Nursing Emotional and Psychological

Mental Health Case Study

Mental health is defined as the condition of a person considering his emotional and psychological well-being. The level of emotional and psychological well-being is signified by the absence of mental illness. Positive psychology perspectives state that mental health includes the ability of an individual to maintain a balance between the efforts for achieving the psychological resilience and life activities for enjoying life (Elliott, Huizinga & Menard, 2012). Millions of people suffer from mental health disorders across the world that includes personality disorders, drug addiction, obsessive-compulsive disorder and social anxiety. These are widespread and common and causes mild to severe disturbances in the behavior and thought and results in the inability to cope with the routines and demands of daily life (Caplan, 2013). The occurrence of mental health can be attributed to a series of events or a particular situation faced by an individual. This essay will discuss the case study of an individual who is suffering from a mental disorder and presents for a checkup.

A set of communication skills will be used by me to communicate with Thomas during his interview. Thomas presents at the medical clinic with his clinical symptoms of getting increasingly irritable and nervous at his workplace without appropriate justification to himself. He appeared calm but was in trouble and his accent was slight which was difficult to place. Considering these facts, it can be said that Thomas was suffering from a mental disorder that requires treatment and care. Being a graduate nurse, I will have to use a set of communication skills for getting engaged with Thomas to understand his problem by interviewing him. Since his accent is slight and difficult to place, speaking at a slow pace would be appropriate for him to understand and reply. As his mind is disturbed, speaking quickly could make him misinterpret certain words to which may not react promptly. When communicating, it should be kept in mind that my voice should not get loud as it might disturb Thomas. Since his accent was slight and difficult to place, it might cause me to raise the voice to make it clear. Therefore, instead of getting loud, focus should be on getting clearer with the communication as this will provide him comfort (Stuart, 2014). Abusive words should never be used as this will disturb him even further. He had the illusion that the customers in the bank are troubling him by accusing when he is not looking. Using offensive words might further make him believe in his illusions. For communication, listening is a powerful and effective tool and therefore, efforts have to be made to listen to Thomas without any interruption so that he can speak out his mind and feel relaxed. Reflection is another communication skill that can be applied to this case to let the interview flowing (Orr et al., 2013). By repeating the words of Thomas, I can confirm his sayings since his accent is slight and if any corrections are required, he can make it done before the process gets over. Body language will be playing a crucial role while communicating with Thomas. Since he is disturbed mentally, therefore there has to be a proper way of delivering the words to him or else he might be receiving conflicting messages that are difficult to understand. If required, a translator can be placed in the interview session if English is not the native language of Thomas (Moss, 2015). This will give him an additional comfort to discuss the issues without any linguistic barrier. Therefore, appropriate communication skills will deliver the maximum information about the problem Thomas is facing and he can be provided with the required remedies.

Out of the many signs and symptoms that have been identified in the scenario, three significant signs and symptoms of Thomas will be discussed. The doctor acknowledged the present mental health condition of Thomas as episodes of psychotic symptoms followed by confusion and distress. This acknowledgment was done from the signs and symptoms that Thomas presented on his arrival and during the interview. On his arrival, he did not interact with the other patients and the other patients seemed to avoid him as well. This indicates that he had developed the tendency of social withdrawal due to the prevailing mental illness. Social withdrawal may result out of three components in case of psychotic disorders and they are divergent thinking, introversion and alienation (Frith, 2014). These components collectively reduce the capacity of the individual to build up good judgment when they are in a social situation. People suffering from psychotic disorders are usually isolated and socially impaired. Introversion might get inexorably intertwined with psychosis and alienation and this makes them withdraw themselves from social commitments. During the interview, Thomas had a slight accent that was difficult to place. This was because people suffering from psychotic disorders often fail to distinguish between illusions and reality. This causes them to speak and act in ways that are difficult to understand by others and do not make proper sense (Galderisi et al., 2013). Their expressions remain emotionally flat and this is due to the fact that their normal range of emotions is different from the healthy people. Their thought pattern does not follow an organized and logical sequence and therefore, their speech is often unrecognizable and provides difficulty in communication. Thomas experienced these problems as part of the negative symptoms that caused him to speak in a different manner that was difficult for the nurse to place. The chief complaint that Thomas arrived with is the troubling of his customers in the bank. Although he knew that they did not abuse him, he had a feeling that they did it when he was not looking. This was a stage of hallucination that he was going through as a symptom that made him irritable and nervous. People suffering from the depressive and psychotic disorders often experience these hallucinations as real and they start believing in them (Strauss et al., 2013). These are the periods of convalescence that results in the development of the clinical manifestations of psychotic disorders and makes the patient feel disturbed. The patients experience these incidents that make them feel disturbed when they see them in real life where the healthy people stay unaffected. Most of the times, these hallucinations are menacing that further exacerbates the mental illness.

Before leaving, Thomas needs to be provided with proper education about his medication. Thomas has been provided with a script of 5mg Olanzapine nocte by the doctor who also asked him for an appointment the next day. Olanzapine tablets contain the generic drug of the same name and belong to the class of antipsychotics used for the treatment of the psychotic disorders like Schizophrenia and manic episodes. Thomas has been advised by the doctor to take the medication at night as this will prevent the recurrence of the symptoms. To check for the improvement with the medication, he has been advised by the doctor to take up an appointment the next day. Therefore, an education has to be provided to Thomas prior to his leaving the clinic. He should be advised to report if any allergic reaction appears due to taking this medication that includes swollen face, itching, rash and shortness of breath. In case he had a medical history of eye problems like glaucoma, he should not be taking the medication (De Hert, Guiraud-Diawara & Marre, 2013). He might feel dizzy or sleepy after taking the medication and therefore, he has been advised to take the medication at night, preferably before bedtime. Olanzapine may cause constipation and therefore, Thomas should eat a well-balanced diet with plenty of water to avoid this. Thomas may experience dry mouth after taking the medication and to avoid the discomfort, he can try sucking sugar-free sweets and chewing sugar-free gums. Unusual muscle movement is another common side effect that might bother him much since he will be sleeping after taking the medication (Simpson et al., 2014). The symptoms of very high temperature, muscle stiffness, sweating and fast heartbeat are rare and if Thomas experiences them, he should seek immediate medical intervention as they are serious neuroleptic malignant syndrome (Patra, Khandelwal & Sood, 2013). Storage of the medicine is important and he should store them in a cool and dry place that should be away from the sight and reach of children and direct light and heat. Thomas should inform whether he has a medical or family history of blood clots as Olanzapine has been found to be associated with the blood clot formation. Thomas should inform the doctor if he on medications like ciprofloxacin, fluvoxamine and carbamazepine as these may have side effects of drowsiness in combination. Alcohol should be avoided while on Olanzapine as it might increase the drowsiness. If he is intolerant to phenylalanine, he should report to the doctor as Olanzapine tablet contains aspartame and it is a source of phenylalanine and should be taken care of by Thomas.

A strategy has to be framed to address the medication compliance issues that might arise. Atypical antipsychotics like Olanzapine may cause medication compliance issues that have to be managed immediately if they cause a serious adverse reaction. For this, strategies have to be developed that are beneficial for the management of the adverse reactions or they might lead to serious medical complications. Monitoring of the heart rate and blood pressure should initiate the treatment along with temperature monitoring. Laboratory tests have to be done for monitoring the ALT and monitoring of the blood glucose levels should be done. Appearance of seizures have to be monitored and immediate medical assistance has to be provided. Olanzapine is associated with the risk of development of tardive dyskinesia and EPS or extrapyramidal symptoms (Kinon et al., 2015). Other side effects that are potentially harmful include anticholinergic side effects that can cause mental and physical impairment. Presence of extrapyramidal symptoms due to tardive dyskinesia should seek immediate treatment for profuse sweating, unstable blood pressure, elevated temperature and incontinence. Anticholinergic side effects can be managed by decreasing the dose and observing the effects if the effects continue with lower doses. If the symptoms persist, Olanzapine has to be replaced with other antipsychotics (Divac et al., 2014). Similar strategy has to be followed with the detection of tardive dyskinesia. Management of the situation in case of the diagnosis of tardive dyskinesia can be done by providing Thomas with vitamin E supplementation in the form of food or medication. However, the dosage should not be high as it might worsen the condition. Anticholinergic delirium can be managed with parenteral physostigmine with medical monitoring for the progress. If Thomas is known to be on other medications which have similar side effects, they have to be either eliminated or the dosage has to be reduced. Unnecessary medications tend to increase the side effects and therefore, should be avoided. Strategy must include sensitization to the particular disorders of compliance issues that arise out of the anticholinergic symptoms as these disorders can have disastrous effects on Thomas (Hasan et al., 2013). They can impair the treatment caused by Olanzapine and can place Thomas at a health risk. Atropine can be administered in case of the symptoms due to anticholinergic delirium that is dry mucous membrane, dry skin and dilated pupils. These strategies can be incorporated for management of the compliance issues due to Olanzapine intake by Thomas.

References

Caplan, G. (2013). An approach to community mental health (Vol. 3). Routledge.

De Hert, M., Guiraud-Diawara, A., & Marre, C. (2013). 2584–Comparison of metabolic syndrome incidence among schizophrenia patients treated with asenapine versus olanzapine. European Psychiatry, 28, 1.

Divac, N., Prostran, M., Jakovcevski, I., & Cerovac, N. (2014). Second-generation antipsychotics and extrapyramidal adverse effects. BioMed research international, 2014.

Elliott, D. S., Huizinga, D., & Menard, S. (2012). Multiple problem youth: Delinquency, substance use, and mental health problems. Springer Science & Business Media.

Frith, C. D. (2014). The cognitive neuropsychology of schizophrenia. Psychology Press.

Galderisi, S., Bucci, P., Mucci, A., Kirkpatrick, B., Pini, S., Rossi, A., ... & Maj, M. (2013). Categorical and dimensional approaches to negative symptoms of schizophrenia: focus on long-term stability and functional outcome. Schizophrenia research, 147(1), 157-162.

Hasan, A., Falkai, P., Wobrock, T., Lieberman, J., Glenthoj, B., Gattaz, W. F., ... & Möller, H. J. (2013). World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of schizophrenia, part 2: update 2012 on the long-term treatment of schizophrenia and management of antipsychotic-induced side effects. The World Journal of Biological Psychiatry, 14(1), 2-44.

Kinon, B. J., Kollack-Walker, S., Jeste, D., Gupta, S., Chen, L., Case, M., ... & Stauffer, V. (2015). Incidence of tardive dyskinesia in older adult patients treated with olanzapine or conventional antipsychotics. Journal of geriatric psychiatry and neurology, 28(1), 67-79.

Moss, R. (2015). Communication Skills of Novice Psychiatric Nurses with Aggressive Psychiatric Patients.

Orr, F., Kellehear, K., Armari, E., Pearson, A., & Holmes, D. (2013). The distress of voice-hearing: The use of simulation for awareness, understanding and communication skill development in undergraduate nursing education. Nurse education in practice, 13(6), 529-535.

Patra, B. N., Khandelwal, S. K., & Sood, M. (2013). Olanzapine induced neuroleptic malignant syndrome. Indian journal of pharmacology, 45(1), 98.

Simpson, G. M., Glick, I. D., Weiden, P. J., Romano, S. J., & Siu, C. O. (2014). Randomized, controlled, double-blind multicenter comparison of the efficacy and tolerability of ziprasidone and olanzapine in acutely ill inpatients with schizophrenia or schizoaffective disorder. American Journal of Psychiatry.

Strauss, G. P., Horan, W. P., Kirkpatrick, B., Fischer, B. A., Keller, W. R., Miski, P., ... & Carpenter, W. T. (2013). Deconstructing negative symptoms of schizophrenia: avolition–apathy and diminished expression clusters predict clinical presentation and functional outcome. Journal of psychiatric research, 47(6), 783-790.

Stuart, G. W. (2014). Principles and practice of psychiatric nursing. Elsevier Health Sciences.

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