CASE ANALYSIS EVALUATION (2)

Case Analysis Evaluation

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Mental illness also referred to mental health disorder, is a term used to refer to mental health conditions, which is a disorder that affects the thinking, mood and behavior of a person. Mental health disorders include addictive behaviors, eating disorders, schizophrenia, anxiety disorders and depression. Many people experience mental health concern at some point in their life. A mental health concern ends up to be a mental illness once the ongoing signs and symptom affects one’s ability to function and cause frequent stress. A mental illness has the capability of making a person’s life miserable and can lead to problems in school, daily life, in relationships or work. These symptoms can however be managed by a combination of certified medication and talk therapy, also known as psychotherapy.

There are several differential diagnoses which are associated with mental health discussed in this paper. These will help get an insight of what the patient in the case study is suffering from, what might have led to the disease and the most preferred screening tools that can be used.

Borderline personality disorder

This a mental health disorder which impacts the way a person feels about themselves and others and affects the way they function in their day to day life (Leichsenring et al 2011). It includes issues of self-image, difficulties in managing behavior and emotions and creates unstable relationships. With this disease, one has a feeling of intense fear of instability and abandonment and might find it difficult to stay alone. They have inappropriate anger, frequent mood swings and impulsiveness which pushes others away even though they crave to have a lasting and loving relationships. This disorder starts by early adulthood and might worsen in young adults but gets better with age. As we can see in the case study, Racheal admits to not getting along with others. She is also angered easily. She as well has the fear of being alone and feels hopeless and lost. On family history, the mother and sister are reported to have had anxiety and depression. She also does not have many friends and has poor relationship with people and this might be attributed to anger issues which is pushing people away. She describes her childhood as being unhappy and lonely.

According to (Leichsenring et al 2011), borderline Personality Disorder can be screened by use of a detailed interview with a mental health provider or a doctor’s psychological evaluation which includes completing questionnaires, medical history and an exam and discussion of the signs and symptoms.

This disorder is presumed to be caused by a history of child neglect and abuse. Genetics are also believed to be a cause of this as they can be inherited. Brain abnormalities can as well be the cause as certain changes in the brain which are involved in aggression, impulsivity and emotional regulation. In addition to this, some parts of the brain which regulate moods such as serotonin, might not be functioning well.

Schizoid Personality Disorder

Schizoid Personality Disorder is a condition which is quite uncommon whereby people avoid social activities and shy away consistently from interacting with others. There emotions expressions and limited in range (Triebwasser, et al 2012). This disease makes one seem as a loner and might lack the skill or desire to form a close personal relationship. This is because they tend to hide their emotions and appear like they do not care about other people or things that are going on around them. This is evident as Rachael stays alone and prefers to drink alone till she passes out. She doesn’t keep close personal relationships. She also does not see anything wrong with her as she describes her director for being irrational as she feels she doesn’t not need any treatment. She also claims that she has more experience about how to handle a daycare much better than her director.

The cause of this disease is not known, though a higher risk of this disorder in families suffering from this illness suggest that there is a genetic susceptibility to the development of this disorder (Bateman et al 2015).

After carrying out a physical exam to help in ruling out other medical conditions, the primary care provider can refer one to a mental health professional to help in carrying out further evaluation. The diagnosis of this disorder is based on thorough discussions of the patient’s symptoms, checking for the symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the patient’s medical and personal history.

PTSD

bulkpost-traumatic stress disorder (PTSD), is a condition which affects the mental health and is triggered mostly by a terrifying event- either witnessing it or experiencing it. The symptoms might include nightmares, flashbacks and severe anxiety (Markowitz, 2015). Uncontrollable thoughts of past events can also be a symptom. Most people experience some traumatic events which might cause one to have difficulty in coping and adjusting. They usually get better with good self-care. In the case study, Rachael depicts an onset on anxiety at the age of 18. This is a major sign of PTSD.

PTSD screening can include a brief questionnaire which can identify people who are more prone to have PTSD. When there is a positive response, it does not necessarily mean that a patient has PTSD but indicate a possibility of the disease (Markowitz, 2015). There would be the need for more investigation for the symptoms of PTSD by a health professional. Secondly, there can be the use interviews by a Clinician-Administered PTSD Scale for DSM-5, PTSD Symptom Scale Interview among other certified interview scales. Self-report instruments can as well be used to determine the severity of the score.

Non-suicidal self-injury (NSSI)

Non-suicidal self-injury (NSSI) is defined as intentionally and directly inflicting damage to the person’s own body tissue mostly with no suicidal intentions and not consistent with the cultural norms and expectations (Brown et al 2018). Patients normally state the lack of intent. Their lack might as well be known due to the continuous use of the nonlethal methods. Despite not showing immediate lethality, the risk of suicide attempts in the future keep increasing with every attempt. Non-suicidal self-injury should thus not be lightly dismissed. Non-suicidal self-injury are commonly being expressed through burning of the skin, stabbing or cutting the skin normally with a sharp object such as a needle, razor blade and knife.

The non-suicidal self-injury normally starts at the early teen stages. It tends to be prevalent more in females (Brown et al 2018). The natural history is quite unclear but the behavior tends to decrease when they reach adulthood. The prevalence is also quite high in the criminal populations and this tends to be mostly male. Their motivation is quite unclear but can be: plea for help; self-punishment for the perceived faults; ways of resolving interpersonal difficulties and a way of reducing negative feelings or reduce tension. In the case study, Rachael admits that she feels flawed and shows off an old scar with superficial burns and cuts. This is a clear depiction of Non-suicidal self-injury (NSSI). Rachael clearly doesn’t have the intention of killing herself but most likely she feels flawed. This disorder is can be diagnosed by the use of the Non-suicidal self-injury (NSSI) criteria. If the patient depicts all the attributes stated in the criteria, they can be considered to be suffering from Non-suicidal self-injury (NSSI).

Conclusion

Most people in the world have had mental health concerns which includes depression especially caused by job losses. These concerns are in most cases time-limited and one feels better with time. When the stress of trying to cope with these symptoms become a lot more than one can handle, seeking treatment might be a good option. This includes a combination of treatments including psychotherapy and medications.

References

Bateman, A. W., Gunderson, J., & Mulder, R. (2015). Treatment of personality disorder. The Lancet, 385(9969), 735-743.

Brown, R. C., Fischer, T., Goldwich, A. D., Keller, F., Young, R., & Plener, P. L. (2018). # cutting: Non-suicidal self-injury (NSSI) on Instagram. Psychological medicine, 48(2), 337-346.

Leichsenring, F., Leibing, E., Kruse, J., New, A. S., & Leweke, F. (2011). Borderline personality disorder. The Lancet, 377(9759), 74-84.

Marshall, R. D. (2015). Is exposure necessary? A randomized clinical trial of interpersonal psychotherapy for PTSD. American Journal of Psychiatry, 172(5), 430-440.

Triebwasser, J., Chemerinski, E., Roussos, P., & Siever, L. J. (2012). Schizoid personality disorder. Journal of personality disorders, 26(6), 919-926.