Psychiatric Diagnosis and Management
Mental health issues like depression, stress, bipolar disorders, and post-traumatic stress disorder (PTSD) are the leading causes of compromised quality of life, suicides, and disabilities. Adolescents, adults, and older adults are susceptible to these conditions due to their proximity to risk factors and causal aspects that perpetrate mental health issues. For example, bullying in schools, workplace stressors, dysfunctional marriage and family lives, the presence of underlying health issues like chronic conditions, and exposure to childhood trauma are the primary causes of mental health conditions.
According to Mehta & Edwards (2018), almost 50% of Americans will satisfy all the thresholds for mental health diagnostic criteria in their lifetime, however, only about 40% of individuals seek and receive timely and convenient care services. The unwillingness to seek medical interventions has resulted in discrepancies between care delivery and population needs, exacerbating the prevalence of mental health conditions and their subsequent sequelae.
Therefore, healthcare professionals are responsible for addressing these chasms by creating awareness of mental illnesses and providing early screening and management services. As a psychiatric mental health nurse practitioner student (PHMNP), I have had opportunities to interact with psychiatric patients and develop plans for patient-centered care. Therefore, this paper reflects a patient’s case study, characteristics, concerns, and strategies for handling concerns with future patients.
Reflection on My Clinical Practice
My clinical practice as a psychiatric mental health nurse practitioner student has been insightful and satisfactory despite the prevalence of multiple challenges consistent with my specialty. The most profound aspect of my clinical practice is the ability to bridge the chasms between theoretical knowledge and practice. Throughout my learning endeavors, I have acquired knowledge regarding care models, theories, and frameworks for providing quality, effective, and convenient care to patients with different mental health conditions.
However, I can ascertain that the knowledge acquired in class remains useless and underutilized without the opportunity to demonstrate an understanding of these concepts. Therefore, real-life encounters with psychiatric patients provide the much-sought-after avenues for actualizing theoretical knowledge.
My experiences with psychiatric patients have provided the foundation for appreciating the role of patients in enhancing recovery, facilitating self-management, and determining care trajectories. Initially, I thought that effective and convenient care meant providing nurse-led interventions with minimal input from patients. However, my practice as a psychiatric mental health nurse practitioner student changed my perception of quality care.
Currently, I have gained insights into identifying patients’ characteristics, healthcare needs, and priorities that form the basis of delivering quality and deserved care to psychiatric patients. Further, I have acquired knowledge of applying different mental health examination strategies, including the Beck Depression Inventory (BDI), Dissociative Experiences Scale (DSC), Goldberg Bipolar Spectrum Screening Questionnaires, and Schizophrenia Test and Early Psychosis Indicator (STEP).
An Overview of the Patient’s Case Scenario
One of the case scenarios that shaped my experience and practice as a psychiatric mental health nurse practitioner student involved a 68-year-old male patient struggling with recurrent depression perpetrated by multiple issues, including past events, lived experiences, and the current feeling of loneliness.
Besides these issues, the patient grapples with underlying chronic conditions like hypertension, diabetes, and chronic obstructive pulmonary disease (COPD) that exacerbate other complications like neuropathy and peripheral vascular disease. Other issues that formed the basis of the patient’s diagnosis include a history of alcoholism and smoking.
Patient’s lived experiences and causes of recurrent depression.
During the patient’s physical examination, he vividly recalled past events that were significant in his life. Firstly, he highlighted his family life as the major inspiration for his existence. For example, the patient indicated that witnessing his children attain high-level education and secure employment in different states was the most significant time in his life. Also, he cited news about the birth of his four grandchildren as vital moments of his life.
Finally, the patient remembered his time with his deceased wife, who lost her life in an accident that claimed his firstborn’s life too about 20 years ago. Although these moments signified a joyous life, the patient remembered past hardships that remained the major causes of grief, depression, and guilt.
The patient encountered a traumatic event after a road accident that claimed the lives of his wife and firstborn daughter 20 years ago. He sustained serious injuries, including a broken left leg, ribs, and multiple scars that act as the reference points for this traumatic event. However, he successfully recovered after a lengthy period of hospitalization.
Although the event was entirely accidental, the patient perceives himself as the primary perpetrator of the accident, considering that he was the driver on that fateful evening that took away the lives of his loved ones. Also, he associates his alcoholic habit as the major cause of the accident despite his previous cessation attempts. The perception of blame, shame, and guilt has aggregated to recurrent depression and post-traumatic stress disorder.
Further, the presence of underlying chronic conditions like hypertension, diabetes, and COPD exacerbate depression by necessitating the need for consistent rehabilitation. Finally, the patient struggles with loneliness, the feeling of hopelessness, and social exclusion that increase his susceptibility to the adverse effects of depression.
What are the characteristics of the patient that make me feel most comfortable with my clinical experience?
In the context of providing care for a patient with recurrent depression perpetrated by past traumatic events, I perceive that the patient’s coping skills, determination to seek medical assistance, and the ability to adhere to clinical recommendations as essential characteristics that make me feel most comfortable in my clinical practice. Firstly, the patient’s coping skills entail practicing new behavior to endure predicaments successfully.
According to Edraki et al. (2018), learning to cope with a problem is a profound strategy for improving self-efficacy and promoting positive behaviors. In turn, enhancing an individual’s self-efficacy can promote psychological well-being and reduce complications associated with the problem (Edraki et al., 2018).
In the patient’s case scenario, he indicated his participation in moderate physical exercise, relaxation techniques, and reading books as his coping strategies. It is valid to argue that these activities significantly reduce the prevalence of depressive episodes and improve self-management practices.
Secondly, I perceive that the determination to seek medical assistance and the subsequent ability to adhere to medications are vital individual characteristics that promote effective management of depression and its effects. According to Dell’Osso et al. (2020), medication adherence encompasses two profound themes: persistence and compliance.
Persistence entails taking antidepressants throughout the intended treatment course, while compliance encompasses following all stipulated medical directions. Non-adherence to antidepressants emanates from various issues, including a lack of adequate patient education, poor follow-up, concerns about side effects, costs of medications, and the fear of overreliance (Dell’Osso et al., 2020).
Regarding adherence to medications, the patient demonstrated his ability to read and understand prescriptions, required dosage, and timing. Therefore, it is plausible to be comfortable when providing care to a client who can understand medication instructions, including the length of the treatment course, dosage, proper storage, identifying and reporting side effects, and appropriate timing.
The sets of characteristics that make me feel comfortable
As a psychiatric mental health nurse practitioner student, I feel comfortable when providing care to clients with specific sets of characteristics, including the ability to read and interpret medication instructions, individual awareness of self-care interventions, and the ability to adhere to personal coping skills. For instance, combining these skills and competencies enables people with mental health issues to exercise autonomy and control over care processes, promoting the tenets of patient-centered and dignified care.
Other patient skills that make me feel comfortable about patients’ health and well-being include the ability to identify vital signs, communicate with healthcare professionals, and coordinate care to alleviate the effects of mental health conditions.
What concerns me about being too comfortable with these characteristics
Although people with mental health conditions like depression and post-traumatic stress disorder can demonstrate awareness of their conditions and effectively adhere to medication instructions, many of these conditions are progressive and recurrent, leading to cognitive impairment. As a result, I perceive that being too comfortable with patients’ skills and characteristics can alter care priorities. For example, people with recurrent depression are likely to encounter non-adherence to medications due to consistent frustration and the feeling of hopelessness.
Other issues that can emanate due to being too comfortable with patients’ characteristics include the effects of unaddressed feelings of guilt and shame, the consequences of loneliness, and the subsequent proliferation of suicidal thoughts perpetrated by shame, guilt, and self-blame. These issues prompt healthcare professionals to consistently engage patients in care delivery and implement follow-up activities regardless of the patient’s set of characteristics.
How to handle these concerns with future patients
Loneliness, self-blame, and guilt are common issues facing people with depression and post-traumatic stress disorder (PTSD). Wang et al. (2020) define guilt as a “compound, self-conscious emotion and contains negative emotional components such as remorse, anxiety, and pain” (p. 3). In the same breath, Dolezal & Gibson (2022) present shame as the proliferation and constellation of negative emotions that are prevalent among trauma survivors.
It is essential to note that shame and guilt can stimulate an individual’s post-traumatic stress disorder symptoms and can result in more self-harm and stress for people with PTSD. Equally, loneliness is an essential determinant of mental health problems because it deprives people with mental health conditions of opportunities for social interactions and activeness, increasing the tendency to remember past traumatic events and other causes of stress and depression (Mann et al., 2017). As a psychiatric mental health nurse practitioner student, I endeavor to address these concerns with future patients by implementing evidence-based practices for preventing loneliness, shame, and feeling of guilt.
A contingency plan for addressing concerns of loneliness, shame, and guilt for future clients with various mental health conditions would include interventions like life review and ego integrity, providing social support, and implementing Trauma-Informed Guilt Reduction Therapy (TrIGR). Firstly, involving depressive patients in life review is an essential strategy for allowing them to extract meanings from past events.
According to Chen et al. (2021), the acceptance of one’s lived experiences improves the ability to deal with regrets, feelings of hatred, past conflicts, and despair. Therefore, collaborating with patients in life reviews can enhance the ability to deal with shame, guilt, and the feeling of hopelessness after traumatic events.
Secondly, it would be essential to provide much sought-after social support to lonely people with mental health conditions to avert the potential consequences of loneliness and social exclusion. Alsubaie et al. (2019) contend that social support improves networks drawn from family, friends, and community to form the basis of interactions and meaningful relationships. It is essential to note that interactions with family, friends, and community members improve the quality of life of patients with mental health conditions and act as the foundation of care.
Finally, implementing Trauma-Informed Guilt Reduction Therapy (TrIGR) can eliminate negative thoughts and emotions that manifest when people blame themselves for all or part of the negative outcome of an event. Norman (2022) contends that the TrIGR model is a 6-session individual psychotherapy that enables clients to evaluate their role in traumatic events and establish constructive ways to express values to eliminate guilt and shame.
Ideal interventions for this framework include adaptive disclosure that promotes self-forgiveness and reparative actions, building spiritual strengths, maintaining functional gains, and shared decision-making with healthcare professionals (Norman, 2022). These approaches are vital in addressing self-blame, shame, and guilt in people with recurrent depression and post-traumatic stress disorder.
My experience as a psychiatric mental health nurse practitioner student has enabled me to understand the thresholds of caring for people with mental health conditions. As demonstrated in the case study, people with mental health issues require direct, coordinated, patient-centered, and dignified care regardless of their ability to adhere to medications and understand self-care interventions.
Some of the concerns that arise when caring for people with mental health conditions like depression and post-traumatic stress disorder (PTSD) include loneliness, guilt, the feeling of hopelessness, suicidal thoughts, and guilt. These issues compromise their health and well-being by increasing mortalities and perpetrating self-harm. I would address these problems with future clients by providing social support, encouraging patients to participate in life review therapy, and implementing Trauma-Informed Guilty Reduction Therapy (TrIGR) to enable them to appreciate past events, build strong spiritual strengths, and encourage reparative actions.
Alsubaie, M. M., Stain, H. J., Webster, L. A. D., & Wadman, R. (2019). The role of sources of social support on depression and quality of life for university students. International Journal of Adolescence and Youth, 24(4), 484–496. https://doi.org/10.1080/02673843.2019.1568887
Chen, P.-Y., Ho, W.-C., Lo, C., & Yeh, T.-P. (2021). Predicting ego integrity using prior ego development stages for older adults in the community. International Journal of Environmental Research and Public Health, 18(18), 9490. https://doi.org/10.3390/ijerph18189490
Dell’Osso, B., Albert, U., Carrà, G., Pompili, M., Nanni, M. G., Pasquini, M., Poloni, N., Raballo, A., Sambataro, F., Serafini, G., Viganò, C., Demyttenaere, K., McIntyre, R. S., & Fiorillo, A. (2020). How to improve adherence to antidepressant treatments in patients with major depression: A psychoeducational consensus checklist. Annals of General Psychiatry, 19(1). https://doi.org/10.1186/s12991-020-00306-2
Dolezal, L., & Gibson, M. (2022). Beyond a trauma-informed approach and towards shame-sensitive practice. Humanities and Social Sciences Communications, 9(1). https://doi.org/10.1057/s41599-022-01227-z
Edraki, M., Rambod, M., & Molazem, Z. (2018). The effect of coping skills training on depression, anxiety, stress, and self-efficacy in adolescents with diabetes: A randomized controlled trial. International Journal of Community Based Nursing and Midwifery, 6(4), 324–333. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6226609/
Mann, F., Bone, J. K., Lloyd-Evans, B., Frerichs, J., Pinfold, V., Ma, R., Wang, J., & Johnson, S. (2017). A life less lonely: The state of the art in interventions to reduce loneliness in people with mental health problems. Social Psychiatry and Psychiatric Epidemiology, 52(6), 627–638. https://doi.org/10.1007/s00127-017-1392-y
Mehta, S. S., & Edwards, M. L. (2018). Suffering in silence: Mental health stigma and physicians’ licensing fears. American Journal of Psychiatry Residents’ Journal, 13(11), 2–4. https://doi.org/10.1176/appi.ajp-rj.2018.131101
Norman, S. (2022). Trauma-informed guilt reduction therapy: Overview of the treatment and research. Current Treatment Options in Psychiatry, 9(3), 115-125. https://doi.org/10.1007/s40501-022-00261-7
Wang, W., Wu, X., & Lan, X. (2020). Rumination mediates the relationships of fear and guilt to posttraumatic stress disorder and posttraumatic growth among adolescents after the Ya’an earthquake. European Journal of Psychotraumatology, 11(1), 1–12. https://doi.org/10.1080/20008198.2019.1704993