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Case Study of Chung: Anxiety and Depression

2.4.1 Analysis of a Case Study

CASE STUDY

Chung is a 35 years-old male who moved to Australia from China five years ago. His parents, older brother and younger sister still live in China. Chung visited his family in China once after a year of moving to Australia. He has not returned to China since, because of his long working hours and need to undertake additional study for promotion. Chung is a doctor working in Accident and Emergency in a busy inner-city hospital. He is studying for promotion to ultimately become an emergency medicine consultant. Two years ago, Chung was under investigation by the hospital Human Resources department due to a drug error. He was very tired and had been on-call over-night with frequent call outs to see patients. The drug error resulted in an eight year-old boy being very sick, requiring intensive care admission. Chung used an intra-muscular medication to treat the boy but administered it intravenously. Chung was subjected to several work-place and medical board investigations and placed on practice supervision for 12 months.Chung met his wife, Harriett, in Australia four years ago. Harriett is 30 years old. They married two years ago.Unfortunately, Chung’s parents and family could not attend the wedding due to the high costs of travel and his mother has severe arthritis in her hips, making travel very difficult. Chung found their wedding day emotionally difficult. He felt the ceremony lacked reference to his Chinese culture. On reflection, he feels that he wasn’t as involved in the wedding planning as he could have been, due to his long working hours. He simply agreed to the suggestions and plans made by Harriett and her family. Chung and Harriett now have a three week-old baby girl, Charlotte. Charlotte was born by caesarean section, due to birth complications. Harriett has had an infection in the operation site since the birth, resulting in lots of pain, frequent dressings and difficulties moving around. Chung was off work for one week after the baby’s birth. However, he has now returned to working shifts, often working through the night, where he may go without sleep for 20 - 24 hours. Harriett’s parents are staying with them to support Harriett while Chung is at work. However, he finds that Harriett’s parents are very involved with baby care even when he is home. Given this, Chung finds he gets very little time and space to be with his new daughter. You are visiting the family in your capacity as a community nurse supporting Harriett with the caesarean section wound care or as a midwife undertaking a post-natal visit. During your visit to the family, you notice Chung looks flat in mood and tearful. His affect is sad and restrictive. He is slumped in his chair, with rounded shoulders and starring at the floor for long periods. You inquire about his health. He has very limited eye to eye contact with you. His speech is slowed and purposeful. On occasions, you need to repeat your question several times to get a reply. However, you do manage to obtain the following information from Chung. He has been feeling increasingly anxious during the past two months, given his continuing long hours, shift work, the high pressure of an Accident and Emergency department, Charlotte’s birth and his wife’s health. He has been having palpitations, chest pains and breathlessness for six to seven weeks. He asked a colleague at work, another doctor, to assess him for cardiac issues several weeks ago as he had been experiencing thoughts that he was going to have a heart attack and die. Chung has been feeling very low in mood for the past six weeks, experiencing sleeplessness, particularly initial insomnia and early morning wakening at 3am. He has lost five kilos in weight during the past month, due to reduced appetite and missing meals. He feels he is worthless and a failure at work within his medical role and he is letting his wife and new daughter down. He has been experiencing fleeting thoughts of suicide for the last week. He is aware of high lethality medications which he could take to overdose. Currently, he is hopeless and helpless and wants to die. He states he feels his situation is self-imposed and that treatments will not be of help at this time.

Question 1 - 500 words - 10 marks

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.

(4 marks MSE, 4 marks DSM V, 2 marks for references)

Question 2 - 500 words - 10 marks

Critically discuss two (2) factors which have contributed to the development of the client’s current mental

health 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.

(2 marks for Stress Vulnerability Model, 3 marks for each contributing factor, 2 marks for references)

Question 3 - 500 words - 10 marks

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.

(2 marks for recovery orientated mental health theory and practice, 2 marks each for factors, 2 marks for references)

An APA reference list must be included with your work. Your work should include at least 10 different

pieces of literature, no more than 5 years old unless it is seminal work.

Answer


Healthcare

Case Study Assessment

Question-1

In the given case study, it is found that Chung is under heavy stress and is not able to perform his daily routine activities as per his desires. He is required to fulfill his work responsibilities as well as family responsibilities in a given environment. However, he is not able to balance the work-family relationship and due to which he is found to be suffering from heavy stress. 

Further, the case mentions that Chung is living in Australia for the last five years. However, his parents and other family members are residing in China. He has visited China only once during this period as he was focusing on his studies and other work activities. He is performing his medical duties in Accident and Emergency in a busy inter-city hospital. While performing his duties on one given day, he wrongly prescribes the medications to an eight-year old child. 

The boy was required to get admitted in the hospital due to side impacts of those medications. Later, several investigations were carried out in this case and the investigators found that due to Chung's mismanagement such an incident took place. However, Chung felt that it was due to over-working conditions and heavy stress at the workplace that made him perform such a wrong course of action. 

As per the case study notes, Chung is nearly working for 20-24 hours a day and hence is not able to eat properly, sleep properly, and not even to spend proper time with his family. He is lacking the desired motivation to live the life and seems like he is into depression. His failure in the medical role has added to the failures in his life and hence he is experiencing fleeting thoughts such as suicide. 

It seems like as per the DSM-V criteria, Chung is suffering from pragmatic disorder. He is not able to communicate properly with the family members, lacks social participation, fails to deliver occupational performance, and also seems to be suffering from depression (Perlman et al., 2014). It is thereby important to consider this case from the mental disorder perspective and determine the key symptoms faced by Chung in a given working condition. 

From the Mental Health Examination (MHE) perspective, it is observed that the physical appearance of Chung is flat and there are no reactions in his body language. Also, from the behavior perspective, it is found that he is communicating properly with his family members. His involvement is less when engaged in a given social environment. It seems like he is under more emotional pressure due to several reasons as discussed in this case. He seems to be restricted in his behavior and as a result lacks social engagement with his wife, parents, and other family members. Since he is not able to give time to his family members, it is noticed that he feels more depressed and angry within. He is not happy with his life and hence is even thinking of committing suicide. 

There are several anxiety and depression problems found in Chung in this case and it is important for the medical professionals to deploy proper medical strategies to heal him. Only then he will be able to solve his given situation. Chung is not able to differentiate different social conditions and hence lacks the skills in making important conclusions of his life. He needs to be motivated in these circumstances so that he can overcome his depression and other mental problems of his life.

It is also found that he is not taking proper food intake in his daily diet routines. He is also lacking support from the relatives of his wife and also from his parents in given conditions. It is difficult for Chung to cope up from such circumstances as he needs to balance his life. He needs to spend more time with his new born-baby and also with his wife as they both need him in these conditions. 

However, with lack of time due to office hours, it is becoming difficult for Chung to balance this situation (George, 2014). He needs to consult a medical physician and undergo medical treatment to overcome the depression. The subsequent steps will provide recommendations on the Stress Vulnerability Model that will assist Chung in overcoming the problems faced by him from the psychological perspective.

Question-2

In a given case of Chung, it is important to first diagnose the major factors that are affecting his health from different perspectives. Second, also it is noticed that he is under severe depression and hence is finding problems in eating, sleeping, and in other daily routine habits. The medical professional needs to inspect the health of Chung from the biological perspective and thereby determine the factors that are causing such troubles, These include - heavy working stress at the workplace, lack of support from the family members, unable to balance the work-life relationship, and unable to cope issues in a given environment.

It is important to analyse the case of Chung by taking into consideration the DSM V criteria. It will help the medical professionals to diagnose the case from the mental health perspective. It is observed that Chung is not able to cope with the daily routines in his life. He lacks the desired motivation to live life and also faces thoughts of committing suicide. 

He has several expectations of becoming an efficient doctor, take care of his family in China, look after his new-born daughter and wife, and thereby spend quality time with his family. He wants to improve his present living and working conditions so that he can overcome the challenges that he is facing in the present life scenario. 

There are different treatment models and therapies based on which a given mental health state of the individual can be cured. However, it is important to first understand the situation of the patient and then deploy the necessary treatment model in a given scenario. It will help the patient to get quickly recovered from the present situation. In this case, the medical professionals need to deploy Stress Vulnerability Model in given conditions to first analyse the case of Chung from the medical perspective. They can thereby determine the important factors that are affecting the life of Chung at given personal and professional place. Chung needs to first start communicating with his family members. He also needs to consult with is Manager at the workplace and discuss the major problems faced by him. 

He needs to work out in a new approach and determine fixed working hours instead of working over-working hours in the respective organization (Jobe & Harrow, 2010). Also, the role of the parents and the wife are important in such conditions as they can assist Chung to overcome these mental health problems and provide him with a new life of motivation. 

Only then the present situation of Chung can be resolved. It is also important to note that the relationship status of Chung has changed after the born of new-baby daughter. Hence, he will be assigned additional responsibilities in such situation (Williams & Doessel, 2016). It will thereby impact on the energy, mood, and through levels of a given individual. The medical professionals need to take steps in this direction to improve the overall health of Chung and protect him against the stress factors in given conditions (Kvalsvig et al., 2014).

Question-3

It is important to recover Chung from the present situation. To overcome the challenges, it is important first to determine the recovery model and then focus on the aspects of empowerment, motivation, and hope (Williams & Doessel, 2016). Chung has lost hope from all the directions and due to lack of support from the family members as well as peer employees he is under severe depression. He is unable to communicate properly with other members of the family. 

Also, he is not able to recover from the stress factors that he faces in his daily work activities of the organization. Further, due to working for nearly 20-24 hours has impacted on his eating and sleeping habits. It is important to highlight the components of recovery in a given case that will provide hope to Chung (Clark, 2017). 

The major components include - self-direction, person-centered care, empowerment, peer support, respect, and hope (Rossen & Cowan, 2014). To recover from the given situation, the medical professionals need to deploy the Three-Pillar model wherein they will be first working on the personal resource base of the individual. They will then work on the knowledge resource base and finally will be working on the socio-economic base of a given individual. 

There is a need to make Chung realize that he will be able to perform better in given working conditions. He needs to be motivated in the present state of illness. Also, the medical professionals need to remain committed toward providing him required medical assistance in given conditions. It is further important to deploy cognitive-based therapies so that Chung will first get motivated and will focus on the major aspects of his daily routine activities. 

Chung needs to find alternatives to his present job; he can apply for similar positions in other healthcare organization. Also, he needs to do mediation and thereby overcome the fears of depression. He needs to remain patient and motivated to achieve his desired in the near future. He needs to change his work schedules to meet the expectations of the organization as well as his family members. Only then he will be able to overcome the major fears of the mental health conditions faced by him in the present situation.

He further needs to think of improving his eating and sleeping patters in a given environment. He needs to consult with the senior management of the organization to make changes in his work routine and assist him in balancing the work-life relationship (Kvalsvig et al., 2014). Only then Chung will be able to devote time to both family and the organization. 

He will able to spend more time with his family that will motivate him from mental perspective. Further, the role of the family members is equally important as they need to support him and provide him with assistance through which he will be able to overcome the fears of depression (Kiely & Butterworth, 2014). The recommendations of the recovery model need to be implemented as suggested ensuring that Chung will be able to recover from the present medical situation.

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