Case Study on Mental Health Assessment and Planning

This case study presents a critical evaluation of the mental health status of Arnold, a mentally ill patient with Mania. It includes a mental status examination, clinical formulation table, and a plan for nursing care. The article also discusses therapeutic engagement, cultural safety, and recovery-oriented nursing care.

Running head: CASE STUDY 1
Case Study
Name
Institution

CASE STUDY 2
Case Study
Part 1: Holistic Assessment and Planning
The current study seeks to present critical evaluation of the mental health status of
Arnold; a mentally ill patient with Mania.
1.1. Mental Status Examination
 Appearance & behaviour
 Appearance
 Motor behaviour
 Attitude to situation and
interviewer
 Arnold depicted neglected self-care as evidenced by
the presence of abrasions and cuts on his body.
 Clothes covered with dust
 Frowning especially when addressing his ex-wife.
 Restless and highly agitated as evidenced by the
patient speech that incorporates multiple themes in an
unorganized manner.
 The patient furrowed his eyebrows during the
interview
 The patient was restless and highly agitated as the
interview session progressed
 Arnold showed an increase in gestural movements
during the interview.
 Speech form
 Rate
 Volume
 Quantity of information
 Very fast and agitated
 High tone at a constant rate.
 Poor quality of information resulting from the little

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 Speech content
 Disturbance of meaning
 Disturbance of language
spontaneous speech.
 The fact that Arnold talked about multiple issues in a
concurrent way led to distortion of meaning.
 Audible and less distorted
 Mood and Affect
 Mood
 Affect
 Congruency
 Arnold depicted a low mood
 Sense of hopelessness due to the accumulating bills.
 Upheld guilt about his past life
 Impaired
 Form of Thought
 Excess, absence, quality of
thought
 Continuity of ideas
 Poor. Arnold could not recall the events that took place
two days ago.
 Poor. The patient lacked coherence in his utterances.
 Content of Thought
 Delusions
 Suicidal thoughts
 Other
 Common (persecutory)
 Absent
 N/A
 Perception
 Hallucinations  The patient showed hallucinations that were based on

CASE STUDY 4
 Illusions
 Depersonalisation/derealisation
his business practices.
 Periodic
 Not pronounced
 Sensorium and Cognition
 Level of consciousness
 Memory:
 Orientation.
 Abstract thinking
 Poor
 Diminishing. The patient was no able to recall the
activities that took place two days ago.
 Poor
 Above average. The patient was able to make
judgments of the issues presented.
 Insight & Judgement
 Extent of individual’s awareness
of the problem
 Can they make rational decisions
 Not aware. Arnold’s medical records do not reveal the
presence of this condition.
 Yes. Arnold’s ability to run the business reveals his
ability to make rational decisions.
Risk Assessment
 Potential for harm to self
 Potential for harm to others
 Potential for absconding
 High. Particularly in his work environment.
 Moderate
 High
 Moderate. The patient revealed that he did not see the
need for the assistance accorded.

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1.2. Clinical Formulation Table
Summarize the pertinent information from case study
Presenting
factors
Arnold presents hallucinations, agitation and restlessness.
The patient frowns and raises his voice a his former wife Maria
The 39 year old patient reveals his inability to recall what he did in the last two
days.
Further, Arnold was highly dehydrated.
Precipitating
factors
The hallucinations depicted by the patient could have been precipitated by
economic factors. There is evidence that the 39 year old patient’s business is
deteriorating. According to, mental illnesses are heightened by environments
that restrict a person’s ability to gain an income.
On the other hand, agitation, periodic frowns and restlessness could have been
precipitated by the patient’s loose social and family ties. Despite the fact that
Arnold has no other family, he is separated from his wife.
Predisposing
factors
There are tendencies that Arnold’s current state was predisposed by the severe
drought, stressful situations, and financial inadequacies.
Perpetuating
factors
Arnold’s current state is maintained by lack of adequate employees, accruing
utility bills, lack of sleep, dehydration and his inability to acknowledge the
need for assistance.
Protective
factors
Despite the current situation, Arnold’s sources of strength include a supportive
ex-wife, higher levels of intelligence, acquisition of a Diploma in Business
Administration and a business that enjoys a history of success.

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1.3. Plan for Nursing Care
High priority problems
Arnold presents hallucinations and stress as the underlying high priority problems.
Humpstome and Broome (2016) explain that while psychotic patients adopt hallucinations to
foster the fulfillment of certain adaptive functions, they may impose great negative effects in
their interactions. As revealed in the case study, Arnold reveals multiple aspects of hallucinations
by imagining his engagements in multimillion dollar contracts, being picked by a private jet, and
paying his pending bills. According to Trauer, Qian, Doyle, Rajaratnam and Cunnington (2015),
mentally ill people develop hallucinations as a way of serving certain wishes in their lives that
are considered to be ungratified. On the other hand, Lai, Bruce and Collerton (2016) reveal that
such viewpoints may be advanced to enhance a person’s ego and superego functions as well as
fostering the restoration of lost objects. On the other hand, Powers, Mathys and Corlett (2017)
explain that an increase in the levels of stressful situations acts as a precursor to the development
of depression.
Cognitive behavioral therapy (CBT) will be adopted as a remedy for the conditions of
stress experienced by Arnold. According to Trauer et al. (2015), CBT plays a significant role in
assisting patients in the processes of reframing occurrences in a more positive way. Currently,
Arnold looks at his social and economic environments in a negative way due to the divorce and
dilapidating state of his business. To address the stresses and anxieties Arnold has been exposed
to, biofeedback will be adopted to minimize the symptomatic expressions depicted by the client
such as muscle tensions and increased heart rate. Similarly, pimavanserin will be prescribed for
Arnold. According to Humpstonb and Broome (2016) and Paul et al. (2015), pimavanserin is one

CASE STUDY 7
of the most effective pharmacological remedies applied in the processes of treating mental
conditions such as hallucinations and delusions.
Clinical handover
Arnold reveals crucial mental health issues such as hallucinations, agitations, distorted
memory, and restlessness. Further, the patient depicts optimistic imaginations concerning the
state of his business and family. An analysis of the mental status examination and clinical
formulation conducted on Arnold reveals that the patient is maniac.
The major areas of concern depicted by the patient include his elevated blood pressure
and precipitous heart rate. Further, Arnold’s state of dehydration as depicted by the dry lips call
for inclusion of instantaneous remedies. Similarly, proper analysis need to be established with
the aim of seeking interventions for the patient’s sleeping patterns as there is evidence that he did
not get sleep for about one week. The clinical interventions sought in the handover play a
significant role in reinstating the patient’s physical and biological functions and therefore,
reductions in the symptomatic expressions of stress and hallucination.
Part 2: Therapeutic Engagement and Clinical Interpretation
Therapeutic relationships play a crucial role in building an environment aimed at
alleviating the symptoms associated with mental conditions (Johnsen & Friborg, 2015). Further,
Cherkin et al. (2016) explain that the nature of ties established between the caregiver and the
patient act as significant determinants of the effectiveness of the remedies adopted to foster
change in character. Similarly, Ehde, Dillworth and Turner (2014) explain that treatment
relationships act as powerful instruments of initiating improvements among mentally ill clients
based on its positive effects in availing helpful environments aimed at strengthening their
abilities to explore. Koffel, Koffel and Gehrman, (2015) consider continuity of the prescribed

CASE STUDY 8
remedies and proper communication as the most effective ways of fostering the advancement of
factors aimed at initiating empowerment. According to Poulsen et al. (2014), proper
institutionalization of a working relationship that encourages the patient on the need to put in
place proper measures of controlling his current condition.
The main aim of adopting empowerment as a technique of fostering therapeutic
engagements among mentally ill persons revealing the symptoms of mania is to enhance the
levels of the affected individual’s independence through minimization of dependence (Poulsen et
al., 2014). According to Armstrong et al. (2018), nurses working with such patients are faced
with the obligation of enhancing their clients’ levels of efficacy in comprehending their
disabilities then working towards making themselves better. In Arnold’s case, establishment of
an effective therapeutic relationship will play a significant role in driving the desired process to
the end with the end goal of returning to independence through normalization.
Cultural safety
To avail culturally safe care to Arnold, I will adopt measures aimed at strengthening my
levels of awareness. According to Henderson, Van Hasselt, LeDuc and Couwels, (2016),
development of cultural awareness among caregivers dealing with mentally ill patients leads to
the alienation of the effects of biases and initially held prejudices; an aspect that leads to the
delivery of high quality care. According to Armstrong et al. (2018), proper advancement of
cultural awareness proceeds through the development of proper insights into a caregiver’s
initially upheld morals and healthcare beliefs. Fortinash and Worret (2014) reveal that when
dealing with mentally ill clients, nurses are faced with the obligation of having a deeper
understanding of their own cultural backgrounds by exploring the biases and prejudices they
might have previously upheld before tackling those of their clients. When working with Arnold

CASE STUDY 9
as the nurse in charge, I will work towards enhancing my cultural knowledge by seeking and
acquiring the pieces of data reviewing the patient’s social and ethnic backgrounds and how they
might have led to the symptoms depicted. Further, I will develop proper ways of understanding
Arnold’s worldviews and the roles they have played in guiding his interpretation of symptoms.
2.3. Recovery-oriented Nursing Care
Cognitive behavior therapy was identifies as the most effective remedy for the
hallucinations and stressful conditions depicted by Arnold. According to Lim, Wynaden, and
Heslop (2018), recovery oriented care is aimed at fostering the delivery of remedies through
inclusion of techniques that enhance recovery among the targeted consumers. Kidd, McKenzie
and Virdee (2014) identify the principles of recovery oriented remedies as uniqueness and goal;
real choices; attitudes and rights; dignity and respect; and partnership and recovery. On the other
hand, CBT works by availing an environment of treatment that is aimed at replacing the
preciously upheld negative thoughts with positive behaviors through realignment of previous
experiences and memories.
Recovery-oriented nursing care encourages the advancement of remedies ion mental
health settings through adoption of real choices. According to Lim et al. (2018), real choices
among patients are developed in instances where they are empowered towards making
personalized lifestyle and social choices that are aimed at fostering the development in ways that
are meaningful and explored with higher levels of creativity. Similarly, he real choices domain of
recovery oriented nursing care plays an essential role in fostering the advancement of relations
aimed at encouraging patients towards concentrating and building on their strengths. On the
other hand, Garneau and Pepin, J. (2015) emphasize on the importance of striking a balance
between offering supports and insisting on the efficacy of the roles played by caregivers in

CASE STUDY 10
allowing people to ace positive risks and making the most out of the new opportunities they are
presented to.
Comparatively, CBT works with the belief that the patient under consideration will
enhance their powers of making sound judgments through effective modification of the
destructive points of view and thoughts revealed by the client. As a consequence, the ability of
CBT to instill behavioral modifications of destructive traits among the affected patients reveals
its connection with Recovery-oriented nursing care. For instance, CBT could be effective in
allowing Arnold to determine the triggers to his current state of hallucination and stress.
Conclusion
An analysis of the symptoms present by Arnold reveals his maniac condition. CBT is
recommended to foster the treatment of stress and hallucinations. Further, pimavanserin is
recommended as a medication for delusions and hallucinations. On the other hand there is need
for the nurse to foster cultural awareness to enhance the effectiveness of the remedies availed.
References

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