NURS20157 Clinical Foundations 1: Mental Health Assessment Case

This case study presents a mental health assessment of a 35-year-old female, Kathy Willet, using the DSM-5 diagnostic criteria. Kathy presents with symptoms of low mood, irritation, and suicidal ideation. The assessment identifies that Kathy has been suffering from low mood due to personal relationship issues and the death of her mother, leading to job loss and isolation. The case study explores diagnostic criteria met, associated features, risk and prognostic factors, and considerations for co-morbidity, including cannabis use. Evidence-based interventions such as psychotherapy (cognitive behavioral therapy and interpersonal therapy) and antidepressant therapy are recommended, along with motivational interviewing and lifestyle management education to improve Kathy's quality of life and coping mechanisms. The study emphasizes the importance of monitoring medication side effects and tailoring treatment to the individual patient's needs.

Running head: MENTAL HEALTH ASSESSMENT 2
MENTAL HEALTH ASSESSMENT 2
Name of the student:
Name of the university:
Author note:

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Introduction:
The Diagnostic and the Statistic manual of the Mental Health disorders is extensively
utilized by the psychiatrists as well as the clinicians. It is mainly used for the diagnosing various
types of the Psychiatric disorders. The American Psychiatric Association mainly published it. It
is mainly seen to cover all the categories of the mental health disorders not only for adults
but also for the children (Schiefer et al., 2015). It has been widely used in the present
generation for the different types of psychiatric diagnoses as well as for the treatment
recommendations and different types of insurance coverage purposes (Uher et al., 2014).
This manual is found to be mainly non-theoretical and it mainly seems to focus on the
different types of the describing symptoms and different statistics and helps in leaning about
which gender is mostly affected by a particular illness, the type of the inset as well as the
effects of the treatment and the different common treatment approaches. This assignment
will show how this tool helps in identification so specific mental health conditions of the
patient. Accordingly, the professionals for the patient would develop interventions.
Diagnostic criteria that were met:
The patient named Kathy is seen to be reported with three important clinical symptoms,
which were irritation, suicidal intention and low mood. It is important for the affected individuals
to experience two weeks of low mood that remains present across all the important situations.
This is mainly seen to be associated with low self-esteem, loss of different types of interests in
different activities in life, lower amount of energy and pain without a clear cause (Kato et al.,
2016). Throughout the entire analysis of the patient named Kathy, it was seen that she had been
suffering from low mood conditions from a long time and the situation of grief and sadness to

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such an extent that she has lost the urge of living. She is showing suicidal intentions and this
reveals of the fact that she is going through chronic mood disorders with the criteria falling into
the depressive mood disorders.
Diagnostic and associated features to support the diagnosis:
While going through the history of the patient, a number of factors has been identified
which help the clinicians in coming to a conclusion about the mental health condition of the
patient. It is seen that the patient is already suffering from low mood since turmoil and breakups
in the personal relationships with her boyfriends. She had been able to overcome it for few
months after she got a good position and job in the bank but the death of her mother made her get
back into periods of low mood, she suffered terribly from isolated feelings and went through
emotional turmoil. Therefore, the situation was seen to gradually deteriorate for her and it
reaches a negative point where her consistent poor performance due to death of her mother
resulted in her losing the job. Therefore, she failed to cope up with the repeated negative events
in her life making her suffer from low mood conditions from a huge number of days that
ultimately resulted in poor health conditions and suffering from major depressive period.
Risk and prognostic factors:
The DSM-5 criteria that allocate a mental health disorder to the category of the major
depressive disorders are irrational worry, preoccupation with unpleasant worries, trouble in
relaxation, feeling of tensed, fearing that some awful will happen and many others (Moller et al.,
2015). The criteria shows that patients need to go through depressed mood, loss of interest and
enjoyment in the usual activities as well as reduction of the energy and decreased activity. The
patient is seen to have no energy in completing any of her tasks and keeps herself locked indoors

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and does not feel like socializing. Moreover, she is suffering from depressed mood and the
conditions have reached to a severe situation where she is even having tendencies of self-harm.
She is having all the properties that match with the criteria for the major depressive disorder.
Therefore, the risk factors that are mainly seen to affect the situations are low social support due
to absence of family members surrounding her, her low coping power, inability to get good
employment and settlement in life, bereavement due to loss of her mother and many others.
Therefore, the prognosis measurement can be done with the help of the DSM-5 classification
system (Oquendo et al., 2014). Two groups of symptoms are made by experts as group A and
group B. By analyzing the symptoms, and calculating the results and the scores, it is found that
she has all three symptoms of group A and two symptoms of group B. therefore, she lies in the
group severe depressive episode and she needs interventions to overcome such situation and lead
better quality lives.
Cultural and gender related issues:
On close analysis of the patient, it was found that she had not gone through any issues
that included problems with gender and with her culture. It was mainly found that she had poor
coping ability to cope effectively with the different strenuous situation in life and therefore, she
had gone through various difficult periods of low moods, inability to feel energetic to perform
her work and thereby took the support of marijuana to cope with the stress. Her condition did not
improve and reached to an acute situation where she tried to self-harm herself.
Considerations for co-morbidity or differential diagnosis:
The patient was seen to have no additional co-morbidity along with the presence of the
depressive symptoms. One of the most important issues that had been identified that might

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worsen the physical and mental health of the patient is her additional intake of the cannabis. She
is taking cannabis on a regular note so that she can manage the stress effectively and cope with
her low mood conditions. However, researchers are of the opinion that use of cannabis may
result in increasing the severity of the situations Sachdev et al., 2015). The studies have reported
that depressive individuals who use marijuana are more prone to undertake suicidal attempts in
comparison to those depressive individuals who do not take marijuana. Therefore, the healthcare
professionals should also consider such substance abuse issues and then interventions need to be
provided accordingly.
Evidence based interventions:
One of the most important interventions that seem to have the most positive benefits on
the mental health of the patient is the psychotherapy. These therapies mainly help in the
treatment of depression by talking about the condition with the patient and understanding the
related issues. Therefore, many of the healthcare professionals call these therapies as the talk
therapies. Different types of therapies have been found to be effective for depression like that of
the interpersonal therapy as well as the cognitive behavioral therapy. Studies have found out the
benefits that remain associated with the different types of therapies (Karyotaki et al., 2015).
These therapies help the affected individuals in adjusting to the crisis as well as other current
difficulties that the patients face. It helps in the identification of the negative beliefs as well as
the behaviors and then help in replacing them with healthier and positive ones. It also helps in
the exploration of the different types of relationships as well as the experiences of the patients
and help in development of positive interactions with the others (Gertlaer et al., 2015). The
therapies also help in identification of the issues that help in the contribution to the depression
and thereby help in changing of the behaviors that cause worsening of the situation. The patients

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become able to regain a sense of satisfaction and thereby help in the controlling of their own
lives helping in the easing of the depression symptoms like that of the hopelessness as well as
anger (Koster et al., 2017). The patients would be also able to set realistic goals for their own
lives. The patients also become able to develop the ability for tolerating as well as accepting
distress using healthier behaviors. Therefore, psychotherapies like cognitive behavioral therapies
as well as interpersonal therapies can be used effectively. This could be applied for Kathy as he
would have positive outcomes on health from these.
Another important intervention that is also advised by the professionals is the anti-
depressant therapy. Many types of antidepressant are present which can be helpful in controlling
the symptoms of the major depressive disorder. However, a large number of side effects are also
noted in the different research studies and therefore, it is very important for the patients to
consult with the doctors if any form of the side effects arise (Opie et al., 2015). Different types of
medications are the selective serotonin reuptake inhibitors, Serotonin-nor epinephrine reuptake
inhibitors (SNRIs), atypical antidepressants, tricyclic antidepressants, Monoamine oxidase
inhibitors (MAOIs) and other medications. These medications help the patients in fighting with
different symptoms of depression and cope successfully. However, a number of important factors
need to be considered while choosing the correct medication for the patient (Fiest et al., 2016).
One medication that might be helpful and effective for one patient might not be successful as
well as effective for the other patient. The professionals therefore need to make the patient
understand that they might need to try out several combinations of the medications before
finding the correct one that works. These would be mainly requiring patience (Taubmen et al.,
2019). This might be mainly because some medication needs several weeks or much longer for
undergoing full effects and different side effects to be eased out before the body becomes

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adjusted. It is seen that Kathy has become frustrated from the anti-depressants, as the
medications had not brought out effective outcomes. Therefore, it should be made to understand
to Kathy that the medications would be taking some time before they start showing full potential
and therefore, she would need to be patient for the outcomes.
Many of the researchers are also of the opinion that although most of the medications are
safe and are seen to carry a black-box warning, some of the medications do increase the suicidal
thoughts of the individuals mainly in children, teenagers as well adults under certain cases.
Therefore, it is the duty of the professionals to closely watch the patients who are taking such
medications and find out whether the patient is showing any form of worsening conditions if
unusual behaviors especially when starting a new medication or when choosing a change in the
dosage (Kolovos et al., 2018). When patients are seen to be having suicidal thoughts while taking
such medications, it should be immediately reported. Therefore, the patient named Kathy should
be first analyzed whether her taking of medication is causing such symptoms or not.
Accordingly, medication would be allocated for her.
Motivational interviewing as well as proper education planning for effective lifestyle
management are some of the best care interventions that help in providing the patients with
better quality life and provide them strength to cope with the negative incidents of life.
Motivational interviewing is one of the counseling method that helps in the resolution of the
different ambivalent feelings and the different insecurities that the patients possess (Koster et al.,
2015). This helps in finding the internal motivation which they need to change the behaviors.
This is one of the practical, empathetic as well as short-term procedures, which helps in
considering how difficult it is to make life changes. Some of the important areas where the
professionals would be providing more importance to in the interview and while educating the

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patient, are helping the patient in learning about depression. They should also help the patient in
sticking to the plans, work collaboratively with the patient for learning about the triggering
factors of the depression symptoms and paying attention to the warning signals (Delgadillo et al.,
2015). Educating patients about the avoiding of the alcohol and use of recreational drugs need to
be prevented.
Researchers are also of the opinion that integrative medicine practitioners believe in the
association of the mind and the body. These two aspects should always be in harmony with each
other for staying healthy both physically as well as mentally. Some of the mind-body techniques
that are found to be extremely helpful for treating patients with depression are acupuncture and
relation techniques like that of the yoga or the tai-chi (Fleming et al., 2018). Some of the other
techniques that can be be also incorporated for the treatment interventions are meditation, guided
imagery, massage therapy. Music therapy, massage therapy, spirituality as well as aerobic
exercises are also found to be important interventions that can prove to be helpful in developing
the quality of the life of the patients with depression. These would be helping Kathy as well as
developing a stability of her feelings and would help in gain serenity and peace and help her
cope with different situations.
Nursing care plans for Kathy:
The patient named Kathy is showing risks for self-harm and this is the most important
priority that needs to be handled by the professionals effectively. The nursing professionals need
to identify the level of the suicide prevention needed. The professional in the outpatient clinic
attending to Kathy need to understand whether there is a requirement of hospitalization of the
patient. In case of low risk patients, professionals also need to assist whether the client is safe to

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go home with the supervision of the family member of the friend. The main rationale for this
assessment would be to help the patient keep safe and protected from her own self-harming
behavior and this can be prevented with constant supervision and safe environment 9Fiest et al.,
2017). Crisis counseling should be arranged for the patients and accordingly the family members
should be communicated and links for self-help should be activated. Researchers are of the
opinion that clients with such disorders need to have a network of resources for helping the
individual diminish personal feelings of helplessness, worthlessness as well as feelings of
isolation. The client should be continuously encouraged for expression of her feelings of anger,
sadness as well as guilt and help the patient in coming up with the alternative ways for handling
the feelings of anger, sadness and frustrations (Baumiester et al., 2014). In this aspect, the
professionals can use the cognitive behavioral therapy to address effectively this arena of the
care plan. Clients need to learn about the alternative modes and ways of dealing with the
overwhelming emotions and these would be helping in gaining a sense of control over her life.
Another care priority area is her impaired social interaction. She does not communicate
or interact with anyone and keeps herself locked indoors. Moreover, she also lacks concentration
in different of her activities and is also seen to suffer from low energy. During the various
sessions that the professionals plan, one can be arranging for activities that would require
minimal concentration of the patient like the drawing, playing of simple board games and many
others. This is mainly because depressed people are seen to lack concentration and memory
(Devenish et al., 2016). Therefore, activities which have no right or wrong or winner or loser
probabilities would help in the minimization of the opportunities helping in the clients for putting
herself down. The patient can be also involved in the gross motor activities that require very little
attention like that of walking for example. Such activities will help in relieving tensions and

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would help in elevating the moods. The client can also be included in different group activities
like group discussions, dance therapies as well as art therapies. Effective socialization would
help in the minimization of the feelings off the isolation. Moreover, genuine regards for the
others can also help in developing the feelings of self-worth among the patients. Client contacts
with others need to be maximized as contacts with others will help in distracting the client from
self-preoccupation. In the communities, the client and the family should be refereed to self-help
groups. This would help the client and her family in getting tremendous support and insight from
the people in sharing their interventions.
It is important for the healthcare professionals to establish a therapeutic relationship with
the patient that would be based on empathy and compassion. The professionals need to be non-
judgmental and consider the patient as unique and develop interventions based on her need rather
than applying “one-for-all” methods of interventions (Klainin et al., 2015). This would help in
developing trust and mutual respect between the patient and the professionals and would help in
effectively providing the above-mentioned interventions besides the antidepressants that would
be found comestible with her care.
Conclusion:
From the above discussion, it becomes clear that depression is one of the mental health
disorder that impacts the quality of life of the patients impacting social interaction and affecting
career and personal peace and stability. Therefore, professionals should first identify the
symptoms and then use the DSM-5 classification system to identify the disorder and accordingly
prioritizes the symptoms. Pharmacotherapy with anti-depressants, psychotherapy sessions like
cognitive behavioral therapy, interpersonal therapy, and motivational interviewing would help in

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overcoming symptoms. Besides dance therapy, music therapy and art therapies are also useful.
Proper evidence based and therapeutic interventions can help patients overcome the disorder and
live quality lives.

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References:
Baumeister, H., Hutter, N., & Bengel, J. (2014). Psychological and pharmacological
interventions for depression in patients with diabetes mellitus: an abridged Cochrane
review. Diabetic Medicine, 31(7), 773-786. https://doi.org/10.1111/dme.12452
Delgadillo, J., Gore, S., Ali, S., Ekers, D., Gilbody, S., Gilchrist, G., ... & Hughes, E. (2015).
Feasibility randomized controlled trial of cognitive and behavioral interventions for
depression symptoms in patients accessing drug and alcohol treatment. Journal of
substance abuse treatment, 55, 6-14. https://doi.org/10.1016/j.jsat.2015.02.008
Devenish, B., Berk, L., & Lewis, A. J. (2016). The treatment of suicidality in adolescents by
psychosocial interventions for depression: a systematic literature review. Australian &
New Zealand Journal of Psychiatry, 50(8), 726-740.
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Fiest, K. M., Hitchon, C. A., Bernstein, C. N., Peschken, C. A., Walker, J. R., Graff, L. A., ... &
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& Fisk, J. D. (2016). Systematic review and meta-analysis of interventions for depression
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