Mental State Examination (MSE)
Mental State Examination (MSE)
Pollard (2018) states that the Mental Status Examination is the presentation of the symptoms and usually begins before and during the interview. On arrival at Chung’s house, Chung was slumped in his chair with rounded shoulders while starring at the floor for quite a long time. Chung equally looked tearful with a slowed and purposeful speech and limited eye contact. The appearance and general behavior of Chung is an indication that Chung could be experiencing underlying psychiatric disorders. The signs of psychiatric disorders displayed by Chung may equally give clues that signifies Chung’s mental and emotional state.
Hepner (2015) explains that during MSE, the ideation, intent and plan of current suicidality should be specifically checked for. As the interview continued, Chung said that in the previous week, he had been experiencing thoughts of suicide. He felt that he was worthless, a failure at work and had let down his wife and daughter. Therefore, he was considering overdosing himself with highly lethal medications. The fact that Chung had fleeting thoughts of suicide is a clear indication that the idea of taking his own life was real. Additionally, Chung had a clear plan of using highly lethal medication to overdose himself. Since Chung works in a hospital set up, high level of monitoring is needed when putting him on suicide precautions at the hospital because he may have access to the high lethargy medications which he was considering to use for taking his life.
A study conducted by Culpepper, Muskin and Stahl (2015) outlines a combination of symptoms that are required to make a diagnosis for major depressive disorder. Chung presented numerous symptoms which could be indication that he was suffering from major depressive disorder. According to Dziegielewski (2014), the DSM V criterion A is the main criteria for diagnosing major depressive disorder. Chung had a flat mood, was tearful, sad and had a feeling of hopelessness. Chung had a significant weight loss of five kilos in one month due to reduced appetite and missing meals. The patient also reported cases of sleeplessness and initial insomnia and early morning wakening at 3a.m daily. Other symptoms which may be identified by criterion A included a feeling of worthlessness, a feeling of guilt that he was letting down his wife and daughter, and having suicidal thoughts and thoughts of death from heart attack.
Additionally, Chung was experiencing signs and symptoms identified by Criterion B of diagnosing major depressive order. These signs included a significant distress in the area of his occupation. Chung was not very competent at work and he was feeling that he was a failure at work. Criterion C could also be used to diagnose Chung’s presentations. The patient was not presenting these symptoms due to any psychological effects of a certain substance or another medical condition. While interacting with Chung, there was no mention of any substance being consumed or any medical condition that could have led to the manifestation of these symptoms.
Pollard’s (2018) view – Understanding the symptoms
Stress Vulnerability Model
Wong, Weissman and Wong (2014) states that the Stress Vulnerability Model helps in understanding the interactive effects of biological and psychosocial stress factors. According to the model, two main factors are involved in the development of a psychiatric disorder and its reoccurrence over time; vulnerability and stress. Wong, Weissman and Wong (2014) further explains that genetic make-up creates different vulnerability levels of different individuals. Any change in an individual’s psychosocial condition may produce stress that surpasses their stress threshold and cause a mental illness (Wong, Weissman & Wong, 2014). Stress refers to the challenges experienced in the course of life that may require an individual to adapt or change.
Family
An article published by Biebel and Alikhan (2018) explains that the arrival of a newborn child may trigger stress and anxiety to a man. A study by Pérez Cortés et al. (2018) confirms that the new responsibility of new fathers may lead to depressive disorders. Therefore, the arrival of Chung’s new baby may be a contributing factor to the development of Chung’s mental health problems. Chung found it difficult to have time and space with his daughter. This may have caused him to have guilt over not being available for the daughter. Caring for the baby especially at night may also have led to sleepless nights.
On the other hand, since Chung’s wife was unwell and not able to move around, Chung may not have had time for himself and his hobbies since he needed to help his wife. This could be the reason why Chung was experiencing very low mood. Harriett was having a lot of pain due to the infection she had in the operation site which may have caused a change in the relationship between her and Chung. The inability to be available for the family may have triggered Chung to think he was a let down to the family.
Work
A study conducted by Philpott and Corcoran (2018) found out that working men with new babies struggled to find balance between work and family. Chung spent most of his time at the hospital and therefore he was not able to be with his family frequently. This may have led to a feeling of worthlessness and a let down to the family. Chung’s long hours of work led to experiences of breathlessness, palpitations and chest pains. Chung was experiencing a lot of anxiety and stress over his work. Since he returned to work, he had been working mostly through the night for about 20-24 hours. The long hours of work and the pressure at the Accident and Emergency department led to Chung feeling increasingly anxious. Since he was not able to care for his family and his medical profession, he was feeling hopeless and helpless. Chung also felt that he was a failure and worthless in his medical profession because a drug error that occurred two years ago. The fact that Chung felt that he was unworthy, a failure, and a disappointment to his family, caused him to experience thoughts of suicide and wanted to die.
The suicidality check
Mental Health Recovery Model
According to Jacob, Munro, Taylor and Griffiths (2017) the mental health recovery model provides a patient-centered approach to mental health recovery. The article states that the model is based on two premises; possibility to recover from mental health conditions and that patient-centered recovery is the most effective. The metal health recovery model provides ten principles in which the recovery is based on. These principles include; self-directedness, individualized and person-centered, empowerment, holistic, nonlinear, strength based, peer support, respect, responsibility, and hope (Jacob, Munro, Taylor & Griffiths, 2017). These ten principles of recovery oriented mental health care ensure that the services of mental health are delivered in a manner that supports the welfare and recovery of the patients.
Respect
Nisbet and Dulmus (2014) states that societal appreciation and acceptance for people with mental health, including protection of their rights and avoidance of discrimination, is fundamental in the recovery process. In order to achieve recovery for Chung, the society around him, the health professionals and Harriett’s family, need to respect him. The professionals need to give Chung adequate time to be with his family. The work ethics and Chung’s rights must be respected. Harriett’s family may also show respect to Chung by allowing him time and space to be with his daughter whenever he is around. They should also consider giving him more time with his ailing wife. The satisfaction of being with his family will give him a sense of self-acceptance thereby helping in his recovery.
Empowerment
A research conducted by Picton et al. (2018) describes empowerment as being determined to extend oneself and participate to strive socially, psychologically, and physically with the support of positive relationships leading to positive change. Allowing Chung to participate in all the decisions that affect him will contribute to his recovery. The decisions may vary such as allowing him flexible time at the hospital in order to attend to his ailing wife and new daughter. The health professionals may also offer empowerment by creating positive relationships with Chung and assuring him that he is not a failure. Additionally, Harriett’s family may empower Chung by letting him to be involved with the baby and giving him space and time to be with his wife when he is around.
Hope
According to Bag (2018), hope is an indispensable part of recovery which includes the interaction and involvement with others. Giving hope to Chung that both external and internal challenges can be overcome and that people have overcome obstacles may give him motivation for the future. The health professionals may help him understand that the errors such as Chung made in the administration of a drug do not describe him but it is an opportunity for becoming better. They may also help Chung understand and remember the obstacles that he has always overcome in the course of his medical practice. Likewise, the family members could be a source of hope by letting Chung know that he has always overcome many challenges and so, the present challenge will be and can be overcome as well. When there is an array of hope, the possibility of suicide may be avoided.
References
Bag, B. (2018). Toplum Ruh Sa?l??? Hem?ireli?inde Uygulamaya Yönelik Bir Model Örne?i : “Recovery”. Psikiyatride Guncel Yaklasimlar – Current Approaches In Psychiatry, 10(4), 471-483. doi: 10.18863/pgy.375814
Biebel, K., & Alikhan, S. (2018). Paternal Postpartum Depression. Journal Of Parent And Family Mental Health, 1(1). doi: 10.7191/parentandfamily.1000
Culpepper, L., Muskin, P., & Stahl, S. (2015). Major Depressive Disorder: Understanding the Significance of Residual Symptoms and Balancing Efficacy with Tolerability. The American Journal Of Medicine, 128(9), S1-S15. doi: 10.1016/j.amjmed.2015.07.001
Dziegielewski, S. (2014). DSM-5 in Action, 3rd Edition (3rd ed.). John Wiley & Sons.
Hepner, K. (2015). Measuring the quality of care for psychological health conditions in the military health system. Santa Monica, CA: RAND.
Jacob, S., Munro, I., Taylor, B., & Griffiths, D. (2017). Mental health recovery: A review of the peer-reviewed published literature. Collegian, 24(1), 53-61. doi: 10.1016/j.colegn.2015.08.001
Nisbet, B., & Dulmus, C. (2014). Person-centered recovery planner for adults with serious mental illness. Hoboken, N.J.: Wiley.
Pérez Cortés, F., Catalán, A., Morales, A., Quinlan, A., Riquelme, D., Navarro, J., & Riquelme, C. (2018). Assessment of Postpartum Depression in a Group of Chilean Parents. Journal Of Men’s Health, 14(2), e56-e64. doi: 10.22374/1875-6859.14.2.7
Philpott, L., & Corcoran, P. (2018). Paternal postnatal depression in Ireland: Prevalence and associated factors. Midwifery, 56, 121-127. doi: 10.1016/j.midw.2017.10.009
Picton, C., Patterson, C., Moxham, L., Taylor, E., Perlman, D., Brighton, R., & Heffernan, T. (2018). Empowerment: The experience of Recovery Camp for people living with a mental illness. Collegian, 25(1), 113-118. doi: 10.1016/j.colegn.2017.04.005
Pollard, C. (2018). Fundamentals of the psychiatric mental status examination. Canadian Scholars.
Wong, D., Weissman, A., & Wong, D. (2014). Clinical case management for people with mental illness. Hoboken: Routledge, Taylor and Francis.
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