Jacks Mental Illness - Case Study Example

Case analysis: Jack’s mental illness Key features of the case Jack is suffering from a serious posttraumatic stress disorder (PTSD). This is a severe condition that results from anxiety, and develops after a psychologically traumatic exposure (American Psychiatric Association, 1994). Jack could have experienced an overwhelming incident in the past, which is currently haunting him and preventing him from coping up with the situation. He appears extremely agitated and unsettled because of re-experiencing of the original trauma, which takes place through flashbacks. Furthermore, Jack does not want to be touched perhaps because he is avoiding stimuli associated with the original trauma. He speaks in a stream of words that refer to the world and how “screw up it is”, when he reflects back on the traumatic experience he underwent. Signs of PTSD can be activated by sounds, memories, and dreams linked to the past trauma (American Psychiatric Association, 1994). In addition, seeing the objects or the people who may have taken some part in the trauma may trigger the symptoms of PTSD. He desperately wants to call his sister because he feels that she could be a source of solace when he is in problems. Jack exhibits post-traumatic stress symptoms, which are classified into three DSM IV categories. First is the persistent re-experiencing of the incident, which is also referred to as the intrusive signs. In this category, the victim could be experiencing vivid recollections, nightmares and a feeling of re-living the incident. Second is the persistent evasion of any stimuli, which might remind them of the traumatic condition. Finally, is a state where the victim experiences hyperaousal condition that causes hepervigilance, sleep interruption, and startle reflexes (Yehuda et al. 2002). The consequence of all these behaviors is some level of mental distortion, which prevents the victims from taking part in their daily activities. Other signs include bad temper, emotional liability, agitation, and sometimes eruption of violent behavior. If Jack is not treated on time, he may result to substance abuse in an attempt to seek self medication. Depending on the duration that Jack has suffered from this disorder since he experienced the traumatic event, the disorder can be categorized based on the DSM IV 4 including acute stress reaction, acute PTSD, chronic PTSD and delayed onset of PTSD. The relevant history taking and components of the mental health assessment for Jack A multiaxial Diagnostic System commonly denoted as DSM-IV-TR uses diagnostic system with 5 levels used in the classification of disorders and illnesses. These five levels assist whoever is providing a treatment with a diagnosis that is complete including the factors influencing the patient’s psychiatric condition. This provides an effective plan for offering treatment. It also provides a standard criteria and a common language in the mental disorder classification. This manual is used in the United States and the world over in varying degrees by researchers, health insurance companies, policy makers, clinicians and the pharmaceutical companies. The current version of this model is the DSM-IV-TR, which is the fourth edition (Ellis, 1988). In dealing with Jack’s ailment, the five DSM levels, which are better known as “axes”, can be used. The first axis incorporates ‘clinical disorders’; the second incorporates the personality disorders as well as the intellectual disabilities; while the remaining ones relate to psychosocial, environmental and medical related factors. The five “axes” and their application in Jack’s case are as follows. Axis I: Clinical Disorders Axis I is the top-level in the diagnosis. The diagnosis contained in this level is the most familiar as well as the most widely recognized in the treatment. This involves the major mental disorders, substance use disorders, as well as the learning disorders. The most relevant categorization of Jack’s disorder in this axis would be the mental disorder. This is because Jack was so troubled mentally and his acts only reflected issues with his mentality. Axis II This axis assesses the personality disorders as well as intellectual disabilities. In most cases, these disorders in a child become life-long problems extending all the way to adulthood. So, what could have led to this situation? According to Yehuda et al. (2002) an early childhood’s disturbance disrupts development and mental health of a child. It is therefore very important to investigate Jack’s childhood traumatic experiences. Axis III This axis describes those physical problems and challenges that may be relevant to the diagnosis and treatment of mental disorders. The medical conditions in this axis are related to a mental disorder, which is an important element in the overall diagnostic picture. In a social setting, this is reflected by odd behavior, unconventional beliefs as well as odd thinking. This disorder makes people feel extremely uncomfortable in maintaining a close and healthy relationship with others and hence they frequently find themselves causing trouble. Axis IV The disorders in this axis are the psychosocial and environment-related problems that are related to the treatment, prognosis and diagnosis of the mental disorders in Axis I and II. An environmental or psychosocial disorder may be an unpleasant life event, a difficulty or deficiency in terms of the environment, stress arising from the family or any other interpersonal issue or the lack of adequate personal and social support resources. In practice, many environmental and psychosocial issues are indicated as axis IV. However, when these issues are the primary focus of clinical attention, they are recorded on axis I, hence, environmental and psychosocial problems of Jack’s case are mentioned in the earlier axis. Axis V This axis is for the Global Assessment of Functioning. It reflects the clinician’s evaluation and judgment of a person’s ability to perform in daily life. A scale that is 100% measures a person’s social, psychological as well as the occupational functioning. Jack’s diagnostic perspective on a practical view on his health, based on ratings of his progress since he was born may reflect a very weak scale on his axis V. In the assessment of Jack’s history, it is important to investigate issues such as his coping abilities; prior stressful situations; self-capacities and ego resources; cultural and religious background; and occupational history. Investigation on Jack’s background helps come up with an ideal plan for treatment, which is tailored for a specific patient. For instance, if Jack appears uncomfortable in his current environment and living circumstances, then he should be put in an environment that is friendlier to him before any treatment is commenced. Also, if he does not feel safe in his current situation, then issues of safety should be given priority. Yet still, if there is evidence that Jack has ever undergone childhood abuse in his past and hence adopted dissociation as his own protection, then the treatment should be directed towards helping him manage his dissociation whenever he undergoes stressful situations. Current literature regarding the biological causes of posttraumatic stress disorder posttraumatic stress disorder Posttraumatic stress disorder takes place after a person directly or indirectly undergoes a life-threatening situation. There is a higher possibility of developing PTSD for those people who experience traumatic situations when they are young than those who experience it later in their lives (Davidson et al., 2004). The children of parents with PTSD are even more likely to develop PTSD, which is caused by nature of stress hormones they inherit from their parents (Yehuda et al., 2000; Yehuda et al., 2002). It is believed that trauma is responsible for physical changes that take place in the brain. Some of these changes include decreased development in the part of the brain responsible for language dispensation, increased development of part of the brain that processes emotions, and contraction in the part of the brain that is responsible for some sorts of memories (Hull, 2002). According to Larkin (1999), PTSD could be caused by the process of natural survival. A person releases adrenaline from their body, when they undergo a traumatic experience – this helps them fight the traumatic event. In addition, the release of adrenaline boosts the traumatic memory, which is repeatedly reactivated in cases of PTSD. Pitman et al (2002) reveals that researchers are using beta-adrenergic blockers to restrain symptoms of PTSD, a breakthrough that is highly promising. Current literature regarding treatment and cares for that person as paramedic Jack’s case requires Gestalt psychotherapy, a holistic or whole-person approach that involves studying the patient’s emotions, body language and interactions with his or her environment. This focuses on a patient’s self-perception and self-awareness rather than the therapist’s own account for, and interpretations of the patient’s experiences (Burkle, 2009). The goal of this method is to help patients become aware of their actions and adjust to accept who they are. The method assists the victims to leave the ugly old ways behind, and embrace a better future. The following is a detailed technique of the whole-person approach on Jack (Hoge et al., 1997). The treatment of PTSD is not well understood, because of its wide range of signs and complicated psychobiologic characteristics that complicate its psychoanalysis. The treatment of PTSD can be categorized into three parts including psychotherapy, pharmacotherapy and patient education. A PTSD patient can benefit from education, which can be administered since the onset of diagnosis. This education should also involve the patient’s family members because they understand the patient well, and hence suitable in undertaking this task. The next step could be calling for pharmacotherapy if the symptoms are extremely severe to extent of averting effective trauma-focused treatment. The three groups of PTSD, including hypervigilance, avoidance and reexperiencing, are reduced by psychotherapy and Pharmacotherapy. Although little attention has been paid to supportive counseling for PTSD, this method is better than remaining untreated, and can be useful for PTSD patients who refuse to seek specialty metal healthcare. Furthermore, it can provide temporary care in an attempt to encourage the patient to accept evidence-based treatment (Melton et al. 2007). An example of supportive counseling is Cognitive Behavioral Therapy (CBT), which is believed to be the most effective for managing PTSD. Another type of therapy, which is similar to CBT, is eye movement desensitization and reprocessing (EMDR), which can helphdrrr stimulate Jack’s brain, and thus lessen the stressful memories (Mental Health Foundation, 2012). Cognitive behavioral therapies (CBT) will be used to treat Jack’s depression, anxiety, post-traumatic stress and schizophrenia. Another therapy is Psychodynamic therapy, which explores Jack’s personality and his early life experiences that may have direct influences to his current thoughts, relationships and behavior (Mental Health Foundation 2012). In addition, Jack can undergo a Dialectic Behavior Therapy (DBT), which combines CBT with meditation ways. This can either be individual or a group therapy. This therapy is necessary for Jack because of his personality disorder of self-harm, taking into consideration that he does not want to be touched. Another therapy that comes in handy is the Humanistic therapy, which treats specific problems. Jack’s depression, anxiety as well as addiction to substances will be addressed in this therapy session (Mental Health Foundation, 2012). A group therapy for Jack will help him listen to other people with similar problems. Since he enjoys his sister’s presence because he was heard calling her, a family therapy will be applicable for his depression and schizophrenia state. Also, selective serotonin reuptake inhibitor (SSRI), which is a type of drug used to treat depression, can be used to treat PTSD. During a cognitive therapy, the patients are counseled by a professional therapist, with the aim of helping them change their mentality regarding trauma and its consequences. The therapist focus on letting the patients understands how particular perspectives regarding disturbance occurrences can stress them and exacerbate their symptoms. The patients are taught how recognize sources of thoughts regarding the world that surrounds them, and which can make them feel afraid or offended. As such, therapist can help them replace such thoughts with those that are less disturbing and more accurate (Schechter 2003). Another type of PTSD therapy is referred to as exposure therapy, which helps the patients reduce the fear that comes from their memories. This is derived from the notion that people become fearful of feelings, thoughts and circumstances that remind them of shocking occurrences of the past. Therefore, the patients can be wooed to have repeated conversation regarding their past traumatic events with the therapists, so they can be able to control their feelings and thoughts regarding the trauma (West & Noffsinger 2006).  Following a traumatic experience, it is important to assess the victim’s cognitive ability since the patient’s cognitive position could determine the manner in which psychotherapy is done, the provision of individual versus group treatment, or the exact psychotherapeutic method that is optional depending on the patient (Davidson et al. 2001). References American Psychiatric Association., 1994. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, D.C.: American Psychiatric Association. Burke, H.L. (2009). Benefits of Forensic Assessment and consultation. 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