Psychiatric Diagnosis and Management Essay

Psychiatric Diagnosis and Management Essay

Mental health conditions like depression, anxiety, stress, and post-traumatic stress disorder (PTSD) are highly prevalent but often underdiagnosed and untreated. According to Kumar et al. (2020), the World Health Organization (WHO) estimates that approximately half (50%) of mental health conditions start before the age of 14. In the same breath, Mehta & Edwards (2018) contend that around 50% of Americans are susceptible to mental health issues and will satisfy all aspects of mental health diagnostics in their lifetime. Despite the prevalence and subsequent effects of these disorders, the global and national healthcare systems often underdiagnose them, exacerbating more adverse consequences, including cognitive impairment, insomnia, suicidality, and compromised quality of life. Psychiatric health nurse practitioners (PHNPs) have the opportunity and professional obligation to spearhead interventions for reducing the burden of mental health conditions by applying evidence-based practices to care for patients grappling with these disorders. As a result, this reflective journal focuses on my practice as a psychiatric mental health nurse practitioner (PMHNP), sets of patient characteristics that make me feel comfortable, concerns about being too comfortable with these characteristics, and interventions for handling these concerns with future patients.

My Practice as a Psychiatric Mental Health Nurse Practitioner

Notably, psychiatric mental health nurse practitioner students have ideal opportunities to address the prevalence and consequences of mental health conditions. It is essential to note that students rely massively upon theory-based and evidence-based learning approaches to enhance their knowledge and awareness of population health issues. My journey as a psychiatric mental health nurse practitioner student has availed limitless opportunities for interacting with people grappling with mental health conditions, understanding the theoretical underpinnings of strategies for treating and managing mental health conditions, and enhancing knowledge of various therapeutic interventions consistent with patients’ symptoms, healthcare needs, priorities, and preferences. Equally, I have acquired knowledge and competencies in nursing care models and frameworks for improving care quality, effectiveness, and timeliness. Undoubtedly, these aspects prepare me for the upcoming daunting task of providing evidence-based care and making informed decisions while caring for people with mental health conditions.

Although my journey as a psychiatric mental health nurse practitioner student has enhanced my understanding and awareness of thresholds for providing patient-centered and evidence-based care, an absence of opportunities for bridging the chasms between theoretical knowledge and clinical practice can render conceptual knowledge useless. It is essential to note that pursuing this course has provided opportunities for me to interact and care for patients with different mental health issues, including adults with unresolved childhood trauma, post-traumatic stress disorder (PTSD), and anxiety. Interacting and providing care to these patients are ideal platforms for translating theoretical knowledge into clinical practice.

Further, providing direct care to patients with mental disorders has changed my mindset regarding the role of patients in quality care delivery. For instance, it is now possible to appreciate the role of patients in fostering recovery, self-management practices, and influencing care trajectories. I have realized that patients play a forefront role in reducing the burden of mental health conditions by seeking early medical interventions, participating in early screening and mental assessments, encouraging self-care interventions like self-driven physical exercise for managing stress, and coordinating care with healthcare professionals. Equally, my experience as a psychiatric mental health nurse practitioner student has strengthened my knowledge and awareness of the ever-increasing demands for quality, timely, patient-centered, and convenient care. In this sense, healthcare professionals have legal, ethical, and professional obligations to promote mental health, conduct early mental health assessments, and enhance patients’ coping capacity.

Finally, I have acquired knowledge regarding the applicability of different scales for assessing mental health conditions and advanced therapeutic approaches for reducing the effects and complications associated with mental health conditions like PTSD and depression. For instance, I can now use different tools for psychological assessment, including Beck Depression Inventory (BDI), Center for Epidemiologic Studies Depression Scale (CES-D), Reminisce Functions Scale (RFS), Geriatric Depression Scale (GDS), and the Hamilton Depression Rating Scale. Besides these assessment tools, I have familiarized myself with pharmacologic and non-pharmacologic interventions for addressing psychological issues, including the administration of antidepressants like selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs). Equally, I can involve mental health patients in therapeutic sessions like cognitive, behavioral, cognitive-behavioral, and dialectical behavioral therapies.

A Reflection of a Patient’s Case Scenario

In my experience as a psychiatric mental health nurse practitioner student, I interacted with BM, a 67-years-old patient grappling with post-traumatic stress disorder (PTSD) exacerbated by occupational traumatic events and the feeling of self-blame and shame. According to the patient, he was diagnosed with post-traumatic stress disorder in 2017, 10 years after retiring from military service. The chief complaint reported various symptoms that were consistent with PTSD, including nightmares, intrusive memories, evidence, severe emotional distress, lack of interest in hobbies, and the feeling of emotional numbness. The patient revealed that he drinks heavily to combat PTSD and its sequelae, including insomnia, nightmares, and intrusive memories. Apart from alcoholism, BM reached out to various online organizations to share his lived experiences and seek medical interventions. Also, the patient participated in various outdoor activities, including charity work, moderate physical exercise, and religious engagements, as interventions for coping with these symptoms of post-traumatic stress disorder (PTSD).

What triggered post-traumatic stress disorder?

Working in military service is one of the contributing factors to post-traumatic stress disorder. According to Kintzle et al. (2018), veterans grapple with PTSD exacerbated by past exposures to field combat. In this sense, combats inflict physical, emotional, and psychological injuries. Another factor that leads to the increased prevalence of PTSD among veterans is non-honorable discharge status. Kintzle et al. (2018) contend that about 16% of veterans who leave the military with non-honorable discharge status often encounter additional constraints like limited access to care and discontentment that result in increased susceptibility to adverse mental health outcomes, including depression and PTSD. Thirdly, veterans are vulnerable to PTSD and other mental health issues due to a loss of social interconnectedness (Kintzle et al., 2018). It is essential to note that military veterans’ transition from civilian life to military service personnel deprives them of opportunities for benefiting from interpersonal relationships, peer affiliation, memberships, social behaviors, and a sense of social identity. The absence of social integration leads to psychological distress, suicidal ideation, depression, and PTSD.

In BM’s case, he singled out the death of a close friend during open-field combat as the primary cause of post-traumatic stress disorder. He associates the death of his colleague with the failure to provide cover during the combat. Therefore, he endures feelings of shame and self-blame. Although service in the US military provides opportunities for a sense of belonging and understanding, the resulting injuries, deaths, and exposure to combats exacerbate mental health conditions.

ORDER A PLAGIARISM-FREE PAPER HERE

What are the characteristics of the patient that make me feel most comfortable with my clinical experience?

Although the patient suffers from PTSD, he exhibits various characteristics and attributes that provide hope and opportunities for PTSD management. Firstly, his coping capacity and approaches make me comfortable with the clinical experience because they signify individual determination to thrive amidst the predicaments perpetrated by post-traumatic stress disorder. Edraki et al. (2018) contend that coping capacity and skills improve self-efficacy, promote positive behaviors, and enhance psychological health and well-being. Secondly, the patient demonstrated knowledge and awareness of various stress management. Although he revealed a habit of alcoholism as a strategy for addressing stress, participation in physical exercise, social activities like charity work, and religious engagements provide ideal opportunities for tackling various psychological issues like PTSD, stress, and depression (Adhikari Baral & K.C, 2019). Finally, the patient demonstrated the ability to answer questions in PTSD assessment tools and read, interpret, and understand medication requirements for PTSD management.

The sets of characteristics that make me feel uncomfortable

Although the patient can influence care trajectories by reading and understanding medication instructions, participating in various coping activities like physical exercise, and demonstrating awareness of self-care interventions, there are areas of concern about his characteristics. For instance, the patient is susceptible to insomnia and other depressive symptoms that compromise his health and well-being. According to Mann & Marwaha (2022), PTSD manifests through recurrent, involuntary, and intrusive thoughts, persistent avoidance of the stimuli, negative and sudden alterations in mood, irritability, recklessness, hypervigilance, and problems in concentration. For instance, I noticed these symptoms while engaging BM in depression assessment processes. In various instances, he refused to participate in life review and ego integrity therapy aimed at enabling him to address the perception of self-blame and shame by reminiscing about past traumatic events and obtaining meaning from past events. Undoubtedly, these characteristics make me feel uncomfortable with clinical practices.

What concerns me about being uncomfortable with these characteristics

Being too uncomfortable with the depressive symptoms that face people with post-traumatic stress disorder (PTSD) brings out other concerns, including the patient’s ability to adhere to medications, the potential consequences of loneliness in exacerbating PTSD, and the patient’s struggles to establish social connectedness. Dell’Osso et al. (2020) argue that adherence to medications relies massively upon patients’ persistence and compliance with medication instructions. Although BM demonstrated the ability to read and understand medication instructions, his persistence, and compliance with these instructions are at stake due to the proliferation of sudden depressive symptoms.

Secondly, the manifestation of PTSD through sudden depressive symptoms is a profound indicator that PTSD patients are at risk of adverse consequences if they are lonely and lack the much-sought-after social support. According to Alsubaie et al. (2019), social support improves interactions and relationships between patients, friends, and family members. It is essential to note that the absence of social support and loneliness can exacerbate mental health conditions and lead to issues like suicidal thoughts. Therefore, I have become too uncomfortable with leaving patients with PTSD to implement self-care interventions in the absence of proper monitoring and coordination with healthcare professionals.

How to handle these concerns with future patients

While concerns of loneliness, the failure to adhere to medications, and a lack of social connectedness manifest when delivering care to patients with post-traumatic stress disorder (PTSD), it is possible to address them with future patients by implementing a contingency plan. Mann et al. (2017) argue that loneliness and limited social support for people with PTSD can increase the tendency of remembering past traumatic events. In the same breath, Johansen et al. (2020) contend that social support can reduce the frequency of PTSD symptoms, including blame, disbelief, and alterations in moods, by enabling social integration, attachment, nurturance, guidance, and reassurance of worth. It is possible to provide social support and address loneliness among PTSD patients by linking them to community organizations, coordinating care, providing timely information, and involving them in every stage of care plan development and implementation.

Equally, the problem of medication adherence among PTSD patients is an essential aspect of consideration when providing care to future patients. According to Steinkamp et al. (2019), it is possible to increase adherence to medications by educating patients and leveraging information technologies like mobile health applications (HHA), telehealth, and electronic pill dispenser. Incorporating advanced health information technology in improving medication adherence fosters timely communication and care coordination between healthcare providers and patients.

Summary/Conclusion

As a psychiatric mental health nurse practitioner student, I have acquired knowledge of theories, models, and care frameworks for delivering quality, timely, and convenient care. The reviewed case study indicates that a patient with PTSD can effectively participate in care delivery, influence decisions, and enhance their coping capacity. However, healthcare professionals should be mindful of inconsistent and sudden depressive symptoms that compromise people’s health and well-being. Other issues of concern are loneliness and limited social support. I would address these issues in the future by educating patients about medication adherence, implementing advanced technologies like telehealth and mHealth, and linking patients to community organizations.

References

Adhikari Baral, I., & K.C, B. (2019). Post-traumatic stress disorder and coping strategies among adult survivors of an earthquake, Nepal. BMC Psychiatry, 19(1). https://doi.org/10.1186/s12888-019-2090-y

Alsubaie, M. M., Stain, H. J., Webster, L. A. D., & Wadman, R. (2019). The role of sources of social support on depression and quality of life for university students. International Journal of Adolescence and Youth, 24(4), 484–496. https://doi.org/10.1080/02673843.2019.1568887

Dell’Osso, B., Albert, U., Carrà, G., Pompili, M., Nanni, M. G., Pasquini, M., Poloni, N., Raballo, A., Sambataro, F., Serafini, G., Viganò, C., Demyttenaere, K., McIntyre, R. S., & Fiorillo, A. (2020). How to improve adherence to antidepressant treatments in patients with major depression: A psychoeducational consensus checklist. Annals of General Psychiatry, 19(1). https://doi.org/10.1186/s12991-020-00306-2

Edraki, M., Rambod, M., & Molazem, Z. (2018). The effect of coping skills training on depression, anxiety, stress, and self-efficacy in adolescents with diabetes: A randomized controlled trial. International Journal of Community Based Nursing and Midwifery, 6(4), 324–333. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6226609/

Johansen, V. A., Milde, A. M., Nilsen, R. M., Breivik, K., Nordanger, D. Ø., Stormark, K. M., & Weisæth, L. (2020). The relationship between perceived social support and PTSD symptoms after exposure to physical assault: An 8 years longitudinal study. Journal of Interpersonal Violence, NP7679–NP7706. https://doi.org/10.1177/0886260520970314

Kintzle, S., Barr, N., Corletto, G., & Castro, C. (2018). PTSD in U.S. veterans: The role of social connectedness, combat experience, and discharge. Healthcare, 6(3), 102. https://doi.org/10.3390/healthcare6030102

Kumar, A., Kearney, A., Hoskins, K., & Iyengar, A. (2020). The role of psychiatric mental health nurse practitioners in improving mental and behavioral health care delivery for children and adolescents in multiple settings. Archives of Psychiatric Nursing, 34(5). https://doi.org/10.1016/j.apnu.2020.07.022

Mann, F., Bone, J. K., Lloyd-Evans, B., Frerichs, J., Pinfold, V., Ma, R., Wang, J., & Johnson, S. (2017). A life less lonely: The state of the art in interventions to reduce loneliness in people with mental health problems. Social Psychiatry and Psychiatric Epidemiology, 52(6), 627–638. https://doi.org/10.1007/s00127-017-1392-y

Mann, S. K., & Marwaha, R. (2022). Posttraumatic stress disorder. StatPearls. https://www.statpearls.com/ArticleLibrary/viewarticle/27568

Mehta, S. S., & Edwards, M. L. (2018). Suffering in silence: Mental health stigma and physicians’ licensing fears. American Journal of Psychiatry Residents’ Journal, 13(11), 2–4. https://doi.org/10.1176/appi.ajp-rj.2018.131101

Steinkamp, J. M., Goldblatt, N., Borodovsky, J. T., LaVertu, A., Kronish, I. M., Marsch, L. A., & Schuman-Olivier, Z. (2019). Technological interventions for medication adherence in adult mental health and substance use disorders: A systematic review. JMIR Mental Health, 6(3). https://doi.org/10.2196/12493

ORDER A PLAGIARISM-FREE PAPER HERE

 

Appendix A. Reflective Video Journal. #1, #2, #3, #4 each worth 25 points = 100 points
USE ANY PSYCHIATRIC PATIENT/CASE

Assignment Steps
To complete this assignment:
A: Reflect on your practice as a Psychiatric mental health nurse practitioner-PMHNP.
B: Describe the characteristics of a patient that you have felt least comfortable with in your clinical experience thus far (both semesters).
C: What about these sets of characteristics makes you feel uncomfortable?
D: What is it that concerns you about being uncomfortable patients with these characteristics?
E: How will you handle these concerns with future patients?
F: Summary/conclusion

Assignment Evaluation
Each of these assignments will be evaluated according to the following rubric:

Criteria Points
Follows the prompt 5 points
Is within time limits for the prompt 5 points
Thoughtfully addresses the prompt 15 points
Total 25 points