Mental State Examination and DSM-V Diagnosis
Before identifying two components of Mental State Examination, it is important to note that the mental state examination consists of evaluating aspects such as general appearance, behavior, any unusual idea or unusual or strange perception (eg, delusions, hallucinations), mood and all the aspects of cognition (eg, attention, orientation, memory).
One component of Mental State Examination associated with Chung is suicidal and / or homicidal ideation. The case shows that Chung has been experiencing fleeting thoughts of suicide for the last week. He is aware of high lethality medications which he could take to overdose. Currently, he is hopeless and helpless and wants to die. If the interview shows that the client plan to commit suicide, the health care provider should consider that as a serious mental issue that should be addressed promptly.
Another component of Mental State Examination concerns the expression of thought. Expression of thought can give an idea about whether a client is experiencing some mental health issue (Cybulski, Cybulski, Krajewska-Kulak & Cwalina, 2017). Assess the form of expression, speed of thought and quality of ideational flow. If it is logical, if it has a purpose, if it is tangential, if there are ideational leaks or failure in associations. The alterations in this element can represent disorders of thought. The case shows that Chung’s speech is slowed and purposeful. On occasions, the community nurse needs to repeat his question several times to get a reply. This shows that Chung is experiencing disorders of thought and this is an indication of a mental health issue.
Motor activity is another component of Mental State Examination that can tell whether the client has a mental health issue or not (Wikberg, Pettersson, Westman, Björkelund & Petersson, 2016). Motor activity entails examining actions such as standing, walking, posture, facial gestures, abnormal movements (tremors, automatisms) and general movement of the body. Observe if they are exaggerated movements, may be a sign of a manic phase, or slow, which could be a sign of a depressive phase. The case shows that during the visit, Chung slumped in his chair, with rounded shoulders and starring at the floor for long periods. This shows that Chung has some motor activity abnormalities.
DSM-V states that when a patient experiences of symptoms such as feeling of worthlessness, suicidal thoughts, psychomotor impedance, and severe loss of general functioning could be an indication of a major depressive episode in addition to the normal response to a significant loss (Riepe, Gritzmann & Brieden, 2017). Chung clearly possess most the symptoms identified in DSM-V that are used to diagnose a major depressive episode. For example, Chung exhibit depressed mood is present almost all day, almost every day, reported by the subject (feeling sad or empty) or observed by others (crying). Chung have also experienced significant loss (5%) in the absence of diet. He is also experiencing insomnia or hypersomnia almost every day. Chung also experiences recurrent thoughts of death (not just a fear of dying), recurring suicidal ideation without a specific plan or suicide attempt, or a specific plan to commit suicide. All these symptoms, according to DSM-V are used to diagnose the presence of a major depressive episode.
Factors Contributing to Mental Health Status
One of the possible factors that must have contributed to the development of Chung’s current mental health status is ineffective coping skills. According to Stress Vulnerability Model, ineffective coping skills are necessary antidote for some of the mental health problems (Padilla Paredes & Calvete Zumalde, 2015). Chung experienced a lot of psychic pressure due to different challenges he faced related to job, family and responsibilities. The case shows that Chung has been feeling increasingly anxious during the past two months, given his continuing long hours, shift work, the high pressure of an Accident and Emergency department, Charlotte’s birth and his wife’s health. These changes require adaptability and self-sufficiency that are difficult to assume, leading to an increase in health problems directly related to working conditions. If Chung had effective coping skills, he could have lessened the magnitude of the mental health problems he is experiencing now. This is because coping skills can aid in handling stress and easening its negative effects on vulnerability (Cui, Shi & Oei, 2013). There are several justifications that shows that Chung lack effective coping strategies. First, Chung does not have appropriate relaxation strategies for coping with stress and tension. The body’s automatic responses to a threat are usually muscle tension, acceleration of breathing or heart response, irrational thoughts, etc. Well, the relaxation response is its opposite, has a recovery effect and returns the organism to its natural state of equilibrium. There are many trends that teach you to live in the moment, to taste and enjoy it. For example, the practice of mindfulness, yoga, meditation … There are also those who do pilates. This is a good way to stretch muscles and oxygenate the body. However, Chung does not engage in any of these relaxation techniques. Second, Chung lack social skills that can enable him connect people, deal with conflict, and obtain support. Social skills can help a person cope with stressful circumstances and hence reduce his chances of developing mental health problems (Yeager, Cutler, Svendsen & Sills, 2013). The case shows that Chung does not have appropriate social skills. One of the main components to work on social skills is assertiveness understood as the capacity for self-affirmation of the human being through the defense of their rights, the expression of their positive and negative feelings in an appropriate way and the acceptance of oneself. The case shows that Chung lacks assertiveness. He has no control over what is happening. He cannot make independent decision regarding his family.
Principles of Recovery: Respect, Empowerment, and Hope
The second factor that must have contributed to Chung’s current mental health problems is social support. Stress Vulnerability Model consider social support as a crucial way of reducing the negative effects of stress on vulnerability. Social support entails having close and meaningful relationships with other people. Chung lacks social support. For example, he is not open and willing to reveal his problems to Harriet or her parents. Lack of social support forces Chung to stay in seclusion and creates feeling of helpless and hopeless. This is evidence by the fact that he feels that he is letting his wife and new daughter down.
The recovery orientated mental health theory is based on the fact that people should be provided with opportunities to find their place and way of being. The increase in the sense of control of one’s own life and the desire to normalize life fully are present in the spontaneous discourse of those affected. They move away from positions focused on pathology, disease and symptoms to approaching positions that emphasize skills and horizons of development and personal growth. Consequently, under the recovery orientated mental health theory, some of the ways in which people can find their place and way of being include respect, empowerment and hope. In Olson, In Young, & In Schultz (2016) demonstrated that personal empowerment and choice are core themes of recovery. Empowerment enables Chung gain mastery or control over his own live and to engage in democratic participation in the life of his family. Personal empowerment entails giving the client or the patient chance to make most of the decisions regarding his or her problem. The relevance that “first-person accounts” of people who are in the process of recovery have been acquiring in recent years, and that show the importance of the subjective perspective of the person concerned and the immediate environment in the recovery. The case clearly reveals that Chung is not empowered. The case shows that Harriett’s parents are staying with them to support Harriett while Chung is at work. However, he finds that Harriett’s parents are very involved with baby care even when he is home. Given this, Chung finds he gets very little time and space to be with his new daughter.Empowerment alone is not enough.
Empowerment is possible if there is respect. In Olson, In Young, & In Schultz (2016) argues that empowerment is an important recovery theme as a process involving respecting oneself, demanding respect from others and expecting and possessing a strong conviction in one’s own sense of agency and self-determination. Lack of respect frequently translates to low levels of self-esteem and self-stigma when individuals adopt negative societal attitudes towards mental illness as their own. Chung’s case shows that he does not get the needed respect from those around him. Harriet’s parents seem to have neglected him and does not care about his problems. They know that he needs to show love and affection to the daughter but they do not allow him to do so. This shows that element of respect is not there. The case also shows that Chung does not have self-respect. The suicidal thoughts are an indication of lack of self-respect. For example, the case shows that Chung feels he is worthless and a failure at work within his medical role and he is letting his wife and new daughter down. He has been experiencing fleeting thoughts of suicide for the last week.
Hope is another essential recovery requirement (Jones-Smith, 2014). Doyle, Lanoil, & Dudek (2013) argues that the main reasons that the affected people give to explain their struggle against recovery often focus on internal elements as important as the hope of change. This is what Chung lacks.
References
Cui, L., Shi, G., & Oei, T. S. (2013). A Study of Cognitive Vulnerability-Stress Model of Depressive Symptoms among Chinese Adolescents. Stress & Health: Journal Of The International Society For The Investigation Of Stress, 29(5), 383-391. doi:10.1002/smi.2484
Cybulski, M., Cybulski, L., Krajewska-Kulak, E., & Cwalina, U. (2017). Self-assessment of the mental health status in older adults in Poland: a cross-sectional study. BMC Psychiatry, 171-10. doi:10.1186/s12888-017-1557-y
Doyle, A., Lanoil, J., & Dudek, K. (2013). Fountain House: Creating Community in Mental Health Practice. New York : Columbia University Press
In Olson, K., In Young, R. A., & In Schultz, I. Z. (2016). Handbook of Qualitative Health Research for Evidence-Based Practice. New York, NY: Springer New York.
Jones-Smith, E. (2014). Strengths-based therapy: Connecting theory, practice and skills. Los Angeles : SAGE Publications
Padilla Paredes, P., & Calvete Zumalde, E. (2015). A Test of the Vulnerability-Stress Model with Brooding and Reflection to Explain Depressive Symptoms in Adolescence. Journal Of Youth & Adolescence, 44(4), 860-869. doi:10.1007/s10964-014-0148-1
Riepe, M. W., Gritzmann, P., & Brieden, A. (2017). Preferences of psychiatric practitioners for core symptoms of major depressive disorder: a hidden conjoint analysis. International Journal Of Methods In Psychiatric Research, 26(1), n/a. doi:10.1002/mpr.1528
Wikberg, C., Pettersson, A., Westman, J., Björkelund, C., & Petersson, E. (2016). Patients’ perspectives on the use of the Montgomery-Asberg depression rating scale self-assessment version in primary care. Scandinavian Journal Of Primary Health Care, 34(4), 434-442. doi:10.1080/02813432.2016.1248635
Yeager, K., Cutler, D., Svendsen, D., & Sills, G. M. (2013). Modern community mental health: An interdisciplinary approach. Oxford: Oxford University Press.
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