Assessment and Collaborative care Plan: Mental Health Analysis - Case Study Example

Running heading: ASSESSMENT AND COLLABORATIVE CARE PLAN 1 MENTAL HEALTH CASE STUDY Daphne is a 70-year-old Caucasian female, who first experienced symptoms of depression at the age of 30 years, after the birth of her second child. She had a strong family history of mental illness on her maternal side of the family, her mother, an aunt were diagnosed and treated for depression, another aunt who was diagnosed and treated for bipolar disorder, all are now deceased. The diagnosis of depression involves an assessment of psychiatric, psychological and social factors collective unknown as biophysiosocial assessment. BIOLOGICAL Serotonin regulates other neurotransmitter systems, low levels of serotonin promotes low levels of norepinephrine that is associated with depression. (Barlow 2005 p 226) There may be a link between the neurogenesis of the hippocampus and depression implicated in the mood and memory, loss of hippocampal neurons found in some depressed individuals, with impaired memory, and dysthymic mood. (Cutter, Norbury & Murphy 2003) Oestrogen was too implicated in depression due to the increase of depressive episodes after menopause and low level of oestrogen is associated with increased risk of low moods. She also suffers from hypertension, that could cause her to have a sleepless night, which left her tired the whole day, and arthritis pain associated could be causing her to lay awake throughout the night, she too drinks alcohol on social basis intake as been found to increase the recurrence of depression episodes. In addition, she is a chain smoker, which would trigger stress and mood swings, and other interactions of nicotine with medications she is using. ASSESSMENT AND COLLABORATIVE CARE PLAN 2 PSYCHOLOGICAL A depressive episode is associated with adverse events in adults like, the quality of early bond between the infant and the adult caregiver especially. This would be particularly on patients who have experienced in early loss or separation like in the case of Daphne she lost her husband. Depressed people may have negative belief about themselves. This would lead to excessive smoking and drinking as in the case of Daphne. A lack of social persuasion that she would succeed on her own despite her somatic emotional state that included tension, stress, and the loss of a loved one in overcoming this. This may be due to the death of her husband, relocation to a smaller town away from her family, a move that turned out to be stressful making the situation worse. She has a strong family mental health history, her maternal mother, her aunt diagnosed and treated for depression, another aunt diagnosed with bipolar disorder. Her husband died three months ago after moving to seaside town, isolation and loneliness she attempted to commit suicide by drug overdose. Still after going through treatment she experienced hopelessness and thoughts of suicide. (Sadock 2003) SOCIAL Social isolation by moving away from her daughter and grandchildren that made her feels lonely. She is a smoker, alcoholic, has arthritis and hypertension increases the risk of major depression disorder. Been feeling stressed, hopelessness, depressed, and fatigue due to insomnia after the death of her husband, she is at risk of committing suicide again hence she is under suicide observation. (Fergusson & Boden & Horwood 2009) ASSESSMENT AND COLLABORATIVE CARE PLAN 3 MENTAL STATE EVALUATION She was found unconsciousness at her lawn. Her neighbour tried to arouse her without success and called an ambulance. Once at the hospital, she recovered but her mood was dysphonic, her husband had dead three months ago and she was feeling worthlessness, an attitude that would explain her suicidal thoughts. She was having insomnia, a sleeping disorder that left her tired the whole day. This complicated her situation. She lost concentration on her paintings and could not get the pleasure she used to get while painting. MAJOR ISSUES/DEPRESSION The ICD-10 defines three typical depressive symptoms that is; depressed mood, anhedonia, and reduced energy, two of which must be present. Daphne has all three symptoms hence major depression was conclusively diagnosed. In addition, DSM-IV-TR has two main depressive symptoms that are; depressed mood and anhedonia at least one should be present. Daphne has low mood, although this method does not give bereavement of her husband three months ago as a cause of depression, it however, contributes to feeling sad, lonely and stressed out, which in turn can trigger depression episodes. This assessment indicates that Daphne may be suffering from the following condition, based on the available evidence. She was diagnosed with adjustment disorder, with depressed mood, which is an indicative of the Dysthymia, low mood that was trigger by psychological stress response of moving to a small town at seaside away from family and the death of her husband. Through his evidence-based diagnosis, daphne was found to be suffering from major depression disorder. ASSESSMENT AND COLLABORATIVE CARE PLAN 4 The patient, family, and staff should build trust with each other especially to the patient so that she can open up and grieve the loose of her husband, and encourage her to talk and share with what might be affecting her through evidence based talk therapy. Cheer her up all the time and try their best to provide a proper environment for her to feel good about herself and encourage her to continue painting to regain her concentration. (American psychiatrist association 2000) Secondly, she has been experiencing loss of concentration and lack of pleasure while paint, an activity that she had been enjoying before this proves that she, has Melancholic depression, which was indicated by loss of pleasure. Thirdly, when she was 30 years old she lost her babe and since then she has been suffering from depression and has been in and out of hospital several times. This is an indicative of postpartum depressed mood experienced after childbirth. They should encourage and take her out to arts exhibitions, or organize some arts exhibition that would give her some motivation to start painting and enjoy doing it. Play her favourite music that would help her to concentrate. DEATH OF HER HUSBAND Bereavement, her husband had dead three months ago, after they had moved to seaside beach area away from their family members and friends, she was found to have been addicted to smoking and drank occasionally, and due to the depression and hypertension, she was on prescribed medicines. The dead of her husband left her stressed up, lonely and felt hopeless, aggravating her depression symptoms. The family ASSESSMENT AND COLLABORATIVE CARE PLAN 5 especially her daughter should be there for her at all times and help her to grieve the death of her husband. Hypertension, the patient has a hypertension already and she is under medication, with the recent development of losing a supportive husband to death, moving to seaside, and smoking. They do elevate blood pressure and results in Sleepless nights, they should comfort her and try to make her calm to control her high blood pressure. Arthritis, the patient has arthritis and she need constant medication to relief pain and will need assistance from time to time in the house especially now that the husband has dead, and she needs to go back to her daughter to take care of her. In addition, she will need special attention at all times, and this will influence the family caregivers to the extent that they have to take care of her. Loneliness aggravated her mood swings since she was left alone at the seaside town, she has been sad and moody, as a result she may be overbearing and the family have to be ready to bear that and give her support eventually she will overcome it. Bereavement three months ago she lost her husband, and she is still grieving and she needs all the support she could get to get over these. In addition, the family members have to be there for her and she should be able to count on them, therefore, they have to open up and build trust so that she can upon up on and talk with them. She was stressed and had sleepless nights which left her fatigued, because she is been stressed, depressed, and high blood pressure complicate her situation and she ended up not getting enough night rest. Her daughter should take her to stays with them, this ASSESSMENT AND COLLABORATIVE CARE PLAN 6 will help in reducing her loneliness, encourage her to take short naps during the day, make her take small portions of food throughout the day. In addition, take her out for a walk or do any form exercise that she is comfortable. SUICIDAL THOUGHTS The symptoms of stress, fatigue, insomnia, hopelessness, and suicidal thoughts are because of chronic depression that she was experiencing. The patient’s assessment had indicated that she had been experiencing suicidal thought and she even attempted to commit suicide by drug overdose. The most efficient treatments for depression are cognitive behaviour therapy, interpersonal therapy or brief, focused analytic therapy. The staff should refer her to a psychiatrist, the family should watch her all the time, and referred to local groups for group counselling. INTERVENTION APPROACHES/TALK THERAPY Individual counselling and support, can be used as a talk therapy to enable the patient to express herself and be encouraged to open up and explore her deepest emotions that may be hurting and preventing her from full recovery, especially the grieve of losing her husband. The family members should learn ways they would be able to use to encourage her to trust them, with her emotions and that their support is paramount for her to accept the loss of her husband. Build a positive imagine and have a positive thinking towards life and that her husband would have wanted her to continue living if he was alive. This method had been shown to work effectively when combined with other therapies, like cognitive behaviour therapy and interpersonal therapy. Daphne’s daughter would be encouraged to have time for her mother, to talk and share. ASSESSMENT AND COLLABORATIVE CARE PLAN 7 SUPPORTIVE PSYCHOTHERAPY Supportive psychotherapy for bereavement or other forms of crisis like the one the Daphne is facing after the death of her husband and the social isolation, the family members have to encourage her to go back and stay with them. (Barlow 2005) BEHAVIOUR/INTERPERSONAL THERAPY Behavioural intervention that is the interpersonal therapy is efficient in controlling new onset of depression, which was found to be successive when delivered individually. Through the internet, eight times 60-90 minutes. Now that she has been experiencing relapses in the past this intervention will help to reduce the changes of relapse occurring. (Cuijpers et al 2008) COGNITIVE BEHAVIOUR THERAPY Cognitive behaviour therapy teaches patient to challenge their self-defeating emotions like in this case of hopelessness, low mood, sadness, and suicidal thought to encourage Daphne to use autosuggestion method. Whereby she will keep repeating good thoughts about herself and why she should be happy and worth to continue living. (Dobson 1989) LOGO-THERAPY Logo-therapy associated with filling meaninglessness, this method if used would make the Daphne feel worth and increase her self- esteem in order to control the feeling of unworthiness, hopelessness and wanting to commit suicide. Through the method, we could restore her ability to find meaning in life and even if her husband has dead, life continues and one is bound to enjoy it to the fullest and encourage keeping painting. ASSESSMENT AND COLLABORATIVE CARE PLAN 8 PRACTITIONER RECOMMENDATIONS TO CONSUMER/FAMILY/CARE GIVER Providing information through effective communication, these will enable the family member to be ready in supporting her and provide information on the management and living with people who have a major depression disorder. Through either the internet, community libraries, personal phone calls. These will serves has a source of information on how to encourage her to engage herself in activities and exercises that will help her to recover, like how to motivate her to keep painting, have regular naps in the day to reduce her fatigue and eat small portions of food regularly at specific intervals. Encourage her to take small portions of meals at regular intervals during the day. Caregiver assessment, they too should be assessed whether they are suffering with any symptoms of depression and be treated first they should be involved in all decision making and thought how to assess useful information on how to take care of themselves and the patient. Negotiate with the consumer and their family or caregivers, about keeping all the information relating to the consumers illness confidential and be open to share information among them. Also, provide information on local families, caregivers, or institutions that provide services to people affected with depression. My recommendation to the patient and caregiver would be, to call me whenever there is a need for clarification or any advice, would refer them to local groups, with similar problem, and give them internet source for materials relating to the management of major depression disorder. There self help groups, which she should go, and check which best suits her, her daughter would help her by accompanying her to check them. ASSESSMENT AND COLLABORATIVE CARE PLAN 9 REFERENCES American Psychiatric Association. (2000) Diagnostic of Mental Disorders, Fourth (e.d) Psychiatric Press. Inc, Washington, DC. Aitken L C, Baldwin R C, (1998) the Management of Depression in the Elderly. Checkley S (e.d) Blackwell Science Oxford. Barlow DH (2005) Abnormal psychology an integrative approach, fifty (e.d) Wadsworth p 226 Belmont, CA, USA: Thomson Cutter WJ, Norbury R, Murphy DG. Oestrogen, brain function, and neuropsychiatric disorders. Journal of Neurology, Neurosurgery and Psychiatry. 74(7):837–40. Cuijpers P, van Straten A, Smit F, Mihalopoulos C, Beekman A.(2008) Preventing the onset of depressive disorders: a meta-analytic review of psychological interventions. Am J Psychiatry. 165(10):1272–80. Dobson KS. (1989) A meta-analysis of the efficacy of cognitive therapy for depression. J Consult Clin Psychol. 57(3):414–9. Fergusson DM, Boden JM, Horwood LJ. (2009) Tests of causal links between alcohol abuse or dependence and major depression. Arch. Gen. Psychiatry. 66(3):260–6. Sadock, Virginia A.; Sadock, Benjamin J.; Kaplan, Harold I. (2003) Kaplan & Sadock's synopsis of psychiatry: behavioural sciences/clinical psychiatry. Philadelphia. GLOSSARY Anhedonia: inability to gain pleasure from enjoys experiences that one enjoyed previously. Bipolar disorder: is a mood disorder in which the individual will alternate between periods of depression and periods of mania. During the manic periods, the person will experience a better than normal mood which may be mild (hypomania) or so extreme that it interferes with their life. The manic periods may last only hours or they may continue for weeks or months before the depression eventually returns. Dysthymic disorder: a mood disorder characterized by depressed feeling, loss of interest or pleasure in one's usual activities, and other symptoms typical of depression but tending to be longer in duration and less severe than in major depressive disorder. Dysphonic: drastic mood swings, anger, depression, irritability, tension, sleep and appetite changes, and fatigue. Insomnia: a sleeping disorder in which the victim is unable to have enough sleep. Melancholic depression: endogenous depression Characterized by pervasive sadness, hopelessness, loss of interest in activities, and physical symptoms, like weight loss, and sleep problems. postpartum depression: severe depression beginning slowly and sometimes undetectably during the second to third week post partum, increasing steadily for weeks to months and usually resolving spontaneously within a year. Somatic complaints such as fatigue are common. It is intermediate in severity between the mood fluctuations experienced by the majority of new mothers. Read More