Mental State Examination (MSE)
Mental State Examination (MSE) is commonly referred to as a structured assessment of the cognitive and behavioural functioning of a patient. The examination mostly involves providing a description of the general behaviour and appearance of the person being assessed, his/her level of consciousness, patterns of attentiveness, speech and motor activity, affect and mood, perception and thoughts. Furthermore, the examination also provides an insight into the attitude of the patient, thereby assisting in the process of gaining a sound understanding of the higher cognitive abilities of the patient. This case study deals with a patient named Chung, who is a doctor and works in the Accident and Emergency department. Upon analysing the case study, two components of the MSE that have been identified in the patient are perception and thought, and mood and affect. Psychotic thinking is primarily characterized by an inability of an individual to process information in an appropriate manner (Yang, Rosenblau, Keifer&Pelphrey, 2015). This is generally demonstrated by the way a person responds to stimuli, by perceiving them. Chung was found to harbor concerns that were related to increased levels of irrational dread and fear. He also responded in an exaggerated fashion to actual event such as, the medication error that he was responsible for, which threatened the life of one of his patients.
Hence, symptoms that highlight the fact that Chung exhibited an increased tendency towards somatisation and was continuously troubled with obsessive ideas about suicide and other intrusive thoughts are enough to testify the disruption in his perception and thought related capabilities (Trzepacz, Hochstetler, Wang, Walker & Saykin, 2015). The component of mood usually refers to sustained emotional temperament of a personality. Chung was found to display a range of affect that were flat and restricted. Presence of a flat mood provided evidence for major reduction in his emotional expressiveness, thus making him show a diminished facial expression. Following a careful review of his presenting complaints, and an analysis of the DSM-V criteria, it can be suggested that Chung suffers from Unspecified Depressive Disorder 311 (F32.9) that is used for the diagnosis of condition where the symptoms are commonly characteristic of depression that results in significant impairment and distress in occupational, social, and other essential areas of functioning (APA, 2013). However, it fails to meet the complete criteria for any of the other kinds of depressive disorder classes.
These criteria act as the principle authority that helps in psychiatric diagnosis and also provides assistance to healthcare providers for the treatment and recommendation proposal for maintaining a sound mental state of a client. He has been diagnosed with unspecified depression type with melancholic features. Some of the common symptoms of the disorder are a loss of pleasure in different activities, and a lack of reactivity to pleasurable stimuli. Furthermore, this melancholic feature was identified in him due to his distinct quality of being depressed, and presence of a profound despondency (Hungerford et al., 2012). Furthermore, the disorder is characterised by early morning awakening, weight loss, guilt and agitation, all of which were found in Chung. Thus, it can be clearly deduced Chung is suffering from moderate-severe form of unspecified depression disorder.
Stress Vulnerability Model and Factors contributing to Mental Health
Three factors that contributed to the development of stress in Chung are cultural diversity, occupational stress and birth of his daughter. The incidents of depression among Chinese individuals who reside in traditional Asian places are low. However, recent cross-psychological studies have found an elevated propensity of anxiety and depression among Chinese immigrants to Australia, into issues that are related to their integration into the Australian society. One of the most common issues faced by such Chinese people are acculturation to stress (Lin, Bryant, Boldero & Dow, 2016). A similar thing was encountered by Chung, where his adaptation to the Australian culture involved modifications in different areas of functioning such as, attitude, beliefs, behaviours and values, which were experienced as stressful events by him. This resulted in a cultural shock that lead to a feeling of disorientation in the patient, when he was suddenly subjected to unfamiliar ways of life and attitudes that were different from his Chinese traditions. Since Chung had an extremely busy work schedule in the Emergency Department, he had been involved in a medication error event that directly threatened patient safety and breach the standards of patient care. Evidences have often established the fact that work related stress often aggravates the severity of existing mental health disorders (Ruotsalainen, Verbeek, Mariné & Serra, 2015). Furthermore, there is mounting evidence that suggests presence of a correlation between occupation and stress in Chung, which in turn increased his risks of depression, mood disturbance, sleep disruption and anxiety.
The fact that Chung was kept under supervision for a year due to the medication error aggravated his condition. Additionally, research studies also illustrate that one in ten males commonly experience Paternal Postpartum Depression, following the birth of a child (Misri, 2018). High scores of depression are found among new fathers, during the initial 5 years of their children’s lives, which is considered as a crucial time for forming a bond with the babies. This is often attributed to a decrease in the levels of testosterone and an increase in the levels of oestrogen that made Chung biologically predisposed to Paternal Postpartum Depression.
According to the stress vulnerability model, there are three critical factors, which result in development of a psychiatric disorder over time namely, stress, protective factors, and biological vulnerability. The biological tendency to development of a particular disorder is generally determined by early biological factors such as, viral infection or genetic factors that increase the severity of disorder. Stress also creates an impact by either triggering the disorder onset, or worsening its course, and is a direct response to certain life situations that require an adaptation of change in the person (Swearer & Hymel, 2015). Protective factors are associated with coping skills and medications, which have the potential of lessening the symptoms and reducing relapse risks. Besides, the model also suggests that families play an important role in improving mental health outcome by building protective factors, which in turn is facilitated by developing good communication, monitoring disorder symptoms, and supporting the person. Distance of Chung from his family and community worsened his condition.
Recovery-Oriented Mental Health Theory and Principles of Recovery
Data reports suggest that 3 in 5 people belonging to the age group of 15 to 64 years, suffered from mental condition in 2014-2015 (Abs.gov.au, 2018). Moreover, depression has also been found to have lifetime prevalence and it has the third highest burden of different diseases in Australia (Blackdoginstitute.org.au, 2018). The journey of recovery from any mental disorder commonly encompasses retaining and gaining hope and understanding the abilities and disabilities of an individual, which in turn allows the person to live a purposeful life. This is most often achieved by engaging in an active life, developing a social identity, identifying life goals, inculcating a positive sense of self-esteem and personal autonomy. Discovering and nurturing hope have time and again been identified as the key to the recovery journey, and it most often includes the sustainable belief in an individual (Kirst, Zerger, Harris, Plenert & Stergiopoulos, 2014). Besides inculcating a feeling of optimism, hope also helps the affected person developer a willingness to persevere through the different setbacks and uncertainties of life. Although it might begin at a turning point in life, it would gradually emerge in the form of a fragile and small feeling. This will make the patient place trust on others and risk his failures and disappointments, thus making Chung develop the desire to lead a better life.
Development of a positive culture that promotes healing is imperative in the recovery approach due to the fact that recovery is not at all synonymous with the cure or treatment of a disease. There is a need of a very strong support network for a successful recovery journey. Self-determination and empowerment are one of the most essential elements that reduce the psychological and social effects of stress. Empowering Chung would help in developing a sense of confidence in him, for exerting his independent assertive decision, and promoting a character of seeking help from others. This will translate in the form of self-care practices and adherence to proper medications. Taking efforts to eliminate social inclusion that he has recently been facing and challenging all the prejudice and social stigma that exist regarding mental distress will form an essential part of patient empowerment. This in turn would help him recover his detached identity and social skills, and can also be facilitated by making him listen to ‘lived experiences’ of people who have had suffered from the same psychological distress, but are now leading a successful life (Grealish et al., 2017). Dignity and respect would also be imperative in his recovery journey, since most people suffering from mental illnesses are treated in a negative way, due to social stigma. These stereotypes trap them in the cycle of disease. Adopting a behaviour that involves being respectful of his values and traditions, and displaying a courteous behaviour towards Chung would help him identify the willingness to treat his condition, and help him understand that his concerns are being genuinely addressed. This would also involve showing respect and sensitivity for the Chinese culture and beliefs, and challenging the existing stereotypes.
References
Abs.gov.au. (2018). 4364.0.55.001 – National Health Survey: First Results, 2014-15. Retrieved from https://www.abs.gov.au/ausstats/[email protected]/Lookup/by%20Subject/4364.0.55.001~2014-15~Main%20Features~Mental%20and%20behavioural%20conditions~32
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Arlington: American Psychiatric Publishing. https://doi-org.ezproxy.uws.edu.au/10.1176/appi.books.9780890425596
Blackdoginstitute.org.au. (2018). Facts & figures about mental health. Retrieved from https://www.blackdoginstitute.org.au/docs/default-source/factsheets/facts_figures.pdf?sfvrsn=8
Grealish, A., Tai, S., Hunter, A., Emsley, R., Murrells, T., & Morrison, A. P. (2017). Does empowerment mediate the effects of psychological factors on mental health, well?being, and recovery in young people?. Psychology and Psychotherapy: Theory, Research and Practice, 90(3), 314-335. https://doi.org/10.1111/papt.12111
Hungerford, C., Clancy, R., Hodgson, D., Jones, T., Harrison, A. & Hart, C. (2012). Mental health care: An introduction for health professionals. John Wiley & Sons Australia, Limited.Retrieved from- https://www.wiley.com/en-us/Mental+Health+Care%3A+An+Introduction+for+Health+Professionals-p-9781742168135
Kirst, M., Zerger, S., Harris, D. W., Plenert, E., & Stergiopoulos, V. (2014). The promise of recovery: narratives of hope among homeless individuals with mental illness participating in a Housing First randomised controlled trial in Toronto, Canada. BMJ open, 4(3), e004379. https://dx.doi.org/10.1136/bmjopen-2013-004379
Lin, X., Bryant, C., Boldero, J., & Dow, B. (2016). Psychological well-being of older Chinese immigrants living in Australia: a comparison with older Caucasians. International psychogeriatrics, 28(10), 1671-1679. https://doi.org/10.1017/S1041610216001010
Misri, S. K. (2018). Paternal Postpartum Depression: A Sad Dad. In Paternal Postnatal Psychiatric Illnesses (pp. 11-34). Springer, Cham. https://doi.org/10.1007/978-3-319-68249-5_2
Ruotsalainen, J. H., Verbeek, J. H., Mariné, A., & Serra, C. (2015). Preventing occupational stress in healthcare workers. Cochrane Database Syst Rev, 4. Retrieved from- https://www.researchgate.net/profile/Jani_Ruotsalainen/publication/268359761_Preventing_occupational_stress_in_healthcare_workers/links/5617b8d708ae3eadf96af256.pdf
Swearer, S. M., & Hymel, S. (2015). Understanding the psychology of bullying: Moving toward a social-ecological diathesis–stress model. American Psychologist, 70(4), 344. https://dx.doi.org/10.1037/a0038929
Trzepacz, P. T., Hochstetler, H., Wang, S., Walker, B., & Saykin, A. J. (2015). Relationship between the Montreal Cognitive Assessment and Mini-mental State Examination for assessment of mild cognitive impairment in older adults. BMC geriatrics, 15(1), 107.https://doi.org/10.1186/s12877-015-0103-3
Yang, D. Y. J., Rosenblau, G., Keifer, C., & Pelphrey, K. A. (2015). An integrative neural model of social perception, action observation, and theory of mind. Neuroscience & Biobehavioral Reviews, 51, 263-275.https://doi.org/10.1016/j.neubiorev.2015.01.020
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