are thoughts that someone is trying to kill you. Another patient may also have the feeling that some other person is trying to take control over their lives. Doctors have referred to this as paranoid ideas and delusions (Gorman et al, 2002). Several episodes may also go through the mind forming something like a film thus making it more real. For some patients, they may start to avoid some situations or try to protect themselves. A standardized psychological assessment if done to Mr. Smith can establish his psychological state. Treatment Treatment for psychotic depression includes what is usually known as electroconvulsive therapy (ECT), along with other combinations of antidepressants and other drugs that have anti-psychotic effects (Fundukian & Wilson, 2008). Generally, mental health workers and other nurses and professionals must look at all the aspects of the patient’s condition. These include the physical, psychological, moral and social aspects. Moreover, the care givers must take into account the environmental aspects as well as providing the nurse with all the necessary information that will be helpful to him/her (Gorman et al, 2002, p. 241). Mr. Smith will thus be put in a conducive environment appropriate for his health and recovery. So far, Mr. Smith has been subjected to medication and enough social support. I am yet to establish whether he has undergone talking treatment. This is the kind of treatment that involves face to face conversations with an expert or a professional. He can also be given a chance to decide which type of treatment is appropriate for him if one is not working. In his case, Mr. Smith has been taking rispridone and prothiadin which he usually takes at night. Other kinds of medication can be added to the list. Psychotic depression is treated with drugs known as neuroleptics and other major tranquilisers (Swartz & Shorter, 2000). This is inevitably necessary because he shows other side symptoms that need to be addressed. For instance, he has experienced loss of appetite for some time. He could be given pills that will help in the improvement of his appetite. Loss of appetite is detrimental as this will mean that he is not having good food and the required nutrients. Moreover, he experiences very poor sleeping patterns. Lack of sleep can lead to bad health and must be countered. Specific prescriptions for drugs that will induce sleep are needed. Furthermore, he has exhibited characters of withdrawn behaviours. Several schizophrenic episodes can result into a pessimistic attitude, stigma and discouragement (Beck & Alford, 2000, p. 57). Due to this Mr. Smith is not exempted from showing behaviours that make him withdrawn from the people around him. Even though most of his time is spent reading newspapers, this could only be an escape route to withdrawal. Therefore the nurse is supposed to take into considerations some of these minor behaviours and prescribe the necessary prescriptions. In addition, clinical expertise and practitioners must be the only ones to give the necessary treatment. Appropriate treatments must be administered and the right procedures followed. It is essential that only practitioners who have skills and enough knowledge diagnose conditions such as psychotic depression and schizophrenia (Tohen et al, 2012, p. 56). There are also a number of psychological treatments that can be effective to deal with the mental status of Mr. Smith. They may include guiding and counselling services (Sutton, 2009). Talking Treatments Talking treatments could also prove to be very helpful in the recovery of a patient with schizophrenia. These provide services such as counselling, cognitive behavioural therapy (CBT), and also psychological therapy (Beck & Alford, 2000, p. 57). Frequent administration of these services reduces levels of stress in a patient. Mr. Smith probably needs therapy because he was once a prisoner of war which might have affected him in a negative way. Moreover talking treatments will help Mr. Smith to cope with depression as well as anxiety. Depression in his life can be caused by various factors. For instance his past life is characterised by engagement in hostile environments. Being a prisoner of war is not very friendly at all. If subjected to counselling, Mr. Smith will be able to talk about and relieve his experiences in as a prisoner of war. Subsequently, the fact that his wife died five years ago might be another stressful factor in his life. The life of a widower can get very depressing at times, which might have contributed to his psychotic condition. Also, the fact that his two sons have really distanced themselves from him could be another contribution factor for stress. Cognitive behavioural therapy is essential also for relieving stress (Snowden, 2003). Moreover, psychotherapy digs into the conscience of the patient in order to help them unleash the harboured feelings. Nursing Care Assessment and intervention of Mr. Smith’s condition needs specialised nursing care and treatment. The most effective intervention in psychotic depression is usually early recognition (Snowden, 2003). However, the early signs of the disease are not usually so easy to detect. Sometimes they are mistaken for mood swings. Moreover, the symptoms may be viewed differently in diverse cultural and linguistic settings (Womble, 2005). Necessary care should be taken to ensure that the patient does not go through chronic depression as some of the symptoms can be very traumatic. If treatment takes too long to start, the symptoms will stay and will hardly go away. Delayed detection also increases the risk of developing more fatal symptoms (Swartz & Shorter, 2000). Earlier detection and treatment will increase the chances of the patient getting even a full recovery. Adequate nursing care should also be supplemented by family support. But for Mr. Smith, he does not get any family support apart from the social support he receives from the home for the aged. Any nurse in charge must see to it that Mr. Smith receives collective nursing care that will meet all his social and psychological needs. Ultimately, quality nursing care involves the involvement of the mental health workers to repeatedly provide reassurance to the patients (Garret et al, 2011). Reassurance and good services help the patients not to give up in life. Furthermore, determining the best treatment for the patient depends on a number of factors. These include the patient’s own preference, the severity of the symptoms, and the duration that the disease has lasted (Barr & Cotteril, 2000, p. 23). Mr. Smith is ultimately in need of regular appointments with the doctor. So far he has only attended a few times. The nurse in charge also needs to set specific goals that he/she must achieve in regard of the health of the patient (Tohen et al, 2012). Mr Smith’s diet in particular need to be improved. In order to maintain good physical condition, there is need that he will be eating healthy foods and follow a healthy nutritional pattern. In intervening about the most appropriate diet, the nurse ought to identify the specific food and meal preferences for Mr. Smith. In providing quality nursing care, the nurse must also ensure that the strengths of the patients are not compromised (Swartz & Shorter, 2000, p. 15). Notably, he must be given a voice in determining the type of foods that he enjoys the most. Enough time should also be allocated for meal times, especially because he believes someone fishes the food he eats out of his stomach. Conclusion Mr. Bob Smith was admitted from Placid Palms, a facility that was set up to provide care and maintenance for the aged to our clinic. He is 94 years of age and has a history of psychotic depression. He was brought to the clinic because of a number of concerns. He had been experiencing a number of delusions, flying ideas and hallucinations, symptoms that are associated with depression and other complex diseases such as schizophrenia. Evidence of this is adduced from the fact that Mr Smith was constantly complaining of weird things such as a person fishing out of his stomach and his room being searched while it is actually being searched. At the time of admission, Mr. Smith was under two types of medication: risperidone and prothiadin. These were mainly administered at night with an intended effect of lowering the levels of depression. After an assessment, his medication was reviewed and he was put under neuroleptics. These are used to treat chronic depression that may result into schizophrenia. Moreover, he was given sleeping pills because it was observed that he was lacking sleep. He was also given drugs that would help increase his appetite. Furthermore, he was put under programmed therapy sessions which helped his psychological health to improve. The other form of treatment offered to Mr. Smith is the talking treatment which included frequent guiding and counselling services with a professional psychologist. The nursing care given to him incorporated reassurance programmes and a good eating diet aimed at restoring his mental health. Social support was also given. Notably, Mr. Smith has shown considerable improvement from the time of admission at our clinic to the time he has been discharged. His health has greatly improved and the hallucinations and delusions are almost fading. An appointment with a psychiatrist has been scheduled for him every Wednesday of the week. The nurses are confident enough that Mr. Smith’s condition has considerably improved. Mr. Smith himself is also positive enough that he will continue attending therapy and the services of a therapy support group near his home. 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