Essay On Mental Health Assistance

In this essay, we discuss On Mental Health Assistance the essay intends to present a differential diagnosis of the case study using the DSM IV and ICD-10 as a provision for a treatment plan and assessment criteria. We can quickly determine a patient's level of depression through the assessments.

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Mental Health Assessment
Name
Institution

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An Examination of Major Depressive Order using Pharmacology and CBT
Introduction
In this essay, we will examine mental health depression disorder in a young female. The
essay aims to use the DSM IV and ICD-10 as a provision for a treatment plan and
assessment criteria to offer a differential diagnosis of the case study. Through the
assessments, we will easily understand a patient’s level of depression. The treatment
plan, on the other hand, will enable the patient to respond appropriately to medication
and attain the wellness of being.
According to Murray & Lopez (1997), one of the leading causes of global disease by the
year 2020 will be depression. Several nations face the challenge of huge cost burdens
for handling depression disorder. Greenberg et al. (2003) and Thomas & Morris (2003)
ascertain that the USA, for example, has an estimated burden of $83 billion. UK’s
burden, on the other hand, is approximately nine billion pounds. Depression can have
negative impacts on the behavior and emotions of an individual (Lin, Dean, & Ensel,
2013). Izard (2013) confirm that depression is a mental illness whose severity of
occurrence is related to the tests that may be conducted on an individual (Izard, 2013).
Sadness, stress, a feeling of unworthiness, fatigue, mood swings, loss of pleasure, and
loss of speech among others are some of the most common symptoms of depression
(Woolery et al. 2004; Thomee et al. 2004; Bender, 2006). Burns (1981) and Dwight-
Johnson et al. (2000) confirm that depression can be cured by physiotherapy and
medication. There has been an increase in the use of anti-depressants among the youths
and adults in the United States of America and the United Kingdom. (Thomas &

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Morris, 2003; Hollinghurst et al. 2005). As stated by Freeman & Dattilio, (1992),
Cognitive Behavioural Therapy is the most preferred psychotherapeutic approach in the
treatment of depression.
In this essay, we will describe the case study, we will also talk about differential
diagnosis, and finally, the essay talks about the treatment plans designed using the
approaches of Pharmacotherapy and CBT.
Description of the case study
From the presented case scenario, we have a young female adult whose name is Safina.
She is a married woman with a one-month-old baby girl. Three years ago, she together
with her husband migrated to the UK for their home country. As it is the norm with
most women of Bangladesh decent, her marriage to her husband was arranged.
However, they never got the time to adequately study one another before the marriage.
The husband has strong ties with her mother who indirectly controls most of the things
in their home. Since their move to the UK, they have been experiencing a lot of
financial challenges. From the case study, we can realize that these financial challenges
have led to Safina’s depression. Safina also struggles with English and thus her husband
in most cases would want to speak on her behalf. The husband has identified that
Safina is reluctant t do anything, be it looking after the baby or taking part in therapy.
During the initial assessment, we notice that Safina is shy, speaks slowly with her head
bowed down. It could even be argued that she is regretting the decision to relocate to the
UK as she had initially questioned what life could be like.

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Differential Diagnosis
The assessment results indicate that Safina is unhappy. Additionally, she has lost
interest in taking care of the baby. Furthermore, she seems to struggle with getting out
of the bed. All these are some of the main diagnostic features of depression. I will,
therefore, apply two separate differential diagnoses to help with her case. These
diagnoses include ICD-10 and DSW IV. These two assessments are important in
ensuring the availability of the right differential that may aid in disclosing the severity
of her depression.
ICD-10: This classification of mental disorders is used by researchers and practitioners
to assess patients with ease. It is inadmissible by the World Health Organization (WHO)
for various mental health disorders that may be used for purposes of research and
clinical practices. This classification is outlined in Chapter V of ICD-10. According to
WHO1(996), and NCCMH (2010), depression is classified under F32 code, which
represents the main mental disorder that Safina experiences.
Safina also shows the following diagnostic symptoms that are associated with
depression.
o According to her husband, Safina is sad and exhibits a low mood since their
financial problems kicked in.
o The husband also reveals that Safina does not want to do anything. This is an
indication that she has lost interest in some of the most important things in her
life including her baby.
o Her confidence is low and she exhibits low self-esteem which is clear from her
reluctance to maintain an eye contact.

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o Her speech is slow which could mean that she is fatigued.
o Safina also showed signs of anxiety and she imagined that living in Bangladesh
could have been much better.
o From the description of the above diagnostic symptom descriptions we can
confirm that Safina also has an adjustment disorder. This disorder under ICD-10
standards is categorized as F43.2.
From the above symptoms, we can confirm that Safina has a mild depression episode. .
she however does not have suicidal thoughts as this is not specified in the case study.
There are, however other associated symptoms that could have been present in Safina’s
case. To justify this claim, however, the DSM-IV Criteria for Major Depressive
Disorder (MDD) is drawn into the diagnosis assignment.
DSM-IV: In this classification there are numerous identified symptoms which a
depressed patient like Safina may experience in the case that that there is MDD. In other
classifications, classifying Safina would depend on the presence of MDD.
o Her husband reports that she is sad.
o The husband also reveals that Safina does not want to do anything. This is an
indication that she has lost interest in some of the most important things in her
life including her baby.
o She stays longer in bed and does not get out which could be an indication of loss
of energy.
o Her misplaced gilt that going for therapy is a shame to the family also pins her
down.
o She is worried about her present situation and of course she imagines what her
life could have been had she stayed in Bangladesh.

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o She is lacking in confidence and has a very low self-esteem.
From the above pieces of evidence, Safina satisfies the three criteria that include loss of
interest, depressed mood, and reduced energy. These three symptoms are enough to
classify her as having a Major Depressive Disorder as outlined and specified as
Category A. Safina also meets two criteria in category B out of the six criteria. These
include guilt and a feeling of low self-esteem and unworthiness. Her functionality is,
however, difficult to evaluate due to the limited information provided in the case study.
We can also say that she has minimal adjustment disorder due to the constant questions
she asks about her country. After performing the final diagnostic evaluation, we can
ascertain that Safina has Additionally, moderate depressive disorder.
Treatment Plan
The treatment plan involves the use of pharmacology and CBT. According to
Kapczinski et al. (2003), applying the two methods provides an instant and long-lasting
symptomatic relief. It is important to note that the application of CBT to activate
behavior by using some kinds of medication can enhance the mental status of a patient.
Medication is important in the initial stages of therapy in cases of moderate depressive
disorders. This helps in stabilizing the patient. In the following stages of CBT
application, the medication can be discontinued. Below, we discuss these treatment
options.
Pharmacology: NCCMH (2015) confirm that the prescription for anti-depressants in the
UK has doubled. It was reported back in 2014 that in excess of 25 million dispensations
of anti-depressants occurred over a 14-year period. In 2008, NCCMH (2015) reports

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that the use of anti-depressants increased from 6.7% to 8.5% among the UK population
due to the financial crisis in 2008. Other than a financial crisis, the other possible
causes of using anti-depressants may include; an improvement on diagnosis, the status
of housing, a reduction in the stigma surrounding mental illness, and use of anti-
depressants to reduce social anxieties and stress (Ilyas & Moncrieff, 2012).
In the year 2009, The National Institute for Health and Care Excellence (NICE) released
clinical guidelines necessary for the use of anti-depressants for a mental disorder. The
recommendation by NICE was that all the patients having mild and moderate depressive
disorders should start the use of anti-depressants at early stages. Another
recommendation suggested that anti-depressants should be used in combination with
social and psychotherapeutic interventions. According to NCCMH (2015), anti-
depressants are good for use for six months to prevent patients from relapsing. The most
common type of anti-depressants is Selective Serotonin Reuptake Inhibitors (SSRIs)
due to its non-addictive nature (NICE, 2009; NCCMH, 2015).
Cognitive Behavioural Therapy (CBT): According to Field, Beeson, & Jones (2015),
CBT is one of the most popular therapeutic interventions for anxiety and depression.
CBT assumes that there is an interconnection between thoughts and mood. This implies
that the mood of an individual is determined by their thought process (Driessen &
Hollon, 2010). Dysfunctional thoughts invariably affect the physical well-being and
behavior of an individual. CBT, therefore, aims to bring awareness and recognition of
an individual’s dysfunctional thoughts to their consciousness. As a result, someone gets
to learn about their negative thoughts and responds appropriately to promote positive
thinking and wellness (Beck, 2002; 2011).

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Beck (2011) says that CBT is a social-psychological interference. It combines the
necessary principles from cognitive and behavioral psychology. This intervention is
evidence-based and it allows the practitioner to ensure that a patient develops the skills
necessary to cope with their maladaptive behavior (Burns & Nolen-Hoeksema, 1991;
Morgan, 2003). According to Brewen (1996), CBT is integrative and thus it focuses on
the problems and actions get rid of challenges. What this means is that CBT is in most
cases specific to a treatment plan. Schacter, Gilbert, & Wegne (2010) also assume that
the symptoms associated with major depressive disorders can be treated with coping
skills thus enabling the patient to process their own cognitive skills.
The following are the six stages of the CBT practice;
Assessment and alliance formation stage: Goss, Rossi, & Moretti (2011) state that this
stage focuses on understanding the personality of the patient and their mental problems.
The patient is thus evaluated to get accurate information her mental health records and
medical records (Gatchel & Rollings, 2010; Framingham, 2011). The counselor and the
patient develop a comprehensive understanding of the problems at hand and a path
towards recovery and healing is directed (Goss et al. 2011). Krupnick et al. (1996)
confirm the importance of establishing a therapeutic alliance between the counselor and
the patient to aid in the CBT sessions. As stated by Thompson et al. (2001); Goss et al.
(2011) and Grant (2012), this CBT technique requires an effective communication using
questionnaire, interviews, and agenda setting
Reconceptualization stage: this is the stage where the counselor is focused on helping
the patient change her and negative thoughts (Gatchel & Rollings, 2010). According to

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Beck (2011) people who suffer depression experience cognitive distortions. Such
distortions prevent them from seeing any positive in their lives. The patients may lack
the motivation to participate in anything in addition to feeling lazy and perceiving
failure. These attributes may bring suicidal thoughts as the patients feel useless and lack
confidence. A major CBT technique applied in situations described so far is cognitive
restructuring. According to Neilson, Johnson, & Ellis (2001), it involves identifying the
most dangerous negative thoughts in the mind of the patient and aiming to change them.
It entails thought records, evidential evaluation, and the skills of Socratic questioning
(Padesky, 1993). Beck (2011) says that these skills help the patient in identifying the
negative thoughts and emotions in addition to helping them connect thoughts with
emotions and feelings.
Skill Acquisition stage: according to Beck (2011), this stage allows the counselor to
modify the patient’s unhealthy behaviors. This is the longest stage because the patient
has to link her thoughts to her behavior. The most important technique in this stage is a
behavioral modification which helps in changing negative behavior.
Skills consolidation and training application stage: The patient in this at this stage
strengthens the skills attained during the course of the therapy. Homework and thought
records are used to help the patient reconnect with society.
Generalization and Maintenance stage: In this stage, it is ensured that the patients do not
relapse to their old selves. They are therefore empowered with the necessary strategies
required in coping.

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Post-treatment Assessment stage: The patient is monitored to track their progress during
the period of the therapy.
Traditional Treatment Action Plan
The plan postulated for Safina has three stages of therapy that include the initial stage
which takes 1-5weekly sessions, the middle stage which involves 6 – 9 weekly sessions,
and the concluding stage which has 10-12 weekly sessions.
Pre-session
The pre-session helps in understanding Safina’s situation. Her mental state was
clinically evaluated, tests were carried out, there was also a discussion of the
appropriate therapeutic program, and finally, a rapport built between the patient and the
counselor. The treatment plan used in this essay resembles that of Beck (1979, 1995).
Initial-Stage (1-5 weekly sessions)
This is where clinical evaluation is completed. This stage helps in educating and
enlightening the client. This is also the stage when we ascertain that the patient
understands the language of communication. As stated by Hassiotis et al. (2012), the
counselor explains the idea around CBT and emphasizes the need for the patient to take
part in homework assignments. Additionally, the counselor and the patient discuss the
reasons why the counseling is important and the frequency of attendance is agreed upon.
Some of the techniques used in this stage are; the use of anti-depressant; setting of an
agenda, activity charts, use of thought records, feedbacks, and homework.

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Mid-Stage (6 – 9 weekly sessions)
The counselor actively and continuously engages the client with coping activities that
are deemed positive. The problem is diffused bit by bit in an organized manner and the
client learns some new coping and adapting ways with positive thinking. It is also
important to note that medication is withdrawn at this stage because it is an exploration
and intervention stage and only the cognitive and behavioral aspects of the patient are
taken care of. Some of the relevant techniques in this stage may include; review of
previous sessions in the initial stage, the setting of agenda, homeworking, the use of
relaxation techniques, behavioral activation, validating and testing patient’s
assumptions, cognitive restructuring, and the elimination of maladaptive thoughts in a
patient.
End-Stage (10 – 12 weekly sessions)
The counselor and the client reflect on the therapeutic progress made thus far. The
counselor empowers their client continuously with coping skills in addition to the use of
homework. The patient also identifies the techniques that they may require to cope
outside therapy within the society at large. All stages are summed and once that is done
then we can mark the end of the end-stage. There is also the possibility of referring the
patient to groups or associations to engage with at the end of therapy. The patient must
be exposed to other techniques to ensure that they do not relapse. The most significant
techniques in this stage include; homework, summation, feedbacks, reflections, and
thought recording.

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Closing session
The patients at this stage are prepared to terminate the therapy. The patient is
encouraged to continuously use homework and other learning skills acquired in the
course of the therapy. It educates the patient on the importance of counseling and its
role in learning the coping skills. The counselor thus motivates their client by telling
him the predictive problems he may encounter and how to deal with them.
Summary and Conclusion
From the essay, we have been able to come up with a differential diagnosis and
treatment plan for Safina. The case study indicates that Safina ran away from
Bangladesh and then migrated with her husband to the UK. They have since struggled
financially thus causing some depressive moods towards Safina. She exhibits a
reluctance of doing anything including looking after her baby.
A diagnosis analysis using, F32, DSW-IV, and ICD-10 were carried out to assess the
mental health status of Safina. The results exhibited various diagnostic features that may
include; unwillingness to do anything, sad or unhappy mood, shyness, low self-esteem,
worries, and misplaced guilt. The diagnosis also reveals that she has minimal adaptation
disorder evidenced by her inability to adopt the UK. The diagnosis also revealed that
she showed minimal anxiety.
Pharmacology and CBT were the recommended treatment plan. In pharmacology, we
applied medication such as anti-depressants to treat mental disorders. The medication is
used in her initial stages of therapy to lower Safina’s mild mood anxiety and. The main
embodiment of the treatment plan was psychotherapy, wherein CBT and its attending

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techniques were used in the design. Medication and CBT were both recommended to
help in quick recovery and avoid lapses.
In conclusion, the essay recommends that the case study analyze the condition of the
patient more exclusively and give more details that may be necessary for evaluation.
Moreover, the use of other forms of treatment would also be necessary for Safina to get
used to her present home in the UK. These other forms of therapy may include; group
physical engagement and exercises, participating in group yoga exercises and having a
balanced food diet. There is a need to adopt more scientific and technical treatment
options that can concurrently detect and measure depression. As a result, the counselor
makes the most thought off decision regarding patients with major depressive disorder.

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Diagnostic Criteria for Major Depressive Disorder and Depressive Episodes
http://www.psnpaloalto.com/wp/wp-content/uploads/2010/12/Depression-Diagnostic-
Criteria-and-Severity-Rating.pdf
Section 2: Differential Diagnosis
http://www.blackwellpublishing.com/content/BPL_Images/Content_store/
Sample_Chapter/1405113243/HibbertSect02.pdf