Components of MSE and DSM V criteria for depression in Munny's case

Answer 1
One of the relevant component of MSE which can be used in Munny’s case is appearance and
behaviour. Munny appeared clean to the nurse however, his clothes were loose which
indicated a recent weight loss. He slumped into the chair which suggested his disinterest.
Munny also avoided eye contact with the nurse even when she greeted him. His activities had
reduced drastically as reported by Ary and he also did not seem very active during the
session. Although he was able to follow the commands and requests. Another component to
be evaluated is speech as listening to spontaneous speech when patient answers open-ended
queries offers valuable information. Nurse observed that Munny only gave monosyllabic
answers to the questions using words such as ’fine’, ’no problems’, etc. When nurse asked
Munny that was his life worth living, he did not say any word just shook his head. People
seeking loneliness and assuming that their life is not worth living is a symptom of clinical
depression (Solomon, 2014). Ary reported that at home also Munny had become less
talkative and spent most of his time alone in bed. He had lost interest in his children, food,
job or any household issues. WHO has laid down certain symptoms which characterise
depression among which many are found in Munny such as constant sadness, loss of interest
in activities that he normally enjoyed along with an inability to perform daily activities, for at
least two weeks, change in appetite, feelings of worthlessness, guilt, or hopelessness and
thoughts of self-harm or suicide (WHO, 2017).
Another tool that is used for evaluating Munny’s health is Diagnostic and Statistical Manual
of Mental Disorders V (DSM V). according to the five (or more) of the well-defined
symptoms have been present during the same 2-week period and denote alterations in past
functioning and at least one of the symptoms is either depressed mood or loss of interest or
pleasure (Shelton, 2019) The two main criteria which are considered crucial for diagnosing
depression are both found in Munny. First is depressed mood and another is anhedonia which

means loss of interest or pleasure. Ary has observed that Munny is depressed most of the day,
almost daily which establishes the first criterion. Ary has also observed that Munny’s interest
has markedly in almost every activity such as work, children, food, household chores, almost
daily. This observation establishes the second criteria. These two diagnostic criteria for
depression vary in their distinguishing ability regarding the level of depression. The most
authentic DSM-5 symptom to distinguish moderate depression from non-depression is
depressed moos while anhedonia serves as a vital tool in distinguishing depression as more
severe. So, it can be said that Munny not only suffers from depression, but his depression
may also be severe. depressed mood is frequently related to the presence of stressors, which
in Munny’s case was his poor performance at work and fear of loss of job. So, it can be said
that depressed mood is a compound factor representing either a reaction to stressful situations
(somatic factor) or a sadness feeling (affective factor) (Tolentino & Schmidt, 2019).
Answer 2
In the stress-vulnerability model “Vulnerability” indicates the fundamental susceptibility of
human to mental health disorders which is regulated by their genetics and early life
experiences. It is affected by our use of medications, and our likelihood of using alcohol or
drugs. “Stress” indicates the challenges faced by them in their lives which is influenced by
their coping abilities, social support, and participation in meaningful activities. In Munny’s
case, the stress he was taking regarding his job made him more vulnerable to mental illness
and was one of the precipitating factors of his depression. Stress in the environment can
deteriorate the biological vulnerability, aggravate the symptoms, and cause relapses (Kinser
& Lyon, 2014). Stress is linked with negative experiences which create adverse imoact on a
person’s life. For Munny, he believed he was doing well at his job but when his employer
informed him about his dissatisfaction with his work and that he could be fired, in case he
didn’t approve came as a surprise for him. He got stressed as he could not bear this challenge

and adapt accordingly. There is an association between the hypothalamo-pituitary-adrenal
(HPA) axis and the development of mental disorders such as depression. So, one of the
contributing factor to Munny’s mental illness was his employer’s dissatisfaction with his
work and the fear of losing his job which led to stress and eventually made him more
vulnerable to development of depression.
Trauma-informed care is an evidence-based strategy for providing care in a manner that
acknowledges and reacts to the long-term health impact of the experience of trauma in lives
of the patients (Coetting, 2016). In Munny’s case, the experience of trauma of his mother’s
death was another contributing factor in development of depression. Munny was very close to
his mother and felt guilty of not taking time off after her death. Ary reported that Munny kept
going on with his life so that he did not have to think about losing her mother. In trauma-
informed method, the effect of trauma on Munny’s physical, mental and social being should
be understood. Trauma influences how an individual sees himself/herself like Munny began
having this feeling that life is not worth living. It may even impact their worldview and
relationships, like Munny became disinterested in his wife and children and stopped taking
notice of them. The experience of a trauma may be different for every individual (Purkey,
Patel, & Phillips, 2018). It is essential to understand how it can take a toll on Munny’s
coping resources and lead to the start of biologically driven survival strategies. Munny had a
rough childhood including the early death of father, having to live 10 years in refugee camp,
leaving studies and taking responsibility of family at early age. It can be assumed that
Munny’s situation is an integration of several traumatic experiences which usually remain
untreated and her mother’s death became the concluding precipitating factor for him which
led to the development of depression.