Health status Report of Vera for Model - myassignmenthelp.com

Question: Discuss about theHealth status Report of Vera for Model. Answer: Health Status Report of Vera Based on Comprehensive Model of Assessment The comprehensive mental health assessment is very important to establish a therapeutic alliance with the patient (Coombs et al 2011). It is important to formulate treatment goals and plans after doing a comprehensive mental health assessment of the patient. A comprehensive assessment include collection of information regarding medical history, personal history, social history, family history, the present mental state, cognitive assessment, substance abuse (tobacco, alcohol, drugs), physical assessment, and potential risks (ibid). Now follows the Health status Report of Vera based on Comprehensive model of Mental Health Assessment. History The history taking is very important component of mental health assessment (Bor et al 2016). The history includes psychiatric history, medical history, personal history (Psychosocial/ developmental history), family history and social history (ibid). In the case of Vera, we could not gather any information regarding history. The only information available is that Vera has this illness since a long time. The interviewer asked twice that from how long he is suffering like this. The only answer was, Long time. While taking the history of medication, it was known that Vera stopped taking medication since few weeks or few months as he suspected that the medicines were poisoned by some invaders. Mental State Examination First of all, it is very important to know patients state of mind at the time of interview. It will further help in providing direction to the assessment. It will tell whether the patient is ready for a comprehensive assessment right now, or he is critical and need to be interviewed discretely and need to be given some medical intervention after diagnosis (Akiskal 2016). The patient in this particular Video was quite disturbed. He was feeling cold and was fully clad with jacket, cap, muffler, and gloves. He was shaking his legs constantly. He was putting goggles. He was looking old and weak. He was worried and upset. He was also looking here and there in order to suspect someone around. This was due to auditory hallucinations and a response to that. He was suspecting that some intruders are spying on him and so he was looking for them here and there in the room. He was having tremors due to which he was shaking his legs. He was restless, withdrawn and uncomfortable. There was a littl e degree of anxiety in the behaviour of Veera. It was difficult for the interviewer to build rapport with the Vera as he was suspecting the interviewer initially but later on he started responding well to the asked questions. His speech was also poor and pressured. His face was showing the emotions of disagreement. There was also incoherence in his thoughts. He was feeling as if some intruders are putting thoughts in his mind. He was not having any suicidal thoughts. Neither he was having thoughts of harming himself, nor was he having thoughts of harming others. He was having phobia. He was fearful of some intruders who were spying on him and were yelling at him. These symptoms suggest of Schizophrenia. The interviewer also knew from his case history or case manager that the patient has a history of Schizophrenia. There is no objective diagnostic test of Schizophrenia as of 2013 (American Psychiatric Association 2013). Diagnosis is entirely clinical and is based on symptoms of patient and his experiences which he tells to clinician. The diagnosis is also based on the behaviour of patient as described by friends and family members of patient (ibid). The symptoms of Schizophrenia are often described in terms of positive and negative symptoms (Kneisl Trigoboff 2009). Positive symptoms are those symptoms which are not present in healthy individuals but are present in Schizophrenia patients. It includes auditory hallucinations, delusions, disorganised thoughts speech, abnormal social behaviour, and other manifestations of Psychosis (ibid). Negative symptoms are those which are deficits in patient with Schizophrenia as compared to normal healthy person. These include poor social skills, inability to form good relationships, difficulties in adjustment, inability to be happy and experience pleasure, poor speech, and lack of motivation in life (ibid). This particular patient is also showing similar symptoms. Sensorium and Cognition Cognition in schizophrenia guides us towards pathophysiology, and treatment of the disease (Green Harvey 2014). The study of cognitive impairment in schizophrenia has become central in the study of schizophrenia itself, and the course prognosis of its treatment (ibid). The poor cognition makes the patient functionally handicap. Anti-psychotic medicines treat the psychosis but cognition needs psychiatric rehabilitation, to be fully functional and participate in social life (ibid). The patient was oriented in terms of time, place and person. He was able to tell the name of the interviewer and his profession. He was also able to tell the day and date. He came all by himself by taking a bus. His memory was fine. He was able to tell the names of past five prime ministers of Australia. He was slightly disoriented. He was having abstract thoughts of 5-6 people in red cars spying on him; people on TV putting thoughts in his mind; hearing voices that tell him to take-off his clothes; intruders have poisoned his medicines etc. Insight Schizophrenia is commonly accompanied with poor insight (Vander-Meer et al 2013). Insight includes clinical insight and cognitive insight. Clinical insight include self-awareness of his illness, and recognizing the need for treatment. Cognitive insight includes ability of patient to distance himself from abnormal experiences and to consider alternative explanations for their beliefs (ibid). The process include self-reflection and conscious evaluation (ibid). The patient did not consider himself ill. He told interviewer that nothing is wrong with him. Veera did not admit that he has any mental illness. He also stopped taking medicines and thought he does not need them and some intruders have poisoned those medicines. He came here because he wanted to get rid of intruders who were yelling at him and spying at him and were harassing him. Veera believed that the interviewer will help him out to fix these intruders. The interviewer assured him that these intruders will be gone by evening. Social and Religious Beliefs of Patient It is very important to assess patient regarding his social, cultural and religious beliefs; which will assist while planning social recovery of the patient (Paniagua 2013). In this particular case, the patient Veera is a religious person who goes to Church every Sunday and he feels safe there. He does not have auditory hallucinations at that place. He considers the intruders which are spying on him cannot enter the church and cannot harm him at that place. It is a very positive clue regarding the patient which can help him in his recovery. Substance Abuse Assessment Drug and alcohol abuse is commonly present in patients of Schizophrenia (Gregg, Barrowclough Haddock 2007). About 50 percent of patients with Schizophrenia indulge in drug alcohol abuse (ibid). The patient was a smoker. At the time of interview, the patient was craving for a smoke and he was having withdrawal symptoms. He was anxious and was shaking his legs. Risk Assessment The patient was not taking his medicines, which was a risk for his health and others too. He was prescribed Olanzipine and was taking it up to few months back. Then he started suspecting that few inruders are around, spying on him, and have poisoned his medicines. So he stopped taking medications. The patient is not suicidal at present. Neither is he having thoughts of harming himself nor others. The patient also does not look violent at present. But we cant ensure that the patient will not be suicidal or violent as the patients diagnosed with Schizophrenia commit suicide impulsively or become very violent impulsively (Taylor 2010). The patient has stopped taking anti-psychotics and is having hallucinations; which is increasingly associated with suicides in Schizophrenic patients (ibid). Critique of the Interview Process It is important to form a therapeutic relationship with the patient while interviewing. Developing a good repo with the patient, winning trust of the patient, and making him comfortable while interviewing; are essential requirements of an effective assessment. The mental health patient should be ensured that this environment is safe for him and the interviewer is here to help him (MacKinnon 2015). It is also important to ask questions regarding his social, cultural and spiritual environment (Paniagua 2013). In this particular interview Vera told the interviewer that he goes to Church every Sunday; which is important information and will help in his recovery. The patient also told the interviewer that he feels safe at Church and do not hear voices there. The interviewer might have further asked where else do he feel safe. He might have asked about his family and friends, his supporters, his abusers etc. He could have gathered positive and negative social cues about his life and social environment. The interviewer did not take detailed history of the patient as the patient was quite upset, uncomfortable, and restless; and therefore in critical situation, interviewer preferred to keep the interview discrete. The interviewer might have asked about psychosocial/developmental history, which is very important. Here we could gather information regarding his childhood, any history of abuse or trauma, past living situations as well as present living situations, any support, education, occupation, hobbies etc. The history about his social environment is also very important including family, friends, work, and finance. History of mental illness in the family or any suicides in the family, relationships of patient with other family members, are very important questions to be asked in an interview. However the mental health assessment can proceed without taking detailed history (Davies 1997). The diagnosis could be made in few seconds (ibid) but it is essential to look for potential risks by taking detailed interview. The interviewer was finding it difficult to build rapport with the Vera. The interviewer subsequently convinced Vera that he will help him out with his problem. Vera was constantly telling the interviewer that, just relieve me of this invaders who are spying on me and yelling at me. The interviewer assured the Vera that by the end of the day, he will be alright and these intruders will be gone. Thus it is very important during mental health assessment, to constantly tell the patient that interviewer is here to help him. The interviewer should not argue with patients abstract ideas. For example here the interviewer told the Vera that these intruders will be gone by the end of the day; instead of telling the patient that there are no intruders. Thus interviewer should never confront the patient (Australian 2017). The patient told the interviewer that he needs to smoke which implied that patient is a smoker. Interviewer must have further asked the patient about other substance abuse, for e.g. alcohol, drugs, sedatives, nicotine, caffeine etc. Further the interviewer must have asked about amount of intoxication and levels of dependence. The interviewer asked Vera to go to the smoking room and continuing the further interview later-on after coming back. This was a good strategy to make the patient comfortable and winning his confidence. The interviewer asked the patient that what these voices tell him. This was a very important strategy to know the potential risks. Generally the voices in patients of Schizophrenia tell them to harm themselves or others; which is a potential risk and have legal aspects (McCarthy-Jones 2017). Thus it is very important to ask the patient what these voices ask you to do? The patients generally respond that, Cant you hear them which is a very common response and should be handled carefully (ibid). The interviewer here further clarified that whether these voices tell you to harm yourself or others; which was a good assessment. The patient was looking quite uncomfortable while giving interview. He was uncomfortable when questions were asked and wanted to quickly get them finished and go for a smoke. The interviewer should have made the patient comfortable first. The starting lines of conversation should include, I am here to help you with your troubles, Tell me all about you, I will find some solution for your problems, You have come here to solve your problems and I will help you in that. The interviewer needs to tell such lines repeatedly and frequently. In this way, the interviewer must have won the trust of patient and the patient would have felt more comfortable giving a detailed interview. This strategy is not as easy as it sounds and may not work most of the times; as recent research has shown that patients with Schizophrenia are less likely to recognize empathy in others questions and behave indifferent to empathetic questions. They only perceive that they are object of anothers attention (Berrada-B aby et al 2016). Thus interviewing a patient with Schizophrenia requires great skills especially when the patient is currently under psychosis and hallucinations. In the present case-study of Vera, the interviewer handled the situation very skilfully and was able to collect lots of information which helped in comprehensive assessment of the patient and this will further help in planning his treatment and recovery. References Akiskal, H. S. (2016). The mental status examination. In The Medical Basis of Psychiatry (pp. 3-16). Springer New York. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5). American Psychiatric Pub. Australian, R. (2017). Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders. Australian New Zealand Journal of Psychiatry. Berrada-Baby, Z., Oker, A., Courgeon, M., Urbach, M., Bazin, N., Amorim, M. A., ... Brunet-Gouet, E. (2016). Patients with schizophrenia are less prone to interpret virtual others' empathetic questioning as helpful. Psychiatry research, 242, 67-74. Bor, R., Eriksen, C., Scragg, P., Oakes, M. (2016). The practicalities of clinical history-taking and mental state assessments of pilots. In: Pilot Mental Health Assessment and Support: A practitioner's guide. Routledge. Coombs, T., Curtis, J., Crookes, P. (2011). What is a comprehensive mental health nursing assessment? A review of the literature. International journal of mental health nursing, 20(5), 364-370. Davies, T. (1997). ABC of mental health. Mental health assessment. BMJ: British Medical Journal, 314(7093), 1536. Green, M. F., Harvey, P. D. (2014). Cognition in schizophrenia: Past, present, and future. Schizophrenia Research: Cognition, 1(1). DOI: 10.1016/j.scog.2014.02.001. Gregg L; Barrowclough C; Haddock G (2007). "Reasons for increased substance use in psychosis". Clin Psychol Rev. 27 (4): 494510. doi:10.1016/j.cpr.2006.09.004. Kneisl C. and Trigoboff E. (2009). Contemporary Psychiatric- Mental Health Nursing. 2nd edition. London: Pearson Prentice Ltd. p. 371. MacKinnon, R. A., Michels, R., Buckley, P. J. (2015). The psychiatric interview in clinical practice. American Psychiatric Pub. McCarthy-Jones, S. (2017). Can't You Hear Them?: The Science and Significance of Hearing Voices. Jessica Kingsley Publishers. Paniagua, F. A., Yamada, A. M. (Eds.). (2013). Handbook of multicultural mental health: Assessment and treatment of diverse populations. Academic Press. Taylor, M., Hor, K. (2010). Suicide and schizophrenia: a systematic review of rates and risk factors. Early Intervention in Psychiatry, 4, 130. van der Meer, L., de Vos, A. E., Stiekema, A. P., Pijnenborg, G. H., van Tol, M. J., Nolen, W. A., ... Aleman, A. (2013). Insight in schizophrenia: involvement of self-reflection networks?. Schizophrenia bulletin, 39(6), 1288-1295.