Answer :

Assessment 1: Case Study Report

Introduction: 

In order to treat mental health problem, history taking, assessment through examination are the key clinical approaches. The report has been developed in order to address the mental health issues of Andy, in the case study shown in the given video through investigating mental state and diagnosis based on case history. 

Past A: Psychiatric history and social environment

History: 

Andy is a 21 year male who is referred to a psychiatrist by his family physicians, is in his university final year. Dr Taylor who is on call psychiatrist starts the interview by taking client’s history. Andy had reported to the psychiatrist that not only his two house mates but his professor in this University have been playing MI5 against him. His two housemates have been playing with his brain as suggested by the professor. 

Andy had stated that his roommates have inserted in his mind which makes him feel and think something those are not his thoughts or feelings and the room mates are playing with his mind. Hearing this, on call psychiatric doctor had asked Andy to describe more on the chip and Andy stated that the chip is a device by which persons can be tracked. With the help of the chip his roommates are able to track Andy all the time when he is outside. The psychiatric doctor had asked about Andy’s coping strategies against this issue, he replied that to keep himself safe, he most of the time remain inside the house and goes out when his roommates are only not in the house. In order to keep himself safe and protected, he keeps a basketball bat and knife although he does not want to hurt anyone, in his room. Andy also has feelings that his roommates are poisoning his food. Andy had informed Dr. Taylor that he never had any violent or lost his patience in past nor does he have any interaction with police previously. The psychiatrist Dr. Taylor wanted to know if Andy ever had a feelings of killing himself he replied that he wanted to get overdose of some pills but he could not get those as he was not able to go out of the room. The psychiatrist asked Andy whether he feels safe or not and Andy replied that he feel safe at his parents’ house. In reply to Dr. Taylor’s query about his general health conditions, Andy had stated that he not physically ill and hence he does not need any medication. He further had added that he consumes alcohol but does not drink much and weed and speed regularly. 

Reason of referral: Increasing distress, social exclusion and hallucinations of the client

 Personal history: Andy is a university student living in a shared house with other three house mates. 

Medical history: The client is suffering from third person auditory hallucinations, persecutory delusions, thought insertion, running commentary, and somatic hallucinations. 

Family history: Andy is worried about his parents as he feels that sharing his issues to his parents will make them worried. He even has stated that his mum will not believe him that he is going through the distress but is willing to involve his mother into the care plan. His family members have no past history of violence, or any other negative occurrence that might have impact on their child. 

Drug and alcohol: The client consumes alcohol but does not drink much and weed and speed regularly

Current treatment: Andy is not under any treatment currently

Parental status: Andy’s parents are living together but far from him. He does not make them worried by sharing his issues with them

Dependants: Andy has no dependants

Past/psychiatric/mental health history: Andy had no past history of mental health issues 

Part B: Mental state of examination

The mental state examination section of the case study report demonstrates a pattern of observation, investigation and recording of information and data about thinking, mood and behaviour of the client. The diagnosis has been developed with the support of the client’s history and social situation and Diagnostic and Statistical Manual of Mental Disorders (DSM–5) report (American Psychiatric  Association, 2013)

Behaviour: Non-verbal communication such as facial expression, movement of hands, eye gaze, gesture, body posture, psychomotor activities against various aspects, social and personal interaction are the key to assess one’s behaviour (Killick & Schaverien,  2013). It has been noted in the given case study that Andy had very poor eye contact with the psychiatrist Dr. Taylor. Body posture of Andy was laid back and was using his hands for nonverbal communication with the psychiatrist. Andy looked very calm in the entire session however he looked very uncomfortable upon including his mother in the conversation. He used to avoid socialization s most of the time as he stated he used to stay indoors. 

Appearance: Self-care standard, lifestyle, and skills for daily living are the key aspects of appearance of an individual to be noticeable. Although Andy had not shaved he is well groomed and dressed well.

Speech: By determining one’s speech, behaviour of individuals can be assessed. Individual’s nature and mood can be determined by his/her voice tonality and volume. Andy has spoken in a stable volume however his voice demonstrated his distress and spoke well without fumbling. 

Mood and Affect: In mood, subjective state of mind of people is expressed while affect is the non verbal behaviour and can be termed as pervasive and sustained emotion for example euphoria, anger, and sadness. Any demonstrated that he is horrified, tension and confusion from his attitude and way of interaction with Dr. Taylor. Although the reason of his tension for his roommates approach towards him is not clear he had stated they are about to harm him. He predicted that they were poisoning his food however he did not go his parents’ house for being concern for them as he also felt that they won’t be able to feel his situation. Nervousness and confusion are the affects with no adequate understanding of the underlying cause. 

Thought content: Real thoughts is determined by individual’s interpretations of his experience that encompasses self-harming or virtual thoughts (Brent, Holt, & Keshavan,  2014). It is clear from the Andy’s delusional thoughts that his professor and room mates are working for MI% and they are always commenting on him. Andy further can hear their voice even if they are not at home.  His suicidal tendencies also is evident when he mentioned of overdosing pill. 

Perception: It is all about one’s sensory perception that actually is not present that also is termed as hallucinations or illusions. Andy had hallucinations that his roommates has fixed a tracking chip in his brain that can track him wherever he goes. He had audio hallucinations as he hears his roommates voice when they are not at home 

Thought form: By investigating expressions, though of a person is identified (Dimaggio & Lysaker,  2015). Andy’s vocals was very clear and he answered all the queries to the point. 

Insight and judgement: Andy’s insights affected by his psychological issues such as hallucinations, tension and distress. However his judgement is balanced as he states that he does not want to put his parents into his issues as he does not want them in trouble. 

Risk assessment: He feels over pilling himself as well as keeping bat for keeping himself safe but he does not want to hurt anyone.  From this, risk assessment can be made that Andy is wishing to over pill sometimes to get rid of his distress.

Needs referral: His suicidal tendencies is evident from his overdosing pill that needs medications paired with counselling. Hence referral is needed to health physicians to assess and treat his physical health problems if there. He also has problem with eating habit.

Formulation: The formulation of the session that has been demonstrated is well structured where Andy has been asked with all relevant questions by the on call psychologists as referred by his physician. 

Intellectual function: Andy’s intellectual function is affected by his thought form of hallucination and delusional thoughts as he thinks that he is controlled by a chip that has been inserted in his brain. 

Provisional diagnosis: Provisional diagnosis can be done as the client has mentioned about his substance abuse and eating habit as Provisional diagnosis will identify the impacts of clients thoughts and habits on his health. 

Part C: Evidence based intervention

Psychosocial Interventions: 

Psychosis cannot alone be either treated or prevent its relapse with the use of pharmacotherapy. Hence to treat psychosis, a combination of psychosocial intervention and medication (Rosenfeld, 2018). Psychological symptoms that have been identified in the given case of Andy are passive suicidal, isolative behaviour, stressed, suspicious attitude and confusion as well as consumption of drugs such as weed and speed and alcohol. The psychosocial intervention has been aimed at improving client’s quality of life, address the likeliness of other substance abuse, maintain social functioning and ability. 

The particular intervention is needed to educate patient and his family about the disorder and treatment through medications and psychosocial interventions so that client’s situation can be developed. Stress leads to increase the symptoms and result in relapse psychosis, therefore, stress management is needed to be learnt by the client (Wigman, et al., 2014). Various relaxation activities such as yoga, music, and exercises can be included in lifestyle and problem addressing problems, living a healthy lifestyle and goal settings by eliminating substance use and alcohol consumption.   Psychosocial treatment includes counselling and psychological therapies, which is effective in improving one’s socializing skill, healthy and confident attitude (Dawson & MacMillan,  2013). Family therapy, substance abuse counselling, social ability training are some of the psychosocial therapies. 

Medical Intervention: Paranoia, delusion and hallucination are the clinical issues of Andy. The therapies aim at diminishing the symptom of psychosis and relapse prevention . 

Medical interventions include pharmacological treatment as well as management during the period of medication. Chlorpromazine is the effective drug for treating the symptoms of psychosis (Wijkstra, Lijmer, Burger,  Geddes, & Nolen, 2013). Continue administration of the particular is very critical in order to have improving in health condition as well as identify any side effects. Other issues such as forgetting to take medication, or refusing also must be considered. 

Nursing intervention: 

Disruptive auditory perception is included in nursing care plan to changed biochemical factors, sensory perception and psychological stress caused by hallucination (Bruins, et al., 2014). The aim is to minimise the hallucination episodes and share things in logical way. Nurse must make Andy aware that the voice is real for him but she does not hear them which will make him aware of invalid things that he hears.  Nurse must make simple conversation and one at a time to facilitate him identify problem and clear thought process. Impaired social engagement owing to thought process that is impaired causes him delusion and preference to stay alone and think of suspicious objects. The aim is to interact with people in his social surroundings and this intervention will enable his distress and phobia among the mates and others. Conversational skills can be used as coping tool that must be suggested to use (Fortinash & Worret,  2014). From his changed communication with family members, interrupted family relationship is evident which needs engagement of family members in the treatment process and seeks family support group. 

Conclusion: 

Treating psychological symptoms can be treated through psychosocial intervention. The aim are to educate patient and his family about the disorder and treatment, interventions and medication, counselling and psychological therapies. Paranoia, delusion and hallucination are the clinical issues of Andy which is treated through medical intervention. Chlorpromazine is the effective drug for treating the symptoms of psychosis. Nursing intervention is included in developing client’s awareness and promote simple thought process. Socialization and family engagement also are included in nursing intervention.