Mental Health Assessment - Predisposing and Precipitating Factors, Applying the Stress Vulnerability Model - Case Study Example

Mental Health Assessment Student’s Name Institutional Affiliation Mental Health Assessment Mental health assessment (MHA) is significant to inform the care required and to assess or evaluate the effectiveness of the provided care. The primary aims of MHA is to enable the nursing practitioner in mental health (NPMH) to create a therapeutic relationship with the patient, to enable the NPMH to collect and collate significant information regarding the mental status of the patient from which the practitioner can come up with a formulation, to allow the NPMH to fathom the mental issues affecting the patient and enable the development of patient management plan that entails the patient's participation, and ameliorate the negative effects of the symptoms on the patient (Coombs, Curtis & Crookes, 2013; Coombs, Curtis & Crookes, 2011). A comprehensive MHA includes the assessment of the patients’, cultural, social, spiritual, psychological, and biological needs in addition to their mental status, patient history and presentation, referral data and any collaborative history, risk assessment, medical assessment and the legal considerations regarding the care of that patient (Elder, Evans & Nizette, 2009). When assessing the mental status, a patient’s behavior and appearance including cleanliness, self-care, motor behavior, and attitude are examined in addition to their mood and affect, form of thought, content of thought, insight, perception and cognition (Shives, 2008). Patients’ history and their presentation comprising the existing complaint, physical findings, history of the mental issue including its impact on the patient’s life, any previous psychiatric history, current medications and any possible side-effect, family and social history including use of substances are all significant considerations during assessment (Shives, 2008). Additional information regarding the client is obtainable from the patient's GP, psychiatrist, significant others, community mental health nurse or case managers. Information obtained from such sources assist in corroborating the history of the patient and limit unnecessary repetition of investigations. The mentally ill patient might be at risk hence the need for risk assessment. Assessment tools such as the HCR 20 are useful during this assessment to ascertain the likelihood of the patient harming themselves or others (Elder, Evans & Nizette, 2009). Mentally ill patients may present legal challenges in terms of their ability to consent and the practitioner’s prerogative of duty of care such as in urgent necessity against the client’s self-autonomy rights (Elder, Evans & Nizette, 2009). In addition, the regulation and Acts governing the mental health service provision need to be adhered to during the assessment and even the management of patients. Applying the Stress Vulnerability Model (SVM) to the Case Study Environmental stress can aggravate the vulnerability of a client, or even worsen the presenting symptoms of a psychiatric patient and result in relapses for a previously controlled patient. Stress, in this case, is deemed as something that challenges an individual such that some form of adaptation is necessary to cope with the stress adequately. It may involve both a negative or positive event that puts pressure on an individual. Moreover, stress can also result from not been involved sufficiently or lack of constructive involvement in something (Goh & Aqius, 2010). Biological, social and psychological attributes of an individual empower or make a person more vulnerable to stress. Using SVM, John’s condition shall be examined in terms of how it presents, its predisposing, precipitating, perpetuating and protective factors. Presenting Problem John presents with symptoms typical of psychosis. He experiences signs of psychosis such as both the positive and negative symptoms. Positive symptoms include suspiciousness and feeling that he is under constant surveillance. He has also experienced auditory and visual hallucination in addition to been delusional. He explains to the police that has observed a shadowy figure of his neighbor pass by his windows and that he has also heard voices of whispers outside his back door, symptoms that are typical of visual and auditory hallucination respectively (Ali et al., 2011). Furthermore, he also exhibits visual hallucination when he says that he sees his dead mother almost every day. John exhibits delusion of paranoia as he believes that his neighbor follows him everwhere with the intention to spy on him (Shives, 2008). In addition, he has unplugged the TV power cable because he believes that his neighbor can influence or send him messages through the TV. Among the negative psychosis symptoms exhibited by John include the inability to take care of his wellbeing such as difficulties grooming as he appears unkempt, unshaven and reeks an offensive smell. Also, he has withdrawn from social activities as he prefers sitting alone in the dark, and he has not checked his mailbox for some days evidenced by the pile of unopened mail box. His mood has been affected too with some depression that had occasionally almost precipitated suicidal tendencies as he is said to have considered cutting his wrist using the knife he keeps all the time for protection from his delusional intruder. John’s appearance is unkempt, unshaven with an offensive smell. His speech is becoming incoherent with inaccurate articulation. He is suspicious especially regarding his neighbor. His form of thought is disturbed with language disturbances and discontinuous ideas. His thought content are delusional with suicidal thoughts while his perception is hallucinatory. John is not aware of his situation and shows limited insight over the problem as he claims not to have any mental issues. His cognition is also impaired with the loss of orientation as he does not know which day or month it is, and his concentration is also poor. Predisposing Factors Based on the SVM, John is highly likely to be genetically predisposed to psychosis based on the history of suicide in the family. The father is said to have committed suicide when he was still a child. The mother has recently died suddenly although it is not clear what the cause of her death was. Nevertheless, his father's suicide may signify a possible mental illness that is a biological risk factor for John’s development of psychosis. John also has some predisposing psychiatric history (Henderson & Martin, 2014). He has previously received mental health services where he was put on the antipsychotic olanzapine, which had kept his psychosis in control. In the previous18 months, John had not exhibited any symptoms of psychosis. This could be attributed to mental health services he had received initially. John is living an adverse lifestyle since the loss of her mother. He does not interact with anyone and has no one to support him do the normal day to day activities such as grooming, washing and cooking. His mother also contributed significantly towards the payment of his bills. Even though it is not clear who pays his bills after the death of his mother, it is apparent that he is struggling to make ends meet. These social strains are possible stressful predisposing factors capable of increasing John's vulnerability to psychosis (Henderson & Martin, 2014). Precipitating Factors John experiences and has habits (stressors) that may easily result in psychotic events in a psychosis predisposed patient like him (Henderson & Martin, 2014. He was previously on antipsychotic medication which he reports having stopped taking. This might have precipitated the psychotic attack considering that no health professional had deemed him safe to stop using the antipsychotic. John just lost his mother, three months ago. He was heavily reliant on her to sustain and maintain himself. Her death has stressed him and tortured him psychologically as he misses her company and financial support. Now that John's mother is dead, he is psychologically deprived by her loss. John also indulges in substances of abuse such as marijuana. He admits to using marijuana to "calm". Degenhardt and Hall (2005) suggest that the use of cannabis can precipitate psychoses in individuals who are already vulnerable to psychoses. Pierre (2011) also demonstrated that cannabis has potential deleterious effects on patients who are highly predisposed to psychoses or who are already psychotic. The drug is commonly associated with poor treatment adherence- explaining John's non-adherence to olanzapine, relapse and aggravation of psychotic symptoms (Pierre, 2011). The hallucinatory and delusion symptoms exhibited by John have also been documented to be potentially caused by cannabis in a dose-dependent manner (Pierre, 2011). Therefore, John might have precipitated the occurrence of psychosis symptoms with the often consumption of marijuana. Perpetuating Factors One of John's biological perpetuating factors includes his discontinuation of olanzapine, a medication that was supposed to control his psychosis symptoms. He reports that the he felt very drowsy on taking the drug and that it made him feel unpleasant. The unpleasant sensation might be attributed to the side-effects of the medication (Frankenburg, 2014). Frequently abusing cannabis is also John’s precipitating factor as the substance has been shown to propagate subdued psychosis (Pierre, 2011). The fact that John does not have any emotional or financial support from anyone after the death of his mother may have accelerated or enabled the persistence of the psychosis symptoms too. His social lifestyle is not conducive and supportive of a symptom-free lifestyle since he lives alone without any moral or psychological support from anyone, and he had to call the police to be rescued from his delusional thoughts. Protective Factors It appears that when John's mother was still alive, he was capable of coping and avoid precipitating factors to psychosis as it is only after her death that symptoms re-occurred again. His mother, therefore, was a source of his strength as he admits to relying on her finances and company. John can cope better if he gets another instrumental and supportive person in his life to act as a guardian to him in addition to seeking mental health services again (Keks & Hope, 2007). This may be through one of his relatives or a supportive environment in mental institutions where staffs such as NPMH would develop an appropriate comprehensive management plan (Handerson & Martin, 2014). He seems to have previously responded to medication although he had raised concerns over how it made him feel. Therefore, resumption of medical therapy may have a protective effect on the manifestation of psychosis symptoms. Conclusion Mental health assessment requires a step-wise, organized and evidence-informed plan. Without a comprehensive mental assessment, it may be difficult to capture all the patient aspects significant in informing the formulation and implementation of a mental health plan. SVM, is a tool useful in the assessment and even management of mentally ill patients. Since stress arising from various factors such as biological, psychological or social elements exerts emotional and mental pressure on a patient, it is a source of predisposing, precipitating and perpetuating elements of psychosis such as was in John's case. By identifying the above stressful factors, it is possible to initiate and implement a holistic, patient-specific management plan (Keks & Hope, 2007). 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