401013 | Diagnostic And Statistical Manual Of Mental Disorder

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401013 | Diagnostic And Statistical Manual Of Mental Disorder

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401013 | Diagnostic And Statistical Manual Of Mental Disorder

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Course Code: 401013
University: Western Sydney University

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Country: Australia

Question 1
 
Using relevant literature critically discuss the mental health status of the client in the case study. Your work should make reference to two (2) components of the Mental State Examination (MSE) related explicitly to the case study and the DSM V.
 
Question 2
 
Critically discuss two (2) factors which have contributed to the development of the client’s current mentalnhealth status. You should demonstrate your knowledge of the Stress Vulnerability Model. Your work should clearly identify the contributing factors; make reference to the case study and relevant literature.
 
Question 3
 
Respect, empowerment and hope are three (3) positive aspects of mental health recovery. Using relevant literature and the case study, critically discuss how these three (3) principles could positively contribute to the client’s journey of recovery. You should demonstrate your knowledge of recovery orientated mental health theory and practice
 
Answer:

Answer 1
The mental status examination (MSE) is a structured way that helps in describing and observing the present state of mind of a patient, under the domains of mood, affect, thought process, speech, thought content, behaviour, insight, cognition, and perception. Hence, the prime purpose of the examination is to obtain a comprehensive description of the mental state of patients, which when combined with psychiatric history, facilitates making an accurate diagnosis of the prevailing condition. In this case study, the major focus is on a patient Chung, who works as a doctor in the Accident and Emergency department. Two critical components of MSE that have been identified in him are suicidal thoughts and attention. Evaluating attention is considered as a refined way of measuring the state of wakefulness in a patient, rather than the consciousness levels. Ideal tests that encompass attentiveness generally encompass assessing the thought conception, motor response, and concentration in doing a simple task (Borsari, Apodaca, Yurasek & Monti, 2017).
The patient was found inattentive, which is elaborated by the fact that some of the questions had to be repeated several times, in order to obtain a reply from him. On the other hand, no examination of the mental status is regarded as complete without evaluating the dangerousness, specifically for homicidal ideation or suicidal tendencies (Schrank, Brownell, Tylee & Slade, 2014). Assessment of risks of suicide often includes questioning in details about the nature of suicidal thoughts, reasons for leaving and beliefs about death (Hungerford et al., 2012). Chung often suffers from mental distress that makes him consider taking attempts to end his life. Hence, it can be suggested that the client is suffering from some kind of psychotic disorder that have resulted in abnormal perceptions and thinking and have made him lose touch with his reality.
The DSM-V diagnostic tool helps in recognising a range of psychiatric illnesses, as well as facilitating healthcare professionals to propose treatment recommendations. After carefully evaluating the presenting complaints, psychiatric history, and biography of Chung, it can be suggested that he suffers from Unspecified Depressive Disorder 311 (F32.9). This particular code is assigned to mental conditions where some of the major characteristics presented by the patients are those of depression that result in significant distress and impairment in their social and occupational life. However, categorising the condition as an unspecified depressive disorder suggests failure to meet all the criteria for different types of depression identified by researchers (American Psychiatric Association, 2013).
Melancholic features have been identified in the patient, which led to diagnosis of the aforementioned depressive disorder. Some of the most common symptoms exhibited by Chung are in complete alignment with those of the disorder such as, absence of reactivity to any kind of pleasurable stimuli, and loss of pleasure in participating in different forms of activities. Chung was also found to exhibit a profound despondency and persistent low mood. Moreover, the case study also suggests that he suffers from sleep disturbances and awakes early than his normal awakening time, in addition to a drastic weight loss.  All of these signs and symptoms observed in him conclude that Chung is suffering from a moderate or severe form of melancholic unspecified depression.
 
Answer 2
The stress vulnerability model focuses on three basic factors or elements that have been found to play an important role in the onset and progress of psychiatric disorders or mental illness, in a patient over time.  The three elements are namely, protective factors, biological vulnerability, and stress. Family has been identified as an essential protective factor that can prevent the onset of any mental illness by engaging in effective communication with the vulnerable person, and monitoring symptoms of the disorder in him/her, besides providing mental and emotional support (Calvete, Orue & Hankin, 2015). Chung was away from his home and culture, which in turn aggravated his condition due to lack of family support. Research evidences have established stress as a negative factor that creates an impact by increasing the likelihood of a person to the development of a mental illness. These occur in response to certain life events, which make the person get adapted to a new environment. His immigration from China to Australia and occupational workload can be considered as two major stress factors. Biological vulnerability also refers to the role of genetic factors and biological pre-determinants such as, infection by a virus in the fetal stage, which increases severity of mental disorders.
Hence, it can be suggested that occupational stress, cultural and ethnic diversity and childbirth are the three contributing factors. Paternal Postpartum Depression (PPD) has recently gained much attention in the field of mental illness research and has been found highly prevalent among new fathers, following the birth of their child due to fluctuations in secretion levels of different hormones. One probable factor that might have led to the onset of PPD in Chung is an increase in oestrogen levels and a reduction in the testosterone levels (Biebel & Alikhan, 2016). Chronic stressful situations in life increase the risk of developing depression if the person fails to cope adequately with stressful events. Chung had been through a stressful incident where his negligence resulted in a medication error that directly threatened the safety of one of his patients, and kept in under supervision for a year. Chronic stress, in particular results in an elevated release of hormones like cortisol and reduction in serotonin and other neurotransmitters such as, dopamine which have been associated with depression. Occupational stress also leads to the development of low mood, in addition to sleep disruption, irritability, and cognitive alterations (Segrin, McNelis & Swiatkowski, 2016).
All of these made Chung Vulnerable to melancholic depressive disorder. Psychologists have also explored a plethora of mental disorders that occur as a direct result of cultural shock. Upon instances when individuals lose all their familiar symbols and signs of social engagement with the community, they try to get adapted themselves to different cultures, living conditions, and lifestyles. The fact that Chung was a Chinese immigrant to Australia resulted in a cultural shock, where he had to adjust to a new way of life, in addition to realising that his beliefs and customs of homeland did not apply to the new setting (Chen et al., 2016). This is when psychological stress began to emerge and let to the development of deeper psychological problems.
Answer 3
Depressive disorder is largely prevalent in the world and has been recognized to contribute to the third biggest burden of different health ailments in Australia (Blackdoginstitute.org.au, 2018). Most people have affirmed the fact that their journey of recovery from mental disorders has not been a steady road, and there were several setbacks and new discoveries. According to statistical reports, an estimated three out of five individuals of the age group of 15-64 years reports their experiences of acquiring some mental illness throughout their life time (Abs.gov.au, 2018). In addition to loss of employment, mental illness also leads to a disruption of financial steadiness, thereby calling the need to embark on a recovery process. Finding hope is one of the most essential elements of recovery, which focuses on the fact that being informed about presence of a mental illness does not mean end of the world (Kidd, Kenny & McKinstry, 2015). With appropriate support and help, such affected people can recover from their mental distress and walk towards accomplishing ambitions of their life.
Although Chung  would encounter several challenges upon beginning the journey, this hope needs to be instilled in him that mental disorders are manageable, and that there are several things that he can do for himself. These will provide him assistance to cope up with his suffering, keep up with his treatment and support self recovery. In other words, hope should be able to motivate Chung, the form of a desire in order to regain normal health and lift purposefully. Providing him assurance and adequate support, in addition to making him engage in an effective interaction with people who have lived through same kind of experiences will also be an essential step. This will facilitate understanding the prevailing mental condition, and will make him take responsibility for self care, while reaching out for necessary help. Respect in mental disorders has also been found to hasten the recovery process (Petros, Solomon, Linz, DeCesaris & Hanrahan, 2016). Miscommunication has often been identified as the route problem, commonly encountered while dealing respectfully with people having mental illnesses. Ignorance, deep rooted misconception and myths, about mental health issues complicate the situation and result in recurring incidents of disrespect and abuses to mentally ill people at home and in the community.
Hence, the primary motive should be to strike a chord with Chung, in order to show him respect and acknowledge his liking and disliking, thus making him realise that he is being cared for. Since several symptoms of mental disorders are beyond the control of a patient, being respectful and providing a helping presence around him will help in bringing him back to life mainstream. This can be achieved by communicating with him and showing genuine happiness over his actions, while being truthful to the promise of reducing his suffering. Empowerment would also encompass eradication of all internalized stigma, dehumanizing attitudes, and low expectations that are commonly exhibited by the society towards mentally ill patients. This would help in redefining certain qualities such as, having the power of decision making, access to relevant mental health resources and information, being hopeful and a sense of assertiveness, all of which would enhance the recovery journey.
 
References
Abs.gov.au. (2018). 4364.0.55.001 – National Health Survey: First Results, 2014-15. Retrieved from https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.001~2014-15~Main%20Features~Mental%20and%20behavioural%20conditions~32
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Arlington: American Psychiatric Publishing. https://doi-org.ezproxy.uws.edu.au/10.1176/appi.books.9780890425596
Biebel, K., & Alikhan, S. (2016). Paternal Postpartum Depression [English and Spanish versions]. Journal of Parent and Family Mental Health, 1(1), 1. Retrieved from- https://escholarship.umassmed.edu/cgi/viewcontent.cgi?article=1000&context=parentandfamily
Blackdoginstitute.org.au. (2018). Facts & figures about mental health. Retrieved from https://www.blackdoginstitute.org.au/docs/default-source/factsheets/facts_figures.pdf?sfvrsn=8 
Borsari, B., Apodaca, T. R., Yurasek, A., & Monti, P. M. (2017). Does mental status impact therapist and patient communication in emergency department brief interventions addressing alcohol use?. Journal of substance abuse treatment, 73, 1-8. https://doi.org/10.1016/j.jsat.2016.10.002 
Calvete, E., Orue, I., & Hankin, B. L. (2015). A longitudinal test of the vulnerability-stress model with early maladaptive schemas for depressive and social anxiety symptoms in adolescents. Journal of Psychopathology and Behavioral Assessment, 37(1), 85-99. https://doi.org/10.1007/s10862-014-9438-x 
Chen, J. A., Shapero, B. G., Trinh, N. T., Chang, T. E., Parkin, S., Alpert, J. E., … & Yeung, A. S. (2016). Association Between Stigma and Depression Outcomes Among Chinese Immigrants in a Primary Care Setting. The Journal of clinical psychiatry, 77(10), e1287-e1292. DOI: 10.4088/JCP.15m10225
Hungerford, C., Clancy, R., Hodgson, D., Jones, T., Harrison, A. & Hart, C. (2012). Mental health care: An introduction for health professionals. John Wiley & Sons Australia, Limited. Retrieved from- https://www.wiley.com/en-us/Mental+Health+Care%3A+An+Introduction+for+Health+Professionals-p-9781742168135
Kidd, S., Kenny, A., & McKinstry, C. (2015). The meaning of recovery in a regional mental health service: an action research study. Journal of Advanced Nursing, 71(1), 181-192. https://doi.org/10.1111/jan.12472
Petros, R., Solomon, P., Linz, S., DeCesaris, M., & Hanrahan, N. P. (2016). Autovideography: The lived experience of recovery for adults with serious mental illness. Psychiatric Quarterly, 87(3), 417-426. https://doi.org/10.1007/s11126-015-9397-8 
Schrank, B., Brownell, T., Tylee, A., & Slade, M. (2014). Positive psychology: An approach to supporting recovery in mental illness. East Asian Archives of Psychiatry, 24(3), 95. Retreived from- https://search.informit.com.au/documentSummary;dn=667107453591942;res=IELHEA 
Segrin, C., McNelis, M., & Swiatkowski, P. (2016). Social skills, social support, and psychological distress: A test of the Social Skills Deficit Vulnerability Model. Human Communication Research, 42(1), 122-137. https://doi.org/10.1111/hcre.12070

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