Ongoing Mental Health Needs: Major Depressive Disorder - Essay Example

?Ongoing Mental Health Needs: Major Depressive Disorder Introduction This paper presents a case study of a chosen service user, one who is suffering from bipolar affective disorder. Patient X, a 35 year old female was admitted to the mental health unit after her mother observed her sullen and melancholy behaviour persisting for about three weeks. She also had a history of attempted suicide. Her mother also observed that she felt tired all the time and was always sleeping. She was previously admitted a year ago for depression, underwent psychotherapy, and was given anti-depressants soon after. She has not attended any follow-up check-ups. Three months prior to her current consult, the patient’s mother consulted with the clinic about her daughter, expressing that after two weeks of manifesting severe depression, she was suddenly acting full of herself, having no care in the world, and often talked non-stop. She was also arrested for drunk and disorderly behaviour two weeks prior. She was later diagnosed with bipolar affective disorder. This paper shall provide a critical appraisal of the diagnostic label used in relation to the service user’s presenting behavioural features with reference to international classification. The impact and implications for service user and families, including long term prognosis and recovery will also be included. Thirdly, details of agreed treatment plan and nursing interventions would also be discussed. Next, a critical evaluation of any emerging legal, ethical, cultural issues in the provision of treatment and care for this service user will also be discussed. Finally, a critical analysis and reflection of my role and involvement in the planning, implementation, and evaluation of the care plan for the patient will be presented. This service user was chosen because she is a patient who needs serious and significant mental health assistance. There is a need to critically analyse her case and establish appropriate health interventions because she may yet again consider suicide. Suicide rates are usually high among those who already have had a history of suicide. Body Critical appraisal of diagnostic label The client’s diagnosis is based on the fact that she manifested repeated episodes where her mood and activity levels were seriously disturbed, with episodes of elevated mood and increased energy and sometimes a depressed mood and decreased activity (World Health Organization, 1992). She also seemed to recover between these episodes. The patient manifested several incidents of alternating periods of depression and mania through elevated moods and increased energy persisting for about two weeks and would plateau for several weeks, and later with depression manifesting for three weeks (WHO, 1992). Her depression is usually longer and her periods of depression are often triggered by trauma, in this case, her depression was triggered by her job loss. This diagnosis is supported by the ICD-10 because it includes the following: manic-depressive episodes, psychosis or reaction, and does not include bipolar disorder, single manic episode or cyclothymia (WHO, 1992). This diagnosis is the closest match to the ICD-10 standards. An initial diagnosis of depression in the patient’s case was very much appropriate, however, the incident shared by her mother brings a different angle to her diagnosis. It brought in the possibility of bipolar disorder which is rightly fitting in her case. If the patient’s case would have been depression alone, she would have persisted in such behaviour for a while, and her symptoms of impulsiveness as well as increased activity would not fit her depressed condition (Swann, et.al., 2008). The diagnostic label was useful in the patient’s case because it helped provide a clearer picture of the patient’s health condition (Angermeyer and Matschinger, 2003). The label helped the health professionals in planning the patient’s care and in helping the patient and her family understand the client’s condition (Angermeyer and Matschinger, 2003). There are however various dangers involved in diagnostic labelling. For one, the label itself can create a stigma against the person and his mental illness. Labelling makes certain behaviour unacceptable in relation to what is considered normal behaviour (Angermeyer and Matschinger, 2003). And yet, it is also difficult to define what behaviour is considered normal in society, especially when what is normal is based on majority behaviour manifested by people. Finally, defining the patient’s symptoms as symptoms of a mental disorder forever dispels the idea that the patient may actually be normal and her symptoms are just part of her personality (Angermeyer and Matschinger, 2003). To a certain extent, mental illness is based on societal assessment; in effect, society may view certain behaviour as deviant or abnormal when it is unable to manage, understand, or control such behaviour (Corrigan, 2004). Labelling the patient’s symptoms as bipolar disorder would now lead to certain expectations on the patient’s part. In the days that would follow, any behaviour she may manifest may be associated with her disease (Corrigan, 2004). The problem is seen in the fact that she may no longer be able to manifest sadness or impulsive behaviour without being labelled as ill. Among the family members, the label may also make them act unnaturally towards the patient (Corrigan, 2004). Although they would likely feel some relief at the identification of the patient’s mental health illness, the label would also dictate how they would behave around the patient. Nevertheless, the diagnostic label given to this patient has a significant amount of merit because it has now guided the client to mental health care and to receive appropriate psychotherapy and medications (Swann, et.al., 2008). It may eventually lead the patient to a better management of her symptoms and give her a chance to live a symptom-free life. It is also important to note that the label of mental illness is often only considered a stigma by society; in the medical world, it is usually a disease like any other which needs and has treatment (Corrigan, 2004). Although mental health professionals may have some bias towards their patients because of these labels, they are usually prompted by medical circumstances to deliver their duties effectively (Corrigan, 2004). The risks of labelling cannot therefore be used as a reason for denying treatment for patients who need it. Critical analysis The patient’s treatment plan included an initial period of health education about her condition and the implications of her condition. This included the identification of the patient’s triggers, early signs of depression or mania, and the importance of continued treatment (National Collaborating Centre for Mental Health, 2006). A period of time for the patient to accept her diagnosis was also provided. Health education among patients is an important part of mental health care because it helps properly inform patients about their disease, its symptoms, causes, treatment, as well as the possibility for a normal life (Mann, et.al., 2004). Health education also helps empower patients because it allows them to understand their disease, and to be informed of their options in its treatment (Mann, et.al., 2004). Knowing more about their disease also reduces their stress and anxiety about their symptoms (Mann, et.al., 2004). A scheduled visit with the community mental health team was also scheduled with the patient on a bi-weekly basis at 1 hour per session. She was also included in a crisis support team for weekly sessions at one hour per session (National Collaborating Centre for Mental Health, 2006). She was also placed on mood stabilizers, primarily lithium; she was also given valproic acid. After two months being symptom free, her lithium was stopped. Lithium toxicity may sometimes set in among patients under prolonged use of the drug, hence, ceasing the medicine at the right time was the correct decision for the health care giver (Young and Hammond, 2007). The multidisciplinary care applied in this patient’s case was appropriate because the care of the patient became more holistic and most aspects of her life were given attention (Leboyer and Kupfer, 2010). The service user was also involved in his plan of care when his preferences were considered and when he was always consulted in his plan of care. This empowered the patient and allowed him to be more independent and autonomous in his care (Johnson, et.al., 2007). The pharmacological interventions for the patient were agreed upon because the client understood that she was going through the worst periods in her disease process and that there was a need to manage these symptoms quickly through pharmacological interventions (Young and Hammond, 2007). The medications proved to be beneficial for the patient as she was able to experience less manic and less depressed episodes. The medications made her feel various side-effects, including headaches, insomnia, drooling, etc, however, after the health education, she was expecting these symptoms to manifest and she understood that she could also choose to take medications to counter these side-effects. Other therapeutic and nursing interventions included cognitive behavioural therapy (Scott, et.al., 2006). The patient participated well with the therapist however, after two sessions was not comfortable around the therapist and much preferred the community mental health centre for her mental health needs. She also preferred talking about her disease with a support group. As a nurse, I discussed the option of psychotherapy with her. I explained that the psychotherapist can help give her guiding tools on how to manage her symptoms and reactions. Cognitive behavioural therapy may work well with depressed patients because it helps them manage the triggers and prevent one thought or incident from leading to another incident which may cause the manifestation of the disease symptom (Scott, et.al., 2006). CBT teaches the patients ways of dealing with each trigger – how to steer it away from depression or mania. Allowing patient preferences in mental health care to be followed is also based on the same notion as patient empowerment (Johnson, et.al., 2007). Giving the patient the treatment helped make the patient more cooperative during the management of her disease. It also made her feel useful in her ability to express her choices in her own care; this decreased her general helplessness regarding her disease. There were no legal, ethical, or cultural dimensions which were not fully addressed in the case of this patient. Patient consent and confidentiality was maintained at all times. The nursing staff and other health professionals were not all privy to the patient’s condition. Only her direct carers were privy to her condition. It may be easy to often disregard patient confidentiality in the mental health unit, especially when most everyone who works in the unit can access the patient’s charts (Videbeck, 2010). However, in order to prevent any harm from befalling the health staff, especially as far as violent and aggressive patients are concerned, there may be a need to inform the nursing staff of the patient’s mental status (Videbeck, 2010). On her admission, she was manifesting severe depression and actually even expressed how she wanted to die. She was actually a suicide risk. This prompted her to be placed on suicide watch and constant monitoring from the nursing staff. At times, this made the service user wary, and at times she felt like the constant monitoring and presence of staff invaded her personal space. However, the nursing presence was necessary because of the suicide risk. Suicide ideation is common among depressed patients. Since the patient was in her depressed phase on admission, there was a need to manage her illness as a depressed patient (Maj, et.al., 2003). For depressed patients with suicide ideation, constant monitoring is needed in order to prevent self-harm. The patient’s prognosis based on his ongoing/mental health needs is that she would likely recover from her symptoms in about a year’s time if she complies with her required mental health care. She would however need a support group and monitoring every six months. Her after care included monitoring; this meant a visit with her mental health professional every three months. She was also scheduled to attend weekly support group every week for one hour per session. Her monitoring was essential in order to ensure early detection of any possible relapse (Miklowitz, et.al., 2007). Critical reflection My role during the patient’s care was to primarily assist the nursing staff in their administration of mental health care. Since I was still a student nurse, I was not legally allowed to carry out any nursing interventions without the staff’s consent. Nevertheless, as a student nurse, I was able to carry out my essential functions well. I checked the patient’s vital signs upon admission, and immediately asked her for her primary complaint. Based on manifesting symptoms, I already understood that she was depressed and so I gathered all the data I could regarding her possible depression. I also checked her previous chart and history and I found out that she was manifesting some manic episodes. I also again gathered information from the patient about her manic episodes. I then endorsed the patient to the staff nurse. After the patient was diagnosed with bipolar disorder, I then started to educate the patient about bipolar disorder. I also asked the family to meet with the nurse for further instruction and education about the patient’s condition. My involvement in the patient’s case was largely on patient assessment and patient education. Patient assessment proved to be a valuable tool for me and the other mental health professionals because it helped to support their diagnosis. It also allowed a thorough and comprehensive evaluation of the patient’s condition which helped the health professionals rule out any other interpretation for the patient’s symptoms (Kessler, et.al., 2006). In relation to patient education, I considered this an important element of the patient care because the patient and the family were able to understand her condition better, including the treatment options available (Mann, et.al., 2004). I believe that I was very effective because I was able to gain the right evidence and establish a correct assessment in order to assist the mental health professionals in their treatment plan. I also believe that my involvement was critical because I was able to assist in soothing the patient and the family’s anxiety (Fristad, Gavazzi, and Mackinaw-Koons, 2003). I was able to sit with the family and tell them that there are treatment options for the patient and that she may still get a chance to live a relatively normal life. Patient assurance is always an important element of health care because it helps reduce anxiety and it reduces the negative impact of the disease (Fristad, et.al., 2003). In some cases, it gives them hope for their future. There are however some skills that I would like to develop in the future. I would like to develop more my therapeutic communication skills. From the very start, the patient was a bit wary of me and my questions. I noted that sometimes she was not truthful in her answers and was often evasive. I believe however that with proper skills in communication, I may be able to get past patient barriers and reluctance. I know this is an important skill to develop because I need to be able to get past a patient’s defences, especially those with mental illnesses (Shattell, Star, and Thomas, 2007). The wrong word or the wrong expression with these patients can sometimes lead to violence, aggression, apathy, or lack of cooperation. Aside from my communication skills, I also need to develop my knowledge on psychopharmacological drugs. These drugs are not the same with the usual drugs for other diseases. These drugs have various qualities and interactions which may contradict each other, and therefore cannot be taken simultaneously or after the other (Rhoads, 2011). I believe that I need to learn more about these medications in order to better understand the application on these drugs, their side effects, their adverse reactions, their half-life, as well as patient precautions. I believe that I also need to learn what drugs can be taken by the patient in order to counter the side-effects. In relation to drug intake, I also need to learn the tricks and techniques which patients often use in order to avoid taking their medications. The importance therefore of watching the patient take the medication and checking his mouth after each intake must be mastered. Conclusion This case study demonstrates the case of Patient X, a bipolar patient. This study was able to establish that based on the symptoms the patient manifested by the patient, she had bipolar disorder affective disorder. This label assisted in establishing the actual condition that the patient was suffering from and to establish the appropriate treatment for her condition. This label however also created a bias against her and her future behaviour. Nevertheless, such label was needed in order to point the mental health professionals in the right direction in her treatment. The patient’s treatment plan included health education, psychopharmacological medications, psychotherapy, and support groups. A multidisciplinary team also helped ensure her holistic care. Health education helped empower her and her family; and it reduced the patient’s anxiety. She was also put on suicide watch because of a possible attempted suicide. In depressed patients with a history of attempted suicide, the possibility of other future attempts is often high. In assessing my actions in caring for this patient, I am confident in saying that I was an effective student nurse in assessing and educating the patient. I was also able to assist the other mental health professionals in caring for the patient. My actions as a nurse made me an essential part of the team, and my actions also helped empower the patient, making her more engaged in her care. I learned that more than anything in mental health care, labelling can be a negative aspects of care because it can create bias from the very start. It is therefore important for me as a future nurse to look beyond labels and try to be as objective as possible, especially when caring for mental health patients. I also learned the importance of patient-centred care and how it can improve patient outcomes and increase patient cooperation in their treatment. 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Lithium in mood disorders: increasing evidence base, declining use?. The British Journal of Psychiatry, 191, pp. 474-476 Read More