Mental Health and Wellbeing: Assessment, Risk Factors, Care Plan, and Positive/Negative Interaction

This article presents a case study of a patient with auditory hallucinations and discusses his appearance, behavior, affect, mood, speech, thought form, thought content, perception, cognition, and insight/judgment. It also identifies risk factors such as social isolation, medication adherence, financial vulnerability, and impaired sleep patterns. A care plan is suggested to improve the patient's condition, including interventions such as scrutinizing behavior, providing a calm environment, establishing a therapeutic relationship, and cognitive therapies. Positive and negative interactions between the nurse and the patient are also discussed.

Running head: MENTAL HEALTH AND WELLBEING
Mental Health and Wellbeing
Name of the Student
Name of the University
Author Note

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MENTAL HEALTH AND WELLBEING
Answer 1
1. APPEARANCE
Dimitri is a young man of Asian origin and presents himself as tidy, neat and
well groomed. He has black hair of medium length and was dressed in casual attire.
His physical built was lean with love skin tone. Dimitri wears glasses and his thin rim
of moustache.
2. BEHAVIOUR
Throughout the interview process Dimitri is found to be cooperative however,
he has extremely slow engagement in the entire conversation. This is evident from
the his gestures like fiddling of fingers and excessive movements of hands. His
sitting posture was little hunched and was aligned on the left side during the entire
tenure of the interview. He exhibited extremely poor eye-contact during the entire
interview process and frequently got distracted when he hear voices. For example,
upon hearing certain voices, he turned his head towards the direction from which the
voice was coming, interrupting the conversation. He looked restless and was less
attentive as he was asking to repeat questions over and over again to the interviewer
(nurse).
3. AFFECT
Dimitri noted to be restricted as he stated that he is scared and is not
comfortable. However, his facial expression does not reveal any expression of fear
or anxiety.
4. MOOD

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Dimitri's mood was not stable and this is evident when he stated that he is not
comfortable during the process of interview conduction. He also reported that he is
scared and fearful when he hears certain voices because he thinks that the voices
are criticising him.
5. SPEECH
Dimitri did not initiate any conversation by his own during the entire interview
process. When he spoke, his voice was slightly slurred, slow spaced and repetitive.
The volume of his voice is normal but at times it became loud when he hearted
voices. During the entire interview process, there was no spontaneous initiative to
indulge or continue the conversation. He was only providing short or one word
answers to the directed question framed by the nurse.
6. THOUGHT FORM
There are evidences of blocking of thoughts, looses association of logic with
the questions along with incoherent mixture of phrases and words. He stars hearing
certain voices even before he lines-up the ideas or these thoughts are finished and
this interrupts his line of thought. Eventually after a brief pause or interruption, he
fails to recall what he was saying.
7. THOUGHT CONTENT
Dimitri was found saying tht he was passing through auditory hallucinations
and those voices were constantly criticising him. He also did not express any signs
of obsessions or delusions at the moment. Moreover, he denied any intentions of
harming others or causing harm to self or self-harm. Dimitri was also found saying
the he will undertake certain protective actions for his self-defences. He also said

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that he has stated writing novel but he was unable to finish the same due to these
auditory hallucinations.
8. PERCEPTION
He was suffering from auditory hallucinations as he recorded that he was
hearing voices.
9. COGNITION AND INTELLECTUAL FUNCTIONING
Dimitri is an oriented human being and was alert about the current place and
time. However, when questioned, he replied back after a brief pause. He mentioned
to the interviewing nurse that he was brought there b y one of his friend names
Cheryl and at present he is at mental health clinic which generally followed an
interview process. When the nurse conducted an intellectual functioning test, he
gave correct answers to simple mathematics questions initially. However, later on,
he corrected himself with wrong answers and informed the nurse that he weak in
mathematics. Memory test was not performed but he displayed a good memory in
the domain of the list of the medication that he is taking.
10. INSIGHT AND JUDGEMENT
Dimitri is aware of the mode of action of his prescribed medication. For
example he said that Olanzapine will help him recover from hearing voices and this
reveals that he has good insight and intact judgement. He also reported that when
he did not take the medication (Olanzapine) for a month when he was in Japan, the
situation became worsen as he started listening voices. He also has good level of
judgement as he agrees to take new set of medications as prescribed by the doctor.
However, he stated that he is not crazy.

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Risk Factors
1. Social Isolation
The potential risk factor in case of Dimitri is the social isolation. Though Dimitri
has been found reporting that he has friends but majority of them are virtual that is in
the social media friends. This lack of real friends creates social isolation. According
to Holt-Lunstad et al. (2015), social isolation increases the risk of early mortality. This
is because, social isolation increases the sense of loneliness and this cast a
negative impact on the mental and the physical health of the healthy adults (Coyle &
Dugan, 2012). He said that he has got a good friend circle but he goes to move
alone. According to Cacioppo and Cacioppo (2014), it is important to get a significant
emotional support from family members and friends in order to maintain a stable and
fit mental status. Support from the family members helps to reduce the sense of
loneliness and this in turn reduces the sense of depression and thereby helping to
increase the mental equilibrium and stability (Liu, Gou & Zuo, 2016).
2. Risk of adherence of medication
Though Dimitri is well aware about the role of the medications and the list of
medication he takes, but there lies a risk of medication adherence. This is evident
from the fact that when he was in Japan for a month, he skipped his medicines and
this worsens his overall mental conditions. According to Thompson and McCabe
(2012), it is challenging from the people suffering from the mental illness to
undertake regular medications and hence can be considered as an important risk
factor of Dimitri who is suffering from auditory hallucinations.
3. Risk of Financial vulnerability

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Dimitri informed the nurse that at present he is unemployed and just came
back from his one month holiday in Japan. This holiday outing in Japan has engulfed
a significant amount of his savings. Thus in the present scenario, it can be
ascertained that Dimitri might be suffering from financial instability as he is jobless
and has spent a significant amount of money in travelling. According to Yoshikawa,
Aber and Beardslee (2012), low economic status or lack of financial stability
increases the susceptibility of stress or depression and thereby increasing the
threats of mental health disorder.
4. Risk of impaired sleep patterns
Dimitri reported to the nurse that the voices he hears are very disturbing.
According to him, those voices criticize him and thereby hampering a sound sleep at
night. According to Short et al. (2013), lack of adequate sleep at night leads to the
development of high level of mood disorder along with depression and anxiety and
thus a potential risk factor of Dimitri who is suffering auditory hallucinations.
Answer 2
CARE PLAN
1. CLINICAL ISSUE: auditory hallucination, as it is clearly seen that Dimitri is
hearing voices. It is a form of hallucination that involves hearing of sounds
without the presence of any auditory stimulus (Hepworth et al., 2012)
RATIONALE FOR CHOSEN ISSUE: Auditory hallucination is a clinical issue that is
mainly faced by people with psychotic disorders. The sounds can be unnatural,
familiar or even sounds of human voices (Hepworth et al., 2012). A proper care is

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required as auditory hallucination can make a patient aggressive, violent, and self-
destructive or may lead someone in to clinical depression.
GOAL/S: The goal is to provide a healthy life style to the patient and the patient
would stop hearing the voices and would be able to concentrate on his life.
INTERVENTIONS -
1. Scrutinizing the behavior and
the attitude of the patient, such
as inappropriate facial
expressions or hand movement
(van der Gaag et al., 2012).
2. Providing the patient with calm
and serene environment or with
structured solitary action. Social
rhythm therapy might be useful
for maintaining the circadian
cycle (Thomas et al., 2014).
3. To establish a therapeutic or
curative relationship with the
patient
RATIONALES
1. Scrutinizing facial expressions can
help the nurse to assess the
predisposing factors of his
behavior. Identifying the signs and
symptoms of patients with
psychotic disorder helps the
caregivers to prepare appropriate
nursing plan for these patients (van
der Gaag et al., 2012).
2. Calm environment and proper
sleep patterns will prevent the over
exhaustion of the brain. Solitary
activities can help to decrease the
tension and stress in the patient
(Gottlieb et al., 2013). Increasing
psychomotor activity can excite the
patient may exacerbate the
symptoms (Thomas et al., 2014).
The nurse can suggest Dimitri to

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use earplugs or headphones as
distraction techniques.
3. A relationship of trust between the
caregiver and the patient helps to
create a non-hostile environment
for the patient and helps the patient
to adhere to the medical treatment
(Chaffin & Adams, 2013). It is
revealed from the video that
medications help to alleviate his
symptoms. A friendly
communication would help Dimitri
to express his emotions and
concerns to the caregivers and
help the nurse to cater to his needs
and understand the risk factors of
the clinical condition. For example
Dimitri expresses concern about
his mom. Relationships of trust can
help the nurse to apply various
cognitive reinforcement therapies
to Dimitri.

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Evaluation
A two-month follow up can be taken after the treatment in order to evaluate
the cognitive condition of Dimitri. Cognitive screening test would help to understand
the mental status of Dimitri, which can be helpful to known the effectiveness of the
interventions. Dimitri would stop hearing the voices, would report of a better life style,
and would be able to concentrate on his work.
A proper therapeutic relationship will ensure Dimitri that his problem will be
addressed. Solitary activities and cognitive therapies would cease the thoughts of
low esteem, self-criticism and would foster self-command in the patient.
In context of the recovery model of care, these interventions will help to
promote, empowerment, hope, connection and healing. This recovery-based model
would help Dimitri to establish the losses related to his mental health.
Activity 3
Positive interaction
1. One of the examples of the positive interaction between the nurse and the
patient is that it was good on the nurse's part to initiate the interview, by
introducing herself to the patient. It can also be seen that she had promised
Dimitri that confidentiality should be maintained; hence, he can feel free to
express his concerns. It can be seen that the nurse had accomplished the
skills of communication, which is a prime quality of nursing (Kourkouta &
Papathanasiou, 2014).
2. It is evident from the video that the nurse has done a commendable job to
initiate the discussion with open ended questions. According to Chaffin &

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Adams, (2013) closed ended questions can be uncomfortable for a patient for
the first time and hence Dimitri might hesitate to disclose his emotions.
3. Another example of positive interaction is that the nurse was able to establish
a calm and serene environment for Dimitri. She has been mindful while
choosing her words to converse with Dimitri, such that she does not get
perturbed. A nurse should be able to deal with their patients in a cam and
compassionate way (Happell et al., 2012). Not paying heed to the patient’s
concern or ignoring their perceptions can hamper the therapeutic relationship
between the caregiver and the patient (Chaffin & Adams, 2013). It can be
seen from the video that the nurse had been successful in active listening with
disrupting the flow of emotions of Dimitri.
4. A nurse should be able to preserve the basic rights of a patient while
delivering care to him. As per the nursing codes of ethics, nurse should
respect the right of decision making and personal beliefs of patients (Gottlieb
et al., 2013). The video reveals that the nurse has respected his decisions to
not to call his mother as he never wanted to overburden his mother with the
news of his illness.
Negative interaction
1. The nurse was in close proximity of Dimitri, which can be dangerous to the
nurse as people with auditory hallucination may show aggressive disorders
and may show violence (Happell et al., 2012). Hence, the nurse should be
careful about the behavioral pattern of the patient.
2. Close and confined area may be claustrophobic for psychotic patients
(Cacioppo & Cacioppo, 2014). The interview took place in a confined area

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and the nurse attending Dimitri would not get any room for escape if the
patient tries to hurt her.

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