Patient Lisa Mental Assessment: Trauma-Informed Care Principles

This case review discusses the mental assessment of patient Lisa and the use of trauma-informed care principles in her treatment. It explores delusional disorder, depression, medication relapse, and the application of trauma-informed care.

Case Study Review
Patient Lisa Mental Assesment
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Patient issues using trauma-informed care principles
Introduction
This case review entails patient Lisa who has visited her counsellor at the local drug
services. She has had six post admission diagnosis of a psychotic state. She is a regular
cannabis substance abuser. Currently, her state is worrying as she has not been taking her
medication and often experiences constant fears. This assessment reviews various mental
nursing care uses for the patient and elaboration on trauma-informed care for health care
delivery for the patient.
Delusional disorder
Persons suffering from delusional disorder may not function properly in the society.
The delusional disorder often occurs inform of psychotic disorder which manifests in
paranoid disorder (Opjordsmoen, 2014). According to Diagnostic and Statistical Manual of
Mental Disorders, Fifth Edition (American Psychiatric Association. 2013 DSM-5), delusional
disorder refer to an illness which is characterized by at least one month of negative thoughts
with no other psychotic symptoms. They result from false beliefs and incorrect inference.
Patient Lisa in the case study depicts prosecutorial delusion by her beliefs that her boyfriend
John is about to harm her and she is afraid always and she suspects that he is up to something
bad, owed to cameras and feeling of being monitored all the time in the house.
Based on Trauma-Informed care, trustworthiness and transparency between patients
and their support system are critical. Maintaining trust in the support system of the patient is
fundamental in ensuring that they gain better health outcome. However, with this regard,
patient Lisa does not trust his boyfriend and she is in constant belief that he is up to harming
her. This has lead to excessive symptoms of her state of condition. Due to the fear, she has
developed she is unease and hears the delusional sounds that his boyfriend is out there to
harm her. The failure of delayed medication and exhibiting usage of cannabis use is the key
likely effect of the increased episodes of delusion for the patient, signifying lack of trust from
internal environment (Skelton, Khokhar & Thacker, 2015).
Depression
Depression is a state of mental disorder which occurs due to persistence feeling of

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sadness and loss of interest coupled with the perception of insecurity. The depression state
has effects on the feelings, thoughts, and behavior which can lead to varied forms of the
emotional and physical problem to the patient. Patients having with substance abuse
frequently suffer from depression and other co-occurring disorders which are associated with
poor treatment leading to increased morbidity and mortality incidence. In depression state,
mood disorder is a common precipitating occurrence of relapse among persons having
substance abuse (Hunter, et al., 2013).
The patient state of feeling insecure and feelings of hallucinations is endangering her
safety such as John. Working on trauma-informed care, there is a need to focus on patient
safety and collaboration with the mental health state of the patient (Correll, Detraux,
Lepeleire & De Hert, 2015). The patient depression state is affecting her physical and
psychological feeling that she is afraid that John might harm her in any way. The patient
lacks empowerment to know her own state. Currently, she feels vulnerable and always
fearing to be at harm and being targeted by her boyfriend., this is necessitated by constant
mentoring which there is surety that they exist in the house or just hallucinations and
paranoia state of the patient.
Medication relapse
Based on patient Lisa mental health assessment, she patient suffers medication relapse
occasioned by disrupted intake of medication. Relapse has very serious effects and
devastating outcome for persons with mental disorders such as anxiety and depression. In this
case, they encounter challenges in recovering from the process. The relapse is often triggered
by the consequents of the body not to recover. More often attributable causes include
medication stoppage relapse and excessive use of substance abuse (Schoeler et al., 2017). The
role of medication on mental care for the patient was geared towards reduction of substantial
risk of relapse, however, since its stoppage, the patient is observed as having difficulty in
concentrations, being tense and neglect to medication.
The critical perspective in trauma-informed care entails the need for peer support and
mental help for the patient. The patient lacks the peer support and moral guidance support in
sticking to her medication. Since she moved into to her boyfriend, her mental state has
deteriorated and she has ceased from taking her medications. Further, patient Lisa lacks
support to ensure that her medication is working well. Trauma-informed care precepts dictate

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that there is a need for collaboration between the patient and the health care professional to
offer guidance during the medication process (Larsen-Barr, Seymour, Read and Gibson,
2018).
Informing collaboration for the recovery process
Delusions entail false beliefs which are not in touch with reality. The patient delusion
thoughts are critical for assessing her abnormal internal experiences which are affecting her
state of health. As a nurse, it is critical to enable informed care process which is crucial in
effective collaborative care process for the patient. The experiences occasioned by the patient
include losing touch with reality, anxiety, distress, hallucinations, and delusional thinking.
Key goals to inform nursing care for the patient entails developing a relationship with
the patient to show empathy and trusts. There is a need to promote the understanding of
features which are appropriate for patient management of delusions. Coping strategies are
essential; for the patient in learning how to deal with hallucination, she is facing. The
underlying stress and emotions act as triggers and delusions for patient recovery. Further, as
nurse developing positive health behavior is essential for the patient in medication
cooperation is essential. Further healthy eating style for the patient is essential so as to keep
fit and manage the urge for drug intake. Patient engagement and social support are critical.
Engage the patent in peer support framework is fundamental to have a social support
network. Further identifying key health care professional to aid in offering the need help for
the patient is critical as it enhances treatment process and facilitates the building of effective
relationship and communication (van Boekel et al. 2014).
Nurses need to be always cautious with the help they offer to patients in a manner
which help in seeking articulate medical advice from other health care staff. Nurses need to
reason with the patients in their best way possible and reassuring them of treatment success.
A key aspect for a nurse is to be able to identify patient experiences on depression as it can
have an effect on poorer outcomes in terms of the recovery process. The nursing challenge is
to recognize and differentiate between symptoms which signify temporary indicative, sadness
and clinical symptoms of depression. In order to facilitate this, seeking collaboration with
mental health expert is key for this crucial assessment and also to in understanding the key
indicative features for the patient (Sweeneey et al., 2018).
Thus for nurses seeking a comprehensive understanding of crucial information for the

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patient is an essential and most effective way which facilitates the recovery process. These,
further aids in patient monitoring and sharing feedback with other health care professionals in
seeking help and guidance for the patient (Monks, Topping & Newell, 2013).
Nurses play a critical role in ensuring that addiction treatment is followed to the latter
and admitted at all stages and process of care. Nurses play the primary role and initial stage
of ensuring that there is a screening of the patent to determine the status of patient health. In
this, the nurse has to liaise with other personnel such as mental health care nurse or the
patient psychologies who will ensure period assessments and review are done for the patient.
(Johansson L & Wiklund-Gustin,, 2016)
As part of ensuring there is proper assessment nurses play a critical role in ensuring
physical and psychological signs of continues drug abuse. Drug history of the patient is
essential in managing clinical treatment for the patient. Thus nurses have to always prepare
themselves adequately and well so as to facilitate this monitoring and checking progress on
drug medication for the patient. Finally, the nurse’s positive attitude improves patients
outcomes studies have indicated that nurses attitude towards the problems of the patients
improves outcomes of care. There is a need for a nurse to develop a positive attitude while
dealing with the patient so as to achieve a positive outcome (Neville & Roan, 2014).
Application of trauma-informed care
Trauma-informed care entails the understanding of the pervasive nature of how trauma
informs and promotes the healing process for patient Lisa in the case study. It enhances the
recovery process and promotes prevention of recurrent relapse and re-traumatization process.
The principles inform how nurses and other professionals are key in ensuring that care is
targeted on the patient.
Enhancing per support and mutual help is key and fundamental for the patient. They
inform an integral part of the society and key pillar for the patient recovery process. In
ensuring collaboration of mental health care delivery for the patient, involving key staff such
as mental health specialist and community nurse for period assessment for the patient is
critical. The mental health professional is essential in ensuring that the patient risks
assessment is undertaken and offering support for her medication support process is key
(Raja et al., 2015). Involving the personnel in the health care system is essential as it
establishes trusts, safety and empowers the patient towards self-belief and building the ability

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to recover.
Building collaboration in the nursing profession between the nurse and the patient is
essential in building trust and confidence. Meaningful relationships between these two
categories of levels are essential for ensuring that the healing process is initiated. Studies
have shown that relationships enhance power sharing and decision making thus improving
the overall health care state of the patient (Koetting, 2016). Collaboration and mutuality in
the health care process allow for increased nurse collaboration and greater relation of care
continuity which all rely on effective collaboration (Bloom, 2010). Involving other team
members of health care such as the clinical community health workers, social workers, and
other pertinent staffs enhances a coordinated care approach for the patient.
The rationale for establishing collaboration of other health care workers entails
adoption of collaborative care which entails a multi component aspect in health care. The
involvement of case managers, social care providers and mental specialists offers team work
focussing on patient needs. The team implements all guided measures which will ensure that
there is adoption of evidenced care process for the patient so as to meet clinical outcome
goals. The aim of the collaborative approach among various health care professionals is to
ensure that patient centred care is achieved and patient goals are incorporated into the health
care practice.
Conclusion
The patient Lisa is currently facing key fundamental issues which entail delusional,
medication relapse and depression. Adopting trauma-informed care for the patient is critical.
Implementation of this approach ensures that they are key collaboration established among
health care staff so as to facilitate quick recovery for the patient.

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References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders (DSM-5®). American Psychiatric Pub.
Bloom, S. L. (2010). Organizational stress and trauma-informed services. In A public health
perspective of women's mental health (pp. 295-311). Springer, New York, NY.
Correll, C. U., Detraux, J., De Lepeleire, J., & De Hert, M. (2015). Effects of antipsychotics,
antidepressants and mood stabilizers on risk for physical diseases in people with
schizophrenia, depression and bipolar disorder. World psychiatry, 14(2), 119-136.
Hunter, S. B., Watkins, K. E., Hepner, K. A., Paddock, S. M., Ewing, B. A., Osilla, K. C., &
Perry, S. (2012). Treating depression and substance use: a randomized controlled trial.
Journal of substance abuse treatment, 43(2), 137-151.
Johansson, L., & Wiklund‐Gustin, L. (2016). The multifaceted vigilance–nurses’ experiences
of caring encounters with patients suffering from substance use disorder. Scandinavian
journal of caring sciences, 30(2), 303-311.
Koetting, C. (2016). Trauma-informed care: Helping patients with a painful past. Journal of
Christian Nursing, 33(4), 206-213.
Larsen-Barr, M., Seymour, F., Read, J., & Gibson, K. (2018). Attempting to discontinue
antipsychotic medication: Withdrawal methods, relapse and success. Psychiatry
research, 270, 365-374.
Monks, R., Topping, A., & Newell, R. (2013). The dissonant care management of illicit drug
users in medical wards, the views of nurses and patients: a grounded theory study.
Journal of advanced nursing, 69(4), 935-946.
Neville, K., & Roan, N. (2014). Challenges in nursing practice: Nurses’ perceptions in caring
for hospitalized medical-surgical patients with substance abuse/dependence. Journal of
Nursing Administration, 44(6), 339-346.
Opjordsmoen, S. (2014). Delusional disorder as a partial psychosis. Schizophrenia bulletin,
40(2), 244-247.

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Raja, S., Hasnain, M., Hoersch, M., Gove-Yin, S., & Rajagopalan, C. (2015). Trauma
informed care in medicine. Family & community health, 38(3), 216-226.
Schoeler, T., Petros, N., Di Forti, M., Klamerus, E., Foglia, E., Murray, R., & Bhattacharyya,
S. (2017). Poor medication adherence and risk of relapse associated with continued
cannabis use in patients with first-episode psychosis: a prospective analysis. The Lancet
Psychiatry, 4(8), 627-633.
Skelton, M., Khokhar, W. A., & Thacker, S. P. (2015). Treatments for delusional disorder.
Cochrane Database of Systematic Reviews, (5).
Sweeney, A., Filson, B., Kennedy, A., Collinson, L., & Gillard, S. (2018). A paradigm shift:
relationships in trauma-informed mental health services. BJPsych advances, 24(5), 319-
333.
van Boekel, L. C., Brouwers, E. P., van Weeghel, J., & Garretsen, H. F. (2014). Healthcare
professionals’ regard towards working with patients with substance use disorders:
comparison of primary care, general psychiatry and specialist addiction services. Drug
and alcohol dependence, 134, 92-98.