Mental State Examination and DSM V Analysis of a Chinese Migrant Medico in Australia

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Added on 2024/07/29

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This case study examines the mental state of a Chinese migrant working as a medico in Australia, who is experiencing symptoms of depression and anxiety. The analysis utilizes the Mental State Examination (MSE) and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) to identify potential diagnoses and contributing factors. The MSE reveals signs of depression, including depressed mood, loss of interest, and suicidal ideation. The DSM-V criteria for major depressive disorder are met, and the possibility of postpartum depression in males is explored. The case study also examines the role of stress and vulnerability factors in the patient's mental health, including cultural adjustment difficulties, work-related stress, and the impact of becoming a father. The analysis highlights the importance of addressing these factors in the patient's recovery plan.

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(Question 1)
As the given case presents a Chinese migrant to Australia working as a medico in a hospital for long
hours and recently had a three week baby girl, this case presents several factors that indicate or
points towards severely examining the patient under Mental State Examination and DSM V. these
tools help to analyse the mental state of an individual and the factors that are cumulatively
responsible for their psychological state (Maercker et al, 2013).
As a community nurse visiting and analysing the behaviour of Chung revealed that there was some
kind of mental disturbances present in the patient. Taking into consideration one of an important
component of Mental State Examination is Behaviour and analysing mannerism, gesture,
psychomotor activity, expression, eye contact, ability to follow commands or requests and
compulsions (Jani & Masri, 2011). The analysis revealed that the patient was making very less eye
contact with the nurse, gestures included flat behaviour and absence of interest, psychomotor
activity was reduced as the patient was staring at the floor and sitting in deep thoughts unaware of
the surroundings. The nurse had to repeat her questions and requests certain times to be
acknowledged and answered by the patient that reveals that his ability to follow and collaborate is
lost.
Another component that is keenly undertaken while analysing this particular patient is the suicidality
and homicidality thoughts. This component makes sure whether the patient is undergoing suicidal
thoughts or not. The questions such as is life worth or not? Have you ever thought of being dead?
Have you ever thought of doing away with yourself? How? Is living not worth? (Taylor, 2013). These
questions must be asked by the nurse as the case study presents an answer to such thoughts when a
patient reveals that he has been going through suicidal thoughts and think his life is not worth as he
is unable to make any difference at work or for his family and feels guilty for the same. He also
revealed that he is a medico and know certain drugs that can be overdosed and help him to die.
DSM V is considered as all in one manual for diagnosis of mental issues and disorders according to
the International Classification of Mental Disorders. The new and revised edition of DSM provides a
platform to easily diagnose the disorder according to the categories listed and the symptoms
presented by the patient. In a given case the patient can be listed under these 18 categories present.
As seen the patient is having feelings of anxiety and depression and worthlessness since he had
become a father. This condition can be termed as postpartum depression for males that cause an
individual to get involved in suicidal thoughts and highlights depressive signs (American Psychiatric
Association, 2013). The DSM V gives grading criteria according to nine symptoms that may be
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present to rule out depression and five out of these nine criteria should be present for a long
duration to diagnose it as depression.
 Depressed mood (subjective or observed
 Loss of interest or pleasure, most of the day;
 Change in weight or appetite. Weight
 Insomnia or hypersomnia;
 Psychomotor retardation or agitation (observed);
 Loss of energy or fatigue;
 Worthlessness or guilt;
 Impaired concentration or indecisiveness; or
 Recurrent thoughts of death or suicidal ideation or attempt.
In the given case, all nine listed signs are constantly present with the patient's condition that points
the diagnosis towards depression and can even be termed as postpartum depression in males.
(Question 2)
As we go through the history and past lifestyle changes of the patient it is revealed that certain
events in the patient's life made a significant impact on his mental status that is present today.
These factors are greatly responsible for dragging the individual to the disturbed mental status.
Stress is the leading elements that are present with most of the psychiatric disorders developed. The
Stress Vulnerability Model indicates that biological factors, as well as stress level and extent, are
responsible for the development of any mental disorders. The biological vulnerability is referred to
as vulnerability towards any biological factors that make an individual more prone to develop certain
diseases and disorders. These vulnerability factors may be genetics, childhood, parental or acquired.
In given case, the factor that is highly responsible in the disturbed mental state of the patient is his
contact lost from his family and culture that makes him upset at times and induces feelings of
worthlessness and anxiety in him. He got away from his family 5 years ago and is unable to meet
them frequently, his family and cultural ethics were not present with him on his marriage day even
that made him emotional and depressed. This factor highlighted with other factors played a major
role in the development of mental illness for the patient. A study by Suárez-Orozco, Bang & Kim,
(2011) reveals that migrants from different countries settling onto other shores develop anxiety and
depression for the first several years after being separated from their families. Same was
experienced by the patient in given case as he was not able to meet his parents and family since last
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4 years and his life events were not favouring it developed as a major stressor in his life and affected
his mental health.
Stress is considered as anything that challenges a person and his coping strategies and worsens the
biological vulnerability towards disorders. The factors the enhanced stress in the patient’s life here
presented are the accusation and retraining given for drug error made in his work during long shifts
and working hours. The 12 months were given for retraining session to make him more competent
towards his work that induced feelings of guilt and worthlessness. After his daughter is born he is
again going through anxious moments and episodes that make him realise he is not worthy to take
care of his family as he is unable to spend time together with his daughter due to heavy load of work
and insufficient time. Kamalifard et al, (2014) in their study concluded that many men experience
postpartum depression and anxiety after they become a new father. This phenomenon is mostly set
unseen and undiagnosed leading to severe consequences at times. The research used the diagnostic
tool as Edinburg scale and 11.7% fathers analysed scored more than 12 in this scale proving that
they are undergoing depression.
(Question 3)
In mental health recovery, the most important criteria are developing the self-esteem and skills that
will enhance self-confidence of an individual to lead his life. Recovery is defined as regaining control
or possession and returning to health and consciousness. The mental health model includes
regaining a normal state of mental health which includes meaningful life, sense of self and active
participation within the community. The mental health recovery is defined as regaining the lost
aspects of self. The recovery model consists of three stages that are an undesirable state, the
process of transition and desirable state. The model provides a framework to shift from the diseased
and ill state that is undesirable state towards the desirable state with normal mental status via a
transition period involving recovery (Wahl, 2012).
Respect is one of the most important necessities in mental health recovery. Usually, the individual
who develops a mental illness is devoid of respect from society and also has lost his own self-respect
and esteem. Angell, (2011) describes in his research that how respect is an important parameter for
mental health recovery as it promotes recovery and induces lost the sense of self. In given case
scenario the patient is to be respected by his colleagues at work especially after he is being accused
of drug error and incompetency, family members should also help him recover by supporting and
respecting him. He should spend more time with his daughter to enhance the sense of respect for
own self and self-worth.
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With relevance to mental health state and recovery empowerment is described as the choice and
control that the user of services may have to empower himself towards better life choices and
recovery from mental illness. Using empowering strategies in the treatment of mental illness is
proved to be beneficial as the individual requires the support and development of decision making
power that is lost and dragged him towards depression. Empowerment provides this ability to make
own decisions and provide better recovery for mental health (Drake & Whitley, 2014). In a given
case the patient should be empowered to make a relevant decision that he suppose will be
beneficial for his family and work. this may include presenting to him various choices that are
planned and integrated as per the recovery plan and that will give him the sense of empowerment
without causing any considerable harm to his health.
Hope is the key to recovery in mental health, the patient with depression lose their hope and the
main pillar on which the recovery can be planned. Providing hope to such an individual who has
become hopeless from life and own self is important in order to build him esteem back ( Mashiach-
Eizenberg et al, 2013). In a given case the individual has thoughts of worthlessness and worthless life
that shows his hopelessness towards his condition and inability to think of recovery. Support
channels like family and social interactions will help him enhance his abilities towards getting
positive thoughts or being worthy and having a ray of light in his life.
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References
American Psychiatric Association, 2013. Diagnostic and statistical manual of mental disorders (DSM-
5®). American Psychiatric Pub.
Angell, M. (2011). The epidemic of mental illness: why. The New York Review of Books, 58(11), 20-
22.
Drake, R. E., & Whitley, R. (2014). Recovery and severe mental illness: description and analysis. The
Canadian Journal of Psychiatry, 59(5), 236-242.
DSM-5 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders. Arlington: American Psychiatric Publishing.
Jani, H. M., & Masri, R. Y. (2011). An improved online mental status examination system and mental
health diagnostic system. Adv Inf Sci Serv Sci, 3(9), 66-75.
Kamalifard, M., Hasanpoor, S., Kheiroddin, J. B., Panahi, S., & Payan, S. B. (2014). The relationship
between fathers' depression and perceived social support and stress in postpartum period. Journal
of caring sciences, 3(1), 57.
Maercker, A., Brewin, C. R., Bryant, R. A., Cloitre, M., Reed, G. M., van Ommeren, M., ... & Rousseau,
C. (2013). Proposals for mental disorders specifically associated with stress in the International
Classification of Diseases-11. The Lancet, 381(9878), 1683-1685.
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Mashiach-Eizenberg, M., Hasson-Ohayon, I., Yanos, P. T., Lysaker, P. H., & Roe, D. (2013).
Internalized stigma and quality of life among persons with severe mental illness: the mediating roles
of self-esteem and hope. Psychiatry research, 208(1), 15-20.
Suárez-Orozco, C., Bang, H. J., & Kim, H. Y. (2011). I felt like my heart was staying behind:
Psychological implications of family separations & reunifications for immigrant youth. Journal of
Adolescent Research, 26(2), 222-257.
Taylor, M. A. (2013). The neuropsychiatric mental status examination. Elsevier.
Wahl, O. F. (2012). Stigma as a barrier to recovery from mental illness. Trends in cognitive sciences,
16(1), 9-10.
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Mental State Examination and DSM V Analysis of a Chinese Migrant Medico in Australia

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