Diagnosis and Treatment Planning

Home Nursing Diagnosis and Treatment Planning
Diagnosis and Treatment Planning

Introduction

Mental illnesses affect people’s process of thinking, their feelings, and mood. The conditions may affect the way people relate with others and function each day. However, it must be noted that the experiences are often different even when diagnoses are the same. A mental health condition is not a result of one event, but multiple linking events may be the cause for it. According to the National Alliance on Mental Illness (2016), the notable causes of mental health conditions are environmental, genetic or lifestyle influences. The U.S. National Library of Medicine (2016) has noted that the genes of an individual, family history, and biological factors play a critical role in the development of the condition. Stressful home life or job and traumatic life experiences are notable examples of how people can be predisposed to the condition.

Mental disorders include anxiety disorders, bipolar disorder, depression, mood disorder, personality disorders, and psychotic disorders among others. Similarly, biochemical processes as well as circuits and the structure of the brain have been associated with the condition. Mental health conditions are prevalent with 20 percent of adults experiencing it, and the effects of such conditions are felt by family members, friends, and the community. Frequent consequences of mental health conditions include frequent changes of work, stains, moves, bankruptcies, unemployment, infection with incurable diseases, and hyper-sexuality. There are other accompanying risks including obesity, overweight, and reduced life expectancy (Webb, Lichtenstein, Larsson, Geddes, & Fazel, 2014). This project draws on the DSM-5 for bipolar disorder and the case study used in this course to formulate a comprehensive diagnosis and develop an effective treatment for the client’s notable symptoms as well as the issues characterizing his condition.

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Overview of the Client Presented in the Case Study

The client presented in the case study is Ashton, a 42-year-old African-American male, who came for the assessment with his girlfriend. He noted that he had very little emotional connection with his distant parents. He had the first episode of mania at age of 16 and since then, he has been in hospital from time to time for 25 years. He has not been able to maintain mood stability, relational constancy, and employment stability. Ashton said that he once had a girlfriend whom he loved much, but she left him claiming that he was very problematic. He also said that he has gone through periods of high functioning, stable employment, and financial stability, which were disrupted by episodes of mania causing depletion of his financial resources.

Assessment: The Methods to Use to Assess and Diagnose the Client from the Case Study Developed

The Young Mania Rating Scale (YMRS) and Bech-Rafaelsen Mania Rating (MAS) are the most common scales that clinician use to assess severity of symptoms. Besides, they can be used to track symptoms for a long period of time (Wciorka et al., 2011). Therefore, they are applicable for assessing and diagnosing the mental condition of the patient in the case study. The YMRS entails a 15 to 20 minutes interview that is conducted by a trained clinician. The interview combines the report of a patient on maniac symptoms and the observations made by the clinician during the interview. The tool covers the major symptoms of mania, including mood, sleep, motor activity, irritability, aggressive behavior, desire for sex, appearance, and grandiosity. The YMRS was used in the assessment of manic symptoms for Bipolar Disorder. Therefore, the YMRS is appropriate to use in the assessment and diagnosis of the patient Bipolar Disorder (Wciorka et al., 2011). However, the limitation of this tool implies that it cannot evaluate mixed episodes of BD that double rating may affect.

The MAS is also an assessment and diagnosis tool that a clinician can use to rate a patient’s symptoms (Wciorka et al., 2011). The tool has eleven items that are usually rated on a scale with five points ranging from not present (0) to severe (4) covering manic symptoms, such as elevated mood, sleep, talkativeness, irritability, increased activity, self-esteem, sexual interest, and noise level. The tool has internal consistency as well as interrater reliability. It may also be used in diagnosing and assessing the patient’s bipolar disorder. The unidirectional rating of MAS can be disadvantageous in rating bipolar (Wciorka et al., 2011). However, it remains the method of choice for assessing the patient in this case.

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Diagnosis: A Comprehensive DSM-5 Diagnosis for the Hypothetical Client

Ashton’s symptoms include hypomanic episodes, high grandiosity, poor judgment, racing thoughts, pressured speech, incoherence, severe agitation, and lack of speech. He is also reported to have been intrusive and euphoric. When Ashton presented to the clinic, he reported that he had been suffering from Bipolar I Disorder. Regier, Kuhl, and Kupfer (2013) noted that bipolar disorders are different from depressive frustrations, but fall in a different category known as “Bipolar disorders and related disorders”. The criteria used in the DSM-5 permits diagnosing bipolar disorder (BD) in two mood disorders, either as maniacal, hypomaniacal, or a mixture of the two. BD I is characterized by a single maniacal episode or a mixture of the episodes. Therefore, big depressive episodes usually occur, but they are not a must. According to Mason, Brown, and Croakin (2016), psychosocial reasons responsible for bipolar disorder include depressive and maniacal disorders resulting from stressful situations. In particular, mania is helpful for the diagnostics of bipolar disorder. According to NIH (2008), patients suffering from bipolar disorder experience psychotic symptoms and often exhibit social dysfunction. Such patients are also at high risk of recurrent memories and suicide ideation.

Therefore, based on the symptoms which are associated with bipolar disorder, such as suicide thoughts, social dysfunction, recurrent memories, and depressive episode, and because the hypothetical patient presented in this case has said that he is suffering from Depressive Bipolar Disorder type I, he is diagnosed with the condition. However, the other medical condition that may form the focus of clinical attention is schizophrenia. Notably, the patient presented with symptoms, such as inability to interact with others without outbursts, which can be considered as social dysfunction, recurrent memories, suicidal thoughts, traumatic events, feeling negative, and other mood disorders.

Treatment Planning

The most appropriate treatment option that was suggested for the hypothetical patient presented in this case is cognitive behavioral therapy (CBT) (National Health Service, 2016). CBT is the treatment option that would be used to help the client manage his problems by changing his way of thinking and behavior. CBT is used in the treatment of depression and anxiety, and it is useful for the patient’s other mental problems. CBT considers negative feelings, thoughts, sensations, and interconnected actions happenings that can trap a person in a vicious cycle (National Health Service, 2016). Consequently, the aim of CBT is helping the patient to deal with the problems that are overwhelming to him or her in a positive manner. Therefore, CBT would be applied to the patient in the case study in order to change his negative way of thinking, including suicidal ideation and social dysfunction. Changing Ashton’s negative feelings will eventually improve the way he feels.

CBT is preferred in the case of Ashton who has suicidal ideation and may abuse other medications by overdosing. Besides, CBT is appropriate because it would teach the patient useful as well as practical strategies that he requires in his daily life even after the completion of treatment. CBT will be applied in a manner that helps the client confront his emotions as well as anxieties, particularly because the patient seems emotionally uncomfortable (National Health Service, 2016).

There are both short and long-term goals that have to be achieved in the case of Ashton. The first short-term goal is to ensure that the patient is given a clear understanding regarding the traumatic events that he has gone through. Secondly, the patient will be educated on the importance of anger management as well as how to learn control skills.

Long-term goals will focus on how the patient can effectively manage his fears as well as stress by appreciating the importance of learning coping techniques, and prepare to manage similar situations in future. Likewise, the aim of the therapy will be to correct the patient’s irrational thinking and other interpersonal problems. The final goal will be to identify and settle issues, such as intrusive thoughts, using the proposed therapy.

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There are a number of specific interventions that will be used to achieve his goals based on the CBT. Firstly, the caregiver will take the client through exposure therapy (ET) that will help him eliminate fears that he would have if he encountered similar traumatic events. In applying the ET, the caregiver will use mental descriptions or imagery, and take the patient to where he previously encountered traumatic events. If implemented successfully, the method will enable the patient learn how to control his feelings and emotions.

Secondly, the cognitive structuring method, that will enable the patient perceive the various traumatic events that he has encountered, will also be used. Importantly, the therapist will give the patient useful insights that will enable him to realistically understand the events that occurred in his life. In the end, he will be expected to alter his perception of the traumatic events that he encountered before.

Thirdly, in psycho-education, the patient will be taught how to react to the traumatic events that occur in his life. The strategy will help to increase patient awareness in an attempt to understand his condition. In fact, the patient will be educated to know that the fear sensations that he experienced were normal part of his life.

Finally, the patient will be taken through systemic considerations where the members of his family as well as his friends will also be required to receive therapy sessions. The strategy will help in increasing their awareness regarding what he is going through, therefore, enhancing the process of recovery (Foa, Keane, Friedman, & Cohen, 2008). It is reported that patients who get emotional support in the course of their recovery heal faster. Consequently, this method is useful in the case of Kristopher.

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Evaluation of the Social Impacts of Social Systems

Therapist interpersonal skills, which manifest as therapeutic relationship as well as therapeutic competencies during assessment and treatment, are critical for positive outcome of the treatment that the patient will undergo. Besides, family and cultural factors, social support, personal preferences, and environmental context affect therapeutic outcomes. Moreover, family intervention can effectively improve critical outcomes including social functioning as well as disorder knowledge. A client with depression, such as Ashton, may view himself as inadequate, worthless, or unlovable. He may also view his environment as prohibitive and overwhelming. Therefore, the role of the family in reassuring Ashton of what he is worth remains critical. It is important to consider the neighborhood characteristics of the place where Ashton lives because it can influence whether he is likely to be depressed. Communities with higher levels of stressors are characterized by higher levels of mental health problems. If Ashton lives in an environment where there is sense of fear, then he can develop low self-esteem, distrust or powerlessness. Stress is also enhanced in a neighborhood that is characterized by crime and possible harm.

Managed care companies and health care systems that require premium charges and may hinder diagnosis and treatment if Ashton’s insurance cannot cater for treatments. Individuals from poor social and economic backgrounds may not afford expensive charges levied by care companies. On the other hand, school systems that offer education on diagnosis and treatment may provide valuable information regarding bipolar disorder from a tender age.

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Conclusion

This assignment provided an opportunity to evaluate a hypothetical client with bipolar disorder. The evaluation has helped to understand the symptoms of the conditions and the ways to differentiate them from other accompanying conditions, such as schizophrenia. The knowledge of the symptoms and the application of DSM-5 diagnostic procedure made it easy to identify correctly the patient’s condition and propose the most appropriate treatment plan. Besides, both short and long-term goals were suggested in order to help the patient overcome his condition. Most importantly, it is vital to consider the social environment of the patient in suggesting an appropriate intervention.

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