- Mental Dysfunction - Case Study Example

?2106 Case Study Overview of the presenting issues as outlined in the case scenario and the best care for Isaac, I and other emergency department staff. From an assessment of this scenario, Isaac is suffering from mental health problems that arose out of his experiences, especially after leaving school. Isaac is suffering from depression. He portrays signs which (Barry (1998) identifies as signs of depression. These are altered sleep patterns, lack of motivation, poor moods and social withdrawal. It is clear that before the day he was sexually harassed, Isaac used to hang out with friends but he withdrew from them since that day onwards. This incident also changed him from being a happy boy into an angry fellow. In addition, it has made him to experience sleepless nights and loose the hope of looking a better future as indicated by his inaction in seeking for a job since that the incident. The sexual harassment incident has also made Isaac to be paranoid, aggressive and agitated. Freeman and Garety (2004) state that paranoia is characterized by excessive suspicion of the actions of other people around a person and hostility towards them and these can be noted in Isaac. He is distrustful and feels very insecure for example, he feels his mother has evil intentions towards him in her actions and accuses her of vague conspiracies. He thinks people in town see him as a gay. Evidence that Isaac is suffering from aggression can be seen in his actions like threatened his mother with a knife, causing problems in the streets and shouting around. He has also turned into behaviours like heavy smoking of marijuana to make him forget about all his bad lucks. These characters contrast his pre-harassment behaviours of being well mannered and trouble free. Isaac’s case presents the need for a good safety plan for him, the nurse in attendance and other local emergency department staff. It is evident that Isaac is suffering from depression. Haber et al (1997) direct that in such a situation, the first step is to begin the administration of a prescribed anti-depressant. This will help to change his moods from that of an angry person into a calm one. It will also restore good sleeping patterns and make him regain some confidence to interact with his friends. This change of mood is important for tackling his aggression and making his presence in the emergency department safer for all its staff. It will eliminate the possibilities of him chasing around the staff. A restoration of the confidence to interact with friends is important because it will make Isaac to cooperate willingly with the departmental staff instead of seeing them as enemies and incite him to fight them. Goldberg (1998) advices that Isaac should be handled with love to reduce his symptoms of aggression which are a sign of inner bitterness and anger. It will also stop him from becoming suspicious of the intentions of the actions of staff towards him hence he will not react negatively. However, Isaac’s hands should remain tied until he shows signs of improvement and a good level of relaxation. As soon as he becomes calm, Isaac should be given restricted freedom within the facility. This should be accompanied by activities that encourage restoration of self-efficacy like personal hygiene. In order to restore a good interpersonal relationship at this stage, he will be allowed to interact with his friends, neighbours, and mother under close supervision to gauge his level of risk once released to go home. The time periods will then be increased for every visit. He should also undergo behaviour therapy to reduce his paranoia state. Isaac’s Mental State Examination Appearance (dress, hygiene, grooming, posture, gait, eye contact) On his admission, Isaac was poorly dressed and very dirty. His hair was unkempt and had lice. Isaac was not able to maintain a stable posture and a straight eye contact for long. He paces back and forth too frequently and quickly turns to look away from the people around him. He is too slim for his age. Behaviour (manner, friendliness, aggression, suspiciousness) Isaac does not display proper manners. He shouts at people anyhow and makes false accusations against them. He is not friendly to anyone and is most irritable even by the slightest action. Isaac has a high level of aggression. He is very troublesome and a threat to safety both at home and in the streets. Isaac is too suspicious of the people around him and their actions. He does not feel secure even at home and cannot trust his mother. Speech (rate, volume and pitch) Isaac does not have a regular speech rate, volume and pitch. He speaks and responds normally at one point then changes into responding too slowly to questions asked. Most of the time, he is incoherent so it is difficult to understand his speech. When most irritated, he speaks a lot and loudly. Mood (sustained internal emotional feeling experienced and expressed) Isaac is constantly angry and depressed. This is expressed by his easily irritable nature, withdrawal from friends and over indulgence in smoking marijuana. Affect (emotional feeling externally displayed and observed) Isaac is aggressive. He finds it hard to relate well with other people and most of the times, he is hostile towards everyone, behaves in a life-threatening manner and shouts at neighbours, his mother and people in the streets. Form of Thought (amount of thoughts and rate production, continuity of ideas, disturbances in language or meaning) Isaac does not have a good form of thoughts. He thinks a lot and the thoughts are inconsistent, changing at a very fast rate. These are indicated by his constant change of mood, behaviours, speech rate and relationship with other people. His poor thoughts are also evidenced by lack of consistency in language expression and comprehension. Content of Thought (suicidal/homicidal thoughts, delusions, overvalued ideas, obsessions and phobias) Most of the contents of Isaac’s thoughts are not good. His mind if dominated by homicidal thoughts as indicated by the threats to kill his mother and overvalued ideas as indicated by the false accusations he makes against others. He is obsessed with marijuana and cigarettes and becomes disturbed if they run out before the next payday. His phobia is about being attacked and this makes him distrustful and suspicious of the people around him including his mother. Perceptual (hallucinations) Isaac converses with imaginary people. He constantly mutters to himself, and shouts to no one in particular and for no tangible reason. Cognition (ability to process information, answer questions, orientation) Isaac has a low cognition as indicated by his low ability to understand and answer questions asked him at the right rate. He takes long to respond and rarely responds in a positive way. Insight Isaac does not seem to understand clearly the situations around him. This is also indicated by the fact that he takes long to respond to questions and not being able to understand the good-willed actions of his mother. Hypothesis/Formulation Isaac is in a bad mental state and is not mentally able to take care of himself. His mental state is also a threat to the safety of his family and the public and should therefore be placed under psychiatric care. Potential Risks Posed by Isaac In his present mental state, Isaac is likely to be risky to himself and others over the next twenty four hours in three main ways. These are committing homicide, committing violence against others and committing suicide. There are very high chances that if set free, Isaac is likely to kill someone. More than once, he has threatened his mother with a knife without a justifiable reason and the police faced a similar treatment at the time of his detention. The likelihood of the occurrence of this risk is supported by the fact that Isaac is growing to become more and more aggressive and easily irritable from the day he was sexually harassed. Isaac has completely changed from a well-mannered and happy boy into an angry, rough person. He also operates under heavy influence of marijuana and this has greatly influenced his moods, reactions, character and actions in general. For example, he no longer remembers to bath, shouts at no one in particular and talks to himself. This means that Isaac is not very cautious of his actions or the intensity and repercussions of such actions. In fact, he seems to have lost control of his own self and his actions are therefore a result of the influence of marijuana and a disturbed state of mind. At the same time, Isaac feels people are intruding into his space and would therefore feel justified to kill anyone who crosses paths with him. Even if Isaac does not commit a homicide, his present state of mind is most likely to drive him to behave violently and hurt many people. It is now clear that he does not trust the intentions of the actions of anybody and would therefore feel obliged to protect himself. However, his constant state of anger and influence of marijuana are likely to lead him to accomplish this through violent reactions. This can also be aggravated by the imaginations and false accusations he holds against the town’s people of taking him as gay. He might therefore be tempted to revenge against innocent people. At the time of his arrest, he was already showing potentialities for this through his constant shouts in the streets and violent reaction towards the police. Isaac knows and remembers very well the source of all his current troubles and loss of focus in life. To live with the reality of having been sodomized is not easy and the worst thing is that the chief sodomizer is his stepfather, the man he lives with in the same house every day. This makes it more difficult for the wound in his heart to heal. Instead, a sight of him could worsen his current situation. A combination of this bitter reality, the fact that he is now the mad man in town and that there is no much hope for a prosperous life ahead of him have the potential of generating suicidal thoughts in the mind of Isaac. Spending long hours of the night without sleep can give him a good time to convince himself on this option and eventually drive him to commit suicide. Q4. Isaac aggression, paranoia, addiction to drugs, and state of carelessness is widely a result of his experiences. First, the malnourishment (a result of inadequate consumption of food) and proper parental care has impacted his physical and psychological development. This is evident in the fact that Isaac is tall and thin; he is too slim for his height. Indeed according to Haber et al (1997), strong parental care helps in maintaining positive child development. Furthermore, feeding and other practices related to child care impact the level of psychological stimulation and positive attachment between a child and his/her caregivers. However, as Isaac claims, his mother only allows him one meal per day, and that is hardly enough for a growing teenager like him. Yet another factor that has contributed majorly to Isaac’s poor state of mental health is his sexual assault experience. One of the people that Isaac should be close to is his father. However, the existence of a step father in this case shows that Isaac’s real father is either dead or somehow separated with his mother. Instead of the stepfather providing adequate support to the family, he sexually assaults Isaac and fails to take the responsibilities associated with fatherhood. This effectively alters the life of Isaac causing his aggressiveness and paranoid behaviour. He does not trust anybody, not even his own mother. After his ordeal at a young tender age of thirteen, he does not get the courage to tall anyone that his own step father assaulted him. This single event actually is the catalyst for all of Isaac’s mental problems. Isaac’s over reliance on cannabis has caused him to be mentally unstable. His mental problems emanate from the fact that he is using too much marijuana, an addiction that was mainly caused by him being sexually assaulted by his own step father. Apart from this incident, there are other mitigating factors that could have led to his addiction. One of them is the poor almost alienated environment in which he was brought up in. the fact that his family including his own mother, grandmother and step father all uses one form of drug or another. That is not all, not one member of his family has ever encouraged him to do something positive with his life. To him, smoking marijuana and cigarettes is a normal part of life. The hypothesis is that Isaac’s mental condition, which is a product of his overindulgence in marijuana, is a direct result of what he has experienced while growing up. Isaac’s behavior and physical condition are signs of depression and psychotic behaviour. His depression stems mainly from his inability to cope with the sexual harassment trauma he underwent. His foul mood, disinterest in anything, insomnia and social withdrawal are some of the greatest indications of the level of depression Isaac is suffering from. This is the depression that made him start smoking marijuana and cigarettes. These two drugs are what have caused his psychotic behavior. Some of the symptoms that Isaac presents to show that he is suffering from psychosis include incoherence and confused thinking, paranoid delusions, changed behaviour and mood swings, lack of self awareness. Nursing Care Plans Problem Plan (Interventions) Expected Outcome (O) and Criteria for Evaluation (E) Rationale Depressive symptoms whose evidence includes: low mood, changing sleep patterns, social withdrawal, and lack of motivation. (1) Begin clinical administration and monitoring of anti-depressant. (2) Start sessions to monitor his emotional status (O) (i) significant increase in mood level (ii) improved sleep hygiene (iii) increased levels of motivation and social inclusion (E) (i) client self-reported mood level (ii) client self-reported sleep hygiene (iii) evidence of increased social increased social interaction Evidence shows that giving antidepressant prescriptions to patients suffering from depression can help balance the patient’s emotions thus getting rid of the depressive symptoms. Evidence also shows that proper counselling for depressed people helps them get over the psychological problem that is causing them to be depressed. Isaac has also shown signs of psychosis which is drug induced. The evidence for this problem includes: incoherence and confused thinking, paranoid delusions, changed behaviour and mood swings, lack of self awareness. (1) commencement of appropriate antipsychotic medicines (2) commencement of psychological therapy (O) (i) Improved coherence and better thinking patterns (ii) Speech is clear and comprehensible (iii) Clarity of thought processes, with no paranoid delusions (iv) Improved behaviour and emotional balance (v) better self awareness and insight (E) (i) evidence of improved coherence and better thinking patterns (ii) evidence of clarity of speech (iii) client self reported clarity of thought processes (iv) client self reported improved behaviour and emotional balance (v) client self reported insight and self awareness References Barry, D. (1998). Mental health and mental illness. Philadelphia. Lippincott. Freeman, D. and Garety, P. (2004). Paranoia: The Psychology of Persecutory Delusions. Hove: Psychology Press Goldberg, R. (1998). Practical guide to the care of the psychiatric patient (2nd Ed). St. Louis. Mosby. Haber, J. Krainovich-Miller, B. McMahon, A. and Price-Hoskins, P. (1997). Comprehensive psychiatric nursing (5th Ed). St. Louis. Mosby. Read More