Assessment of the Socio-cultural, Mental Status and Risk of the Patient Report

Introduction

This paper is an assessment report aimed at assessing the socio-cultural, mental and risk status of a patient named, Janet Grey. Janet Grey is a 31 year old patient who had a history of suicide attempts and drug abuse (Coyotemedicinetv 2008a). She is also a mother of two children, a boy and a girl. The interview is aimed at assessing her general health to establish if she can be discharged. The interview is undertaken by Lewis. The notes taken in the interview easily define the framework for this report, and comprehensively, they are obtained from a product of a division of task (note taking and interviewing) during the course of undertaking the interview. Comprehensively, this report states the signs and symptoms regarding the above assessment criteria, within the framework of three clinical analysis frameworks. The frameworks used are the clinical dementia rating method, 12-item general health questionnaire and the neuropsychiatric inventory method (Elder, Evans and Nizette 2009). This assessment report will therefore be categorized into three segments including the socio-cultural assessment criterion, mental status assessment criterion and the risk status assessment criterion.

Socio-cultural Assessment criterion

To assess the socio-cultural factors affecting Jane Grey, the clinical dementia rating method will be used (Pang 2003). In this assessment criterion, six domains are analyzed. They include “memory; orientation; judgment and problem-solving; community affairs; home and hobbies; and personal care” (Benet 2010, p. 12). These factors explain several social and cultural elements associated with patients. For instance, a person with good problem solving skills, good judgment skills, commendable personal care, and a good memory is likely to rate highly on the social scale. Likewise, a person who rates highly in community affairs and orientation is likely to have an excellent cultural skill.

Memory

When Jane is asked by Lewis, “How is your memory?” Jane replies that her memory is good. However, she hesitantly answers this question. She affirms that “I experience trouble concentrating. For instance, there is this book I am reading and I have been unable to complete it because of lack of concentration”. In reference to Lewis’s question of if there was any significant change in memory, Jane states that she was able to read better or concentrate more in the past, than she does now.

Orientation

When Lewis asked Jane, “what happened to your daughter and how did you lose her?” Jane is able to give a detailed account of how she lost her children and why she feels badly about her role as a mother.

Judgment and problem Solving

When Lewis asked Jane, “What do you think should happen, should you go home, or should you go to a psychic ward…?”Jane rejects the idea of being admitted into a psychiatric ward because she feels no need to do so. Also, in reference to a question asked by Lewis regarding if she wanted to continue doing whatever she did in her past (suicide attempts), Jane admits she does not want to commit suicide anymore and wants to live.

Community affairs

When Lewis asked Julia, “so do you worry a lot?” Jane points out that she was worried of the fact that she was unable to take good care of her children and family. Here, she explains that she was unable to pull her life together, thereby permanently losing her daughter to foster care. In reiteration, Jane says, “I worry a lot about my daughter because I do not know where she is”

Home and Hobbies

Jane makes no reference to any specific hobby.

Personal Care

When Lewis asks Jane “How often do you drink?” Jane replies “sometimes I drink five to six days a week, and on rare occasions, I drink every day. Collectively, I drink probably four to five times a week”. When Lewis asks if Jane takes any drugs, Jane replies “I drink beer and other types of alcohol. Four to five shots would get me drunk. I also smoke pot, take antidepressants and smoke cigarettes”. Jane however explains that she drinks more than she takes pot. In further reference to her personal care, Jane explains that, she only takes pot whenever it is around and has no trouble sleeping because always, she is tired and would retire to bed easily. Finally, when asked how her appetite was, she explains that her appetite is normal and she has not experienced any signs of drastic weight gain or loss.

Mental Status Assessment

The mental status assessment criterion will be based on the 12-item general health questionnaire. However, the factors to be analyzed will be summarized into three components which constitute anxiety and depression, social dysfunction, and loss of confidence (Benet 2010, p. 12).

Anxiety and depression

When Lewis probes why Jane takes drugs, Jane declares that she uses the substances to numb her feelings about the normal life stressors that affect her. She also explains that she is a frequent smoker, but on occasions (when she is anxious and stressed), she smokes more than a packet. When Lewis asks her if she notices anything out of the ordinary if she has panic attacks, Jane explains that she experiences a surge in her heartbeat rate, while eating. When this occurs, she is unable to swallow her food. Jane further explains that, on such occasions, she has to go to the bathroom to calm down before she goes on with her daily routine. When asked if there is a particular reason why she feels badly about herself, Jane explains that she feels badly about her role as a mother. She further explains that she has no idea where her daughter is, and almost equally, she feels badly that she is not able to take care of her son. Her son is living with her brother. Due to persistent feelings of worthlessness, Jane explains to Lewis that she feels like she should not be alive anymore. She feels like dying would be an easy way out of her misery. When Lewis asks “How often do you have these thoughts?”, Jane replies that she rarely thinks about killing herself, but when she gets really depressed, she thinks of committing suicide. When asked how she sleeps, Jane replies that she sleeps regularly, but sometimes, she experiences difficulties (in sleeping), especially when she wakes up very early in the morning (like five o’clock).

Social dysfunction

Sometimes, Jane battles with feelings of constant depression and anxiety. These feelings prompt her to have thoughts of ending her life (Garety 1997). When Lewis asks Jane, “do you see or hear things that other people do not?” Jane replies that there are certain episodes where she sees ghosts or images of objects which do not exist. She gives an example of when she went to visit her father’s grave, where she saw an eagle. However, she asserts that her sister saw the eagle too. When Lewis asks Jane if she has experienced any similar incidences, Jane replies that she once saw an old woman who died two years ago walking. She however explains that she did not tell anybody about this event because she thought it was weird. When Lewis asks, “How is your sex life?” Jane replies, “I have an active sex life”. She also explains, “I have a boyfriend, though he is not fully committed to the relationship”. When Lewis asks if she experiences thoughts that she cannot get out of her head, Jane affirms that she feels very badly about out her failure as a mother. She also explains that she experiences constant thoughts of killing herself. When asked how her work is going, Jane explains that she is capable of easily completing her work. She also explains that she likes being at work and is almost always on time.

Loss of Confidence

When Lewis asked Jane what her biggest concern was, Jane explained that she felt badly about the fact that she has not been a good mother to her children. She further explains that, she feels like a failure and a disgrace to her family. When Lewis probes Jane’s relationship with her children, Jane explains that, she goes to visit her son, but she feels badly when she is around him because she feels like she could have been a better mother and provided a better life for her children.

Risk Status Assessment

To carry out an effective risk status assessment, the neuropsychiatric inventory method will be used. This criterion will be an indicator to the future occurrence of suicidal attempts for Jane Grey. This evaluation criterion evaluates ten factors which determine the level of severity and frequency of mental health factors. These ten elements include “delusions; hallucinations; dysphoria; anxiety; agitation/aggression; euphoria; disinhibition; irritability/lability; apathy; and aberrant motor behavior” (Benet 2010, p. 12). These factors define the signs and symptoms of a patient suffering from negative health effects associated with mental dysfunction or poor socio-cultural adaptation.

• Delusions: In response to Lewis’s questions, Jane states all her facts in a normal way. Her responses are logical and similar to the responses of any normal person.
• Hallucinations: When Lewis asks Jane, “do you see or hear things that other people do not hear or see?” Jane replies that there are certain episodes where she sees ghosts or images of objects which do not exist.
• Dysphoria: When asked if there is a particular reason why she feels badly about herself, Jane explains that she feels badly about her role as a mother.
• Anxiety: When Lewis probes why Jane takes drugs, she declares that she uses the substances to numb her feelings about the normal life stressors that affect her. She also explains that she is a frequent smoker, but on occasions (when she is anxious and stressed), she smokes more than a packet.
• Agitation/aggression: When Lewis asks Jane about her work, Jane explains that she relates well with her colleagues.
• Euphoria: When Lewis asks if Jane takes any drugs, Jane replies “I drink beer and other forms of alcohol. Four to five shots would get me drunk. I also smoke pot, take antidepressants and smoke cigarettes”.
• Disinhibition: When Lewis asked Jane, “What do you think should happen, should you go home, or should you go to a psychic ward…?”Jane rejects the idea of being admitted into a psychiatric ward because she feels no need to do so.
• Irritability/lability: When Lewis asks, “How is your sex life?” Jane replies, “I have an active sex life”. She also explains “I have a boyfriend, though he is not fully committed to the relationship”.
• Apathy: In response to Lewis’s question about the impact drugs have on her life, Jane explains that, she often feels sad, except for the times she is drinking (Coyotemedicinetv 2008b).
• Aberrant motor behavior: When Jane is asked by Lewis, How is your memory?” Jane replies that her memory is good. However, she hesitantly answers this question.

Conclusion

This paper uses three assessment frameworks to identify the socio-cultural, mental and risk factors affecting Jane Grey. Jane’s behaviors are perceived from her perception of her view of life and the drug use that affects the same. These insights show various mental, social and cultural health factors affecting Jane (Bozarth 1994). Comprehensively, Jane’s health can be understood from these factors.

References

Benet, W 2010, ‘Rating scales in old age psychiatry’, Web.

Bozarth, A 1994, Life is goodbye, life is hello: grieving well through all kinds of loss, Hazelden Publishing, New York.

Coyotemedicinetv, 2008a, Psychiatric interview pt. 2 standard, Web.

Coyotemedicinetv, 2008b, Psychiatric interview pt. 3 standard, Web.

Elder, R, Evans, K & Nizette, D 2009, Psychiatric and Mental Health Nursing, Sydney, Elsevier.

Garety, P 1997, Delusions: investigations into the psychology of delusional reasoning, Psychology Press, Michigan.

Pang, S 2003, Nursing ethics in modern China: conflicting values and competing role requirements, Rodopi, Beijing.