Importance of Mental State Examination in Psychiatric Practice
1.Mental State Examination (MSE) is an important assessment in psychiatric practice which provides a structured way of describing psychological functioning of a patient at a given time frame. Considering the case study of Chung, domains of speech, mood and affect are explicitly relevant that provides a comprehensive description of his mental state and allows accurate formulation and diagnosis for treatment (Mitchell, 2013). The speech of the patient is observed based on paralinguistic features like rhythm, loudness, pitch, rate, quantity and latency. His speech was slow and purposeful (Taylor, 2013). There were repetitions of questions and it was difficult to get information from him. Most of the time, Chung was non-responsive when the nurse inquired about his health. Speech is also associated with mood and affect. Chung’s affect is sad and restrictive and he was quiet, slow and flat in mood and tearful. According to the case study, Chung’s mood is described anxious as apparent through his non-verbal behaviour. There is blunted or flat affect that may be associated with any sort of heightened or dramatic effect showing anxiety. During the assessment, the patient had restricted affect where he was totally un-reactive and not with the flow of the conversation. A bland lack of concern in response to the conversation was observed in Chung.
According to the American Psychiatric Association, DSM V, anxiety disorders shares its features with anxiety and fear. Anxiety is anticipatory and in the given case study, Chung is anxious in response to a perceived threat where he is experiencing thoughts of a heart attack in the future. The signs and symptoms experienced by Chung meet the DSM-5 Diagnostic Codes of 300.01 Panic Disorder. The primary features that define panic disorder experienced by Chung are inappropriate worries or fear about future, unexpected and persistent panic attacks as he might get a heart attack (American Psychiatric Association, 2013). Various changes take place in the body due to panic attacks like trembling, dizziness, sweating and increased heart rate that is also witnessed in Chung. Physical and cognitive symptoms also accompany in panic attacks that is enough to recognize panic attacks and diagnose panic disorder of a certain expected nature. In the case study, Chung persistently worried about his recurrent physical symptoms and intense fear that he might get a heart attack in the future and die. He has been experiencing chest pains, palpitations and breathlessness, sleeplessness particularly initial insomnia and early wakening. Panic Disorder Diagnostic Criteria: 300.01 (F41.0) outlines the unexpected panic attacks when there is an abrupt increase of intense discomfort or fear reaching peak within a short period of time. This abrupt surge occurs from anxious or calm state where symptoms like sweating, shaking, pounding heart, and feeling of choking, discomfort or chest pain, fear of dying or losing control occur and also manifested in Chung (Edition & American Psychiatric Association, 2013). Therefore, the symptoms manifested by Chung in the given case study fulfil the criteria outlined in anxiety disorders, panic disorder 300.01 (F41.0).
Relationship between Environmental Stressors and Panic Disorder
2.The Stress-Vulnerability Model explains that there are three critical factors that are responsible for the development and progression of a psychiatric disorder over the course of time. The interaction between stress, biological vulnerability and protective factors contribute to a psychiatric condition. Stress has a great impact on the vulnerability that can trigger the onset of a disorder or worsen it. Stress is thought to be caused in response to life situations that make it difficult for an individual to change or adapt to the situation (Russo, 2015). If an individual is unable to adapt to the stress, mental issue or psychiatric symptoms may develop or progress in response to the stressors. The examples include tense relationships, life events and lack of productive life activities that are witnessed in the given case study (Butcher, Mineka & Hooley, 2013). Chung is a doctor working in Accident and Emergency (A&E) department at a busy, inner city hospital migrated from China to Australia. Two years back he was under investigation due to wrong route medication error and was placed on practice supervision for a year. He always remained tired and stressed out due to overnight calls and that resulted in the medication error. On his wedding day, his parents were not present and the ceremony lacked reference to Chinese culture made him emotionally weak due to lack of family support. Moreover, he was unable to participate in the wedding planning due to his long working hours.
As described by the model, life event, birth of a child is a psychosocial stressor also contributes to stress and can trigger psychiatric symptoms. Chung and his wife, Harriett has a three week old baby girl, Charlotte and during delivery, his wife had an infection that resulted in pain, dressings and difficulty in mobility. Due to Chung’s long working hours and hectic schedule, he is unable to take care of his wife and baby depicting tensed and detached relationships. He is stressed due to long working hours and high pressure environment at A&D acting as an occupational stressor. Altogether, the three stressors, wife’s health, Charlotte’s birth and lack of productive and useful activity made him anxious and he is experiencing chest pains, palpitations breathlessness. He is also experiencing feelings of hopelessness and helplessness and wanted to die. He is feeling worthless, unproductive and failure in his medical role and letting his family down as he lacks healthy coping skills with the present situation that is progressing towards a psychiatric condition (Brewin, 2013). He is attacked with suicidal thoughts, blaming him for the situation and is panicked that he might get a heart attack and die.
Introduction to the Stress-Vulnerability Model
The current situation of Chung is explicitly explained through the stress-vulnerability model where the environmental stressors are contributing to psychiatric disorder experienced by him. This stressful situation is challenging for him as the situation demands good adaption and family support that is lacking in the current scenario. The lack of Chung’s involvement in meaningful life-in activities such as parenting and medical work is sources of stress that is contributing to his psychiatric condition. Therefore, lack of coping skills, social support, involvement in meaningful activities are the contributing factors to Chung’s stress and course of psychiatric condition, panic disorder.
3.Positive mental health recovery is not only being free from mental illness, but also allows an individual to enjoy pleasures of life, believe oneself and have the ability to cope with the daily life challenges while working productively and enjoy socializing (Slade et al., 2014). Recovery model of mental health is an approach to emphasize and support an individual’s potential towards the process of recovery. This is helpful in providing a new purpose and meaning in an individual’s life so that one evolves beyond their mental illness condition (Chronister, Chou & Liao, 2013). Recovery oriented mental health practice has three important positive aspects that comprises of hope, respect and empowerment that facilitates recovery and impart positive sense in oneself. Dignity and respect are important for Chung as there should be honest and respectful interactions. The recovery process should involve respect and sensitivity being courteous in every aspect (Davidson, 2016). A mental health professional should appreciate and accept the Chinese culture, beliefs and values of Chung so that he feels valued and respected crucial to recovery. The uniqueness of the individual should be recognized and there should be inclusion of one’s health beliefs so that the one has opportunities for choices and live a satisfying, meaningful and purposeful life (Storm & Edwards, 2013). As a mental health professional, it is important to accept that recovery outcomes are unique and personal and beyond physical health focusing on quality of life and social inclusion.
As depicted in the case study, Chung is experiencing feelings of helplessness and hopelessness being a failure in medical role and personal life, therefore empowerment is important for his recovery process. He should be empowered so that he recognizes his capabilities and potential in engaging in meaningful activities. He should be empowered and supported in making his own choices about how he want to lead his life and make real choices in living a creative and productive life (Jacob, 2015). He should be supported building on his strengths and empower him referring to level of influence, choice and exercise control over events in his life. Empowerment would help Chung to overcome his state of powerlessness and gain control of his own life. Gradually, he would be able to define his ambitions and needs and focus on the development of his resources and capacities that support him. His family can support him in the recovery process by establishing healthy social network with him, promoting cohesion and empowering him through period of vulnerability and difficult transition (Priebe et al., 2014). This empowerment is also intended to help him adopt autonomy and self-determination and gain self-esteem and hope in his life. Empathetic communication can help to instil hope in Chung about his future and capability to live a purposeful and meaningful life (Gilburt et al., 2013). Healthcare professionals should acknowledge that every individual is a master in his or her life and work in realistic and positive ways so that one realizes their own goals, hopes and aspirations in life.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
Brewin, C. R. (2013). Cognitive Foundations of Clinical Psychology (Psychology Revivals). Psychology Press.
Butcher, J. N., Mineka, S., & Hooley, J. M. (2013). Abnormal psychology. ^ eNew York New York: Pearson.
Chronister, J., Chou, C. C., & Liao, H. Y. (2013). The role of stigma coping and social support in mediating the effect of societal stigma on internalized stigma, mental health recovery, and quality of life among people with serious mental illness. Journal of Community Psychology, 41(5), 582-600.
Davidson, L. (2016). The recovery movement: Implications for mental health care and enabling people to participate fully in life. Health Affairs, 35(6), 1091-1097.
Edition, F., & American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Arlington: American Psychiatric Publishing.
Gilburt, H., Slade, M., Bird, V., Oduola, S., & Craig, T. K. (2013). Promoting recovery-oriented practice in mental health services: a quasi-experimental mixed-methods study. BMC psychiatry, 13(1), 167.
Jacob, K. S. (2015). Recovery model of mental illness: A complementary approach to psychiatric care. Indian journal of psychological medicine, 37(2), 117.
Mitchell, A. J. (2013). The Mini-Mental State Examination (MMSE): an update on its diagnostic validity for cognitive disorders. In Cognitive screening instruments (pp. 15-46). Springer, London.
Priebe, S., Omer, S., Giacco, D., & Slade, M. (2014). Resource-oriented therapeutic models in psychiatry: conceptual review. The British Journal of Psychiatry, 204(4), 256-261.
Russo, M. (2015). Work–home enrichment and health: An analysis of the mediating role of persistence in goal striving and vulnerability to stress. The International Journal of Human Resource Management, 26(19), 2486-2502.
Slade, M., Amering, M., Farkas, M., Hamilton, B., O’Hagan, M., Panther, G., … & Whitley, R. (2014). Uses and abuses of recovery: implementing recovery?oriented practices in mental health systems. World Psychiatry, 13(1), 12-20.
Storm, M., & Edwards, A. (2013). Models of user involvement in the mental health context: intentions and implementation challenges. Psychiatric Quarterly, 84(3), 313-327.
Taylor, M. A. (2013). The neuropsychiatric mental status examination. Elsevier.
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