The Predisposing, Precipitating and Maintaining Factors of Mental Health - Essay Example

?Case Study of Mental Health Looking at the presenting problems, what kind of ‘diagnosis’ would be most appropriate for this case? Explain why. Identify the predisposing, precipitating and maintaining factors at play in the case you are exploring Mental health diagnosis is a stepwise process (Morrison 2007). It begins with evaluating if mental illness symptoms are present in an individual. This is done through asking the patient some questions regarding their symptoms and medical and family history. Sometimes it may be necessary to perform some physical tests. If the condition is not caused by any other illness as per the test results, the person is referred to a specialist in mental health like a psychiatrist. The psychiatrist use specially designed assessment tools. The diagnosis is based on the patients reported symptoms like social and functional issues emanating from the symptoms. Next is the psychiatrist to determine if the patient’s symptoms and degree of the effect relates to any specific mental disorder (Morrison 2007). In the presenting problem, the diagnosis will take the highlighted stepwise process. I will start by asking Sarah questions concerning the highlighted symptoms which are difficulty in sleeping, feeling wary and afraid, flashbacks and feeling of anger for not reporting the rape, inability to let go, and move on in relationships, and the tendency to isolate herself. I will also need to know if in the family history, there was or there are individuals who suffer from the same problem as Sarah. The answer to the questions will aid me in understanding why she has all those issues as well as direct me to knowing the best test to carry out. Some of the questions will include how long the patient has had the symptoms, when the symptoms started, the severity of the symptoms, and any treatment taken so far (NIH 2011). As a doctor, I will also ask Sarah if she is using drugs/alcohol and whether she is thinking of death or committing suicide to be able to evaluate the magnitude of the effect. At this level, it is important to carry out a physical examinations and medical test to expose patient’s overall state of health hence be able to rule out factors that could be contributing to the symptoms (Morrison 2007). This is because certain medications and some medical situation like thyroid disorder have the same symptoms as mentioned (Elder et al 2009). The physical examination will be done to test any signs of prior mental health. In the case of Sarah, her issues seem to emanate from relationships. This will lead me to assess the given symptoms. Upon ruling out medical condition and bipolar disorder, a psychological evaluation will therefore be important. According to the description given, some of these symptoms are observable while others are hidden. The observable symptoms include withdrawal from people, leaving her job without any solid reason, having difficulty sleeping, and expressing fear that is inwardly felt. The hidden symptoms in the case of Sarah include anger, blame, flashbacks, and inability to move into another relationship, which expresses lack of trust in the opposite gender. From the assessment of the symptoms, it is clear that Sarah is suffering from depression. Having suffered from this disorder for more than 2 years, the depression can be described as a major one. The given diagnosis will be the most appropriate for Sarah since it will be all rounded. It will highlight all the symptoms hence make it easy for the intervention to be carried out effectively. Sarah’s case has several predisposing, precipitating, and maintaining factors at play. The predisposing factors in this case include stress that was caused by the difficult marital breakup she went through. This incident raised a level of anxiety and lowered her mood. Another predisposing factor was life events like rape. The incident left her afraid and disillusioned. She actually had to leave her place of work to a less enjoyable work in efforts to run away from the effect of the rape. This lead to further problems in blaming herself for having let the colleague make her leave her job where she was enjoying every bit of it. The feeling of “flesh crawling” out of Sarah when the idea of being touched by a man is suggested shows some level of trauma. In this case, trauma that was developed by both the broken marriage and the rape incident is so much at play. This sets her at a point where she finds it difficult to relate with men leading her to isolating herself and unable to disclose her problems to anybody including her best friend and a sister who is said to be close to her. Isolation is another predisposing factor that is at play in Sarah’s condition. The fact that she does not share with anybody her concerns in the last two years makes the depression develop to a major one. As the saying goes “a problem half shared is a problem half solved,” Sarah could have arrived at solutions to her problems way before it got that serious. Her anxiety increased due to the failure of talking her issues out. The effects of the anxiety translated to issues like lack of sleep, feeling of fear and worry a lot of the time, and having flashbacks of past traumatizing events. Talking out could also have helped her in easing the anger she had on the colleague and probably arrive at justice instead of leaving her job to a lesser enjoyable job. Rape, as a life event, ties as both a predisposing and a precipitating factor. As a precipitating factor, it exposed Sarah to flashbacks that could be a cause of her lack of sleep. It exposed her to anger and inability to let go of what men had done to her to be able to move on. The event also exposed her to mistrust towards men. She got so fearful that the case says she could not get into another relationship since the suggestion of a man touching her “makes her flesh crawl.” This phrase explains the magnitude of the damage that was caused by the event. Anxiety is another precipitating factor that is so much at play in Sarah’s case. The anxiety has grown over a period of two years hence it had enough time to develop into depression. This factor is the cause of her developing some characteristics like isolation and mistrust since she is uncertain of what will happen if she shares her problem. She is afraid of being rejected like in the situation where she failed to report the rape to the police for fear of being dismissed. Anxiety creates worry and fear in Sarah. This sense of fear could be the reason why she closed herself in her own world where she is the only one who knew what she was going through. Maintaining factors to depression can be defined as the incubating factors to the development of the disorder (Carson 2011). In Sarah’s case, anxiety played a great role in the development of the depression. Through anxiety, Sarah was uncertain of what to expect in life as far as men are concerned. She was uncertain of whom to talk to including her best friend and relatives. Anxiety directed her to leaving her job an aspect that left her blaming herself and angry. All the mentioned effects of anxiety contributed to the development depression. Stress ties as both a predisposing and maintaining factor in Sarah’s case. Stress from her failed marriage played a great role in developing depression. Stress is also evident in her work place especially after the rape incidence. This led her to leaving the place to another one. Self-criticism is another maintaining factor that is at play. Sarah criticizes herself for not being able to report the rapist and being so easy in leaving her enjoyable job because of a colleague. Sleep is one of the most important parts of a person’s life (COMH 2007). It gives an individual the opportunity to relax and rest. When a person has trouble in sleeping, her brain chemistry changes, hence leading to her suffering depression. Social withdrawal is an action that has a great contribution to development of depression (COMH, 2007). Through isolation, Sarah lacks somebody to share her problems hence making it necessary for her to see a specialist when it is too late. If she had talked it out to somebody, the level of depression could have been lessened. 2. Explain how two theoretical models would make sense of the case you have chosen Theoretical models seek to explain two mental disorder perspectives: biomedical and psychosocial (Hankin & Abela 2005). Biopsychosocial model of depression integrate these two perspectives in efforts to identify their interconnection and interdependence (Aquirre & Garcia-Toro 2007). In other words, the mind and the body are not independent since what affects the mind will also affect the body. Complete wholeness involves psychological and social status wellness (Nemade et al 2007). The Psychological factors include negative thinking, inability to cope, problem judgment the inability to perceive, understand, and express emotions (Nemade et al 2007). The social factors like experience in traumatic incidences, loose of loved ones, and lack of social support. When stressors impose so much on an individual, it at times goes beyond the vulnerability threshold. This sends feedbacks to the mind or brain that affect brain functioning. Therefore, the model suggests that the interdependent factors, i.e biological, psychological, and social factors, affect each other interdependently. Any combination of the mentioned factors suffice as a trigger to depression hence making it necessary for all the factors at play be considered when highlighting a case of depression. Biopschosocial model stands out as one of the theoretical models that well explain the case at hand. The physical abuse that Sarah suffered sends triggers to her mind that ends up generating negative thoughts and feelings. Her stressful marriage that ended up in marital breakup probably due to her inability to cope sets her vulnerable to believing that she cannot find love again. This is made worse when she went through rape. The stress pulled her vulnerability beyond threshold making her to make decisions that she ends up regretting. Sarah suffering from inability to express herself through sharing plays as a social problem. This develops a psychological factor that shows that she does not trust that her problems will remain a secret once one extra person knows. The result of the silence is that she experiences fear and worry most of the time. This shows that there was a strong interdependence between her psychological and social stressors hence contributing to her general development of depression disorder. Diathesis-stress model is another model that can describe Sarah’s condition. This model describes the relationship between potential causes of depression and the degree of vulnerability, which is describes as diathesis, in reacting to these causes of depression. The vulnerability as in diathesis-stress model is both biological and psychological as in biopsychosocial model. The model proposes that different individuals have different levels of vulnerability though for the disorder to develop, an individual have to intermingle with stressful events either socially, biologically, or psychologically to be triggered to suffer from the depression. The less vulnerable individuals often require great levels of stressors to be depressed while the higher vulnerable individuals require less stressor to develop the disorders. However, they both are stressed depending on vulnerability and stressors imposed on them. The ability of the patient to manage a crisis, brought about by stressors, psychologically and biologically, is dependent on diatheses like hereditary susceptibility, personality, and temperament (Stuart 2006). Sarah seems to have a lower vulnerability. Her problems started from her marital break-up, which left her, stressed, with low moods and lots of anxiety. Her ability to deal with the crisis was law in that when twelve months down the line another traumatizing experience hit, she was shattered and unable to move on completely. Somebody would think that one year is a long time that Sarah could have gone through her marital stress and healed. However, this is not the case with Sarah; she seems to have a pile of issues that have build over time causing her to go into depression. This shows that Sarah’s low vulnerability is more damaged whenever a new crisis happens. 3. Explain what intervention strategy you would use for this case, and why. Depression is one of the highly treatable disorders. Just like many other disorders, the earlier the intervention the more effective the treatment is and the higher the likelihood that the treatment will reduce chances of the depression recurring in the future (NIMH 2011). The intervention will involve both medication and psychotherapy to enhance effectiveness. This is because Sarah is suffering from major depression that is more serious than mild depression. Medication involves antidepressants that normalize naturally occurring brain chemicals like neurotransmitters (Hankin & Abela 2005). The antidepressants contain some chemicals that work in regulating moods (Shives 2008). The patient will need to take regular doses of antidepressants for three to four weeks with further recommendation based on the level of response to medication. The conclusion to stop the medication will be arrived at through an agreement by both us. The stopping process will be a gradual one to avoid some withdrawal symptoms or relapse. Besides giving antidepressants, I will advice Sarah to avoid foods and medications like cheese, wine, and decongestants that contains high levels of the chemical tyramine (Shives 2008). This is because tyramine increases blood pressure. This will work to assist the patient in avoiding serious effects of depression. Besides medication, psychotherapy, which is also known as talk therapy, will also be administered. This will aid Sarah in coming to terms with the past, letting go of the past and be able to move on. The therapy to be administered will be interpersonal therapy (IPT), which helps the patient in understanding and working through her distressed personal relationships that led to the depression. This therapy resolves symptoms, develop interpersonal performance, as well as augment social support (Stuart 2006). The therapy will start by having the patient’s interpersonal inventory done in the first three sessions of IPT. This will help us identify the history of the patient’s interpersonal relationships and the start of the patient’s interpersonal problems to create a base for the therapy (Stuart 2006). The next stage will be to identify interpersonal problem areas. This stage will highlight interpersonal disputes, grief and loss, and interpersonal sensitivity. This stage will help in alleviating some of the anger and griefs while at the same time create a personal connectivity. The next stage will involve interpersonal formulations. This stage will make use of the interpersonal inventory together with the patient’s biological and psychological makeup, and attachment style to explain the patient’s symptoms (Stuart 2006). The final stage will be the maintenance treatment stage. This will be to reduce chances of relapse and maintaining prolific interpersonal functioning. According to NIMH (2011), patients who respond positively to the initial treatment of medication and interpersonal therapy have a less likelihood of having depression recur especially when they take the combined treatment for at least two years. For the purpose of follow-up, the therapeutic relationship will still be there even after the problem is solved. This will be to ensure that I remain available for the patient in case any further crisis arises. This stage will also include health maintenance to ensure that Sarah has gone to full recovery. 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