Mental Health Care in Cannabis Addiction Case Essay

Introduction

In mental health care, special attention is given to the role of nurses, who interact with patients, acting as the key providers of services, supporters and communicators. The majority of mental health problems develop in childhood and adolescence, which affects a person’s physical and psychological health in adulthood (Cowie, 2018). As reported by the World Health Organization (WHO), “10-20% of children and adolescents worldwide experience mental disorders; half of all mental illnesses begin by the age of 14 and three-quarters by mid-20s” (Adolescents and mental health, 2017). Therefore, it is important to be aware of the challenges that are encountered by people in their adolescence to understand their current struggles and assist them.

This paper will examine the case of Diana, a 24-year-old female patient, who is now at an acute mental health inpatient care. Since the parents of Diana were unable to look after her, she was put on foster care at the age of two in the family with several other children. The new family was not comfortable and supportive to the girl except Angel, who left their home soon. When Diana was caught with selling cannabis, her parents asked her to leave them, and she started living with squatters. The patient became addicted from cannabis, aggressive and suspicious to others, practising self-harming several times per day. This paper will use a three-phase conversational model (connect, exchange information and find agreement) to explore the importance of mental health care in the given case. A 4P model, including predisposing, precipitating, perpetuating and protective factors, will be applied to evaluate Diana.

Exploring the Case of Diana

Case formulation is one of the most critical skills for nurses to develop since it implies turning a patient’s story into a coherent report for further treatment. The process of case formulation should include a patient’s narratives, examination information, interviews with parents, and any other available data. In case of Diana, it is possible to assess her background, current physical and mental condition, as well as prescribed medication. In terms of the biopsychosocial model, it is important to prevent reductionism by applying a comprehensive approach to the evaluation, which involves taking into account social, psychological and biological factors. Timely and professional biopsychosocial care of concomitant physical and mental disorders carries great potential. The social background of the given patient is associated with a lack of attachment with her parents and also the new family, which caused self-harming behaviours (Johnson, Connolly and Goulding, 2018). The girl felt loneliness and struggled with inattentiveness and noise in her home, which led to self-destroying practices.

According to a trauma theory, the concept of mental trauma refers to the harm caused to the mental health of a person as a result of the intense influence of adverse environmental factors or acute emotional, stressful effects other people made on his or her psyche (Wade et al., 2018). Among the modern theories of mental trauma, the approach developed by Peter Levin seems to be the most relevant to the case of Diana. Developing it, the author integrated relevant knowledge in the field of not only psychology and psychotherapy, but also biology, psychophysiology and neuropsychology. In this case, trauma is understood as a breakthrough in the barrier that protects a person from influences accompanied by an extremely strong sense of helplessness (Truesdale et al., 2019). The absence of support from the family led to a psychological trauma in case of Diana, which occurred due to the lack of individual resources necessary to overcome the traumatic event. The destructive power of psychological trauma affected her personality by weakening it, the degree of her psychological security and the ability to self-regulate were not developed.

In terms of an attachment theory, modern studies show that the attachment system is the primary genetically-fixed motivational system that is activated immediately after birth and performs the function of providing the child with maternal care that guarantees survival (Bifulco et al., 2017). Based on the experience of studying the stories of juvenile delinquents, Bowlby revealed the influence of early separation from the mother and the experiences of loss and separation associated with it on the violation of the child’s behaviour in subsequent years of life (Fonagy, 2018). The inability of the emotional contact between a mother and child deprived Diana of vital support issues, such as acceptance and guidance, developing self-destructive patterns in childhood.

The two main health concerns that are evident in case of Diana are cannabis use and psychosis. The young female was caught selling drugs and using them extensively to relax. In addition, her condition deteriorated steadily as she developed bare eating, drinking fizzy liquids and felt lethargic. The connection between psychosis and cannabis is explored in the literature: many people believe that there is no link, but scholars state that cannabis addiction exists (Berry et al., 2018). Even though the risk of developing it is lower than from other drugs, tobacco or alcohol, cannabis is addictive in about 9% of consumers (Pearce et al., 2017). For those who consume it several times a week, the risk of dependence reaches 30%. In the UK, marijuana addiction is on the list of mental disorders, and it affects more than four million people (Berry et al., 2018). There are hotlines and support groups for addicts – you can test yourself right now by answering 12 questions about marijuana consumption.

In the academic literature, the best studied psychoses are those that occur with cannabis in various forms (Pearce et al., 2017). A large dose of hemp or a small one, but with high tetrahydrocannabinol (THC) content can cause acute psychosis – a mental disorder, in which a person loses the connection with reality and the ability to behave appropriately (Colizzi and Murray, 2018). It is possible to see hallucinations, hear voices and express delusions. In medicine, there is a special term of cannabis-induced psychosis that is accompanied by incidents of fear caused by terrible hallucinations and aggression (a person tries to defend themselves from them). The condition of an addict is described as an amotivation syndrome: a weakening and slowing of mental abilities, a decrease in interest in the outside world (Truesdale et al., 2019). All of the mentioned symptoms are relevant to Diana, as well as passivity, a lack of ambition and motivation, fatigue and self-harming. However, it is critical to note that not only the use of cannabis but also the overall lifestyle of this patient caused her current adverse state.

The 4P model identifies predisposing factors that led a patient to a particular condition, while precipitating factors can be understood as triggers. Diana’s predisposing factors were negative family history and genetics (both of her parents were addicted), the immature defensive structure of her self and life in a socially-disadvantaged family. Although it is not mentioned that the family had a low income, the presence of several children, crying and a shortage of assistance are the negative factors (Thompson, Cox and Stevenson, 2017). Among the precipitating factors that are characteristic of the chosen patient, there are her recent loss of Angel as a psychological complication, family-related and squatters’ related stressors and the reaction of her body on cannabis. The current symptoms of Diana also point to her negative living conditions and fear that other people could steal her ideas and items, which is contrary to the actual evidence (Reeder et al., 2017). The social withdrawal of Diana was related to living on the street and with squatters, who also potentially had mental concerns. It is understandable that her experience frightens the young woman, causing depression, obsessions and substance abuse to forget about her problems at least for a while.

Speaking of the perpetuating factors that are pertinent to Diana, one should note that there are behavioural patterns of avoidance and cognitive patterns of suspiciousness. These factors maintain her unhealthy state and bring additional discomfort (Goh and Agius, 2010; Glenn et al., 1999). Considering that she is not open to the mental health care unit care providers to share her problems, it is a challenge for them to build relationships and interact with this patient. At the same time, she has substance addiction that affects her mood and body. Diana says that she wants to go home, but, in fact, she has no home, and it is another problem. There is a need to strengthen her protective factors to create the opportunity for the woman to acquire a home and family/friends.

The protective factors are the attitudes and experiences that impede or delay the implementation of negative behaviours and indirectly indicate the duality of the intention. The more protective factors, the higher the self-destructive barrier of personality and the lower the risk of self-damage are. The anti-self-harming tendencies that are included after the appearance of the previous incidents can be determined by the emergence of positive emotions in relation to the past and present (Thoits, 2011). The review of positive factors that can help her revive shows that there is little or no support from her family, while her friends can be contacted for further information gathering. In terms of biological issues, her body seems to be strong enough to cope with the consequences of cannabis use since no concomitant diseases are reported. Nevertheless, she has a lack of hopefulness or resistant to changes and assistance from professionals (Kogstad, Ekeland and Hummelvoll, 2011). Diana seems to be willing to receive support from Angel and actively engage in society.

As emphasised by a stress formulation theory, the psychosocial processes often cause distress. Accordingly, risk and safety issues emerge as the accompanying symptoms of Diana’s psychopathology that includes mania, disorganisation and impaired social functioning (Newman and Beail, 2010). The patient feels unsafe since her early childhood, and she believes that there is no one to help her to overcome these problems. Psychosocial formal and informal support from loved ones, employees, colleagues, a religious community and professional services is critical. The cohesion of the group or family contributes to coping with stress, prevents and reduces the development of mental disorders and, indirectly, self-harming (Goh and Agius, 2010). The empathy of a nurse with self-damaging messages helps to alleviate distress and accelerates professional assistance. In particular, a nurse can apply a three-phase conversational model to become closer to Diana, showing compassion and creating the foundation for effective care.

The effectiveness of drug therapy with psychotropic drugs is determined by the correspondence of the choice of the drug to the clinical picture of the disease, the correct dosage regimen and the duration of the therapeutic course. In psychiatry, it is essential to take into account a range of medicines that the patient takes since their mutual action can lead to undesirable consequences. The combination of Aripiprazole 15mg daily, 25mg Promethazine (as required), Metformin 1000mg daily and Clonazepam 0.25mg seems to be useful and effective for Diana. The expected results of these medications include antipsychotic and reduction of motion sickness. Some studies show that patients with high blood pressure should take Metformin with caution as it the continued intake of cannabis can violate its effect and also cause tachycardia (Vázquez-Bourgon et al., 2019). The nurse should convince the patient that recovery is real, and taking medications is necessary to achieve a positive result.

The three-phase conversational model (TPCM) implies engagement, exchange of information and planning as a way to provide effective and compassionate care. The first phase prescribes establishing the connection with Diana through staying aware of her background and culture to enable change. A nurse can practice mindfulness and compassion, which can be implemented by applying a non-judgemental approach to her challenges. The main goal is not to point to the mistakes that were made by her but to show that there is the opportunity to find another direction. In this regard, the nurse should be open to learning from Diana and her experience. Curiosity, courtesy, clarity, commitment, collaboration and culture can help in establishing a conversation between the patient and the nurse. For example, the fact that Diana is of Hungarian origin and that her parents were addicts can be especially difficult for this patient to accept since she lives in different settings.

In addition to knowledge of professional duties and a complete understanding of the problems, the nurse should be able to timely notice all changes in the patient’s health (Hussain et al., 2018). This is especially important when the patient’s condition worsens or is complicated likewise in Diana. These changes can be timely taken into account only in the most careful attitude to all, even to the most insignificant manifestations of the disease. Proper and fruitful treatment is impossible if the signs of shortness of breath, depression, a fall in the pulse and other signs that may be completely invisible to the patient are missed (Cleverley et al., 2020). Constant attention to the smallest changes in the patient’s condition gradually develops through observation.

Various difficult experiences, anxieties, fears, suffering and constant thoughts about the disease change the patient’s psyche. The attitude towards these concerns should be passionate and responsive. It is well known how important the state of the nervous system is for the onset of the disease, its course and outcome. Therefore, the nurse should, first of all, have a beneficial effect on the patient’s nervous system (Isobel and Delgado, 2018). It is not acceptable to argue with the patient, be angry with her, express negative thoughts or be impolite in any way. On the contrary, one must treat Diana kindly, respectfully and calmly, even if she is excited and rude. It should be reassured by all possible means, and if possible, create the illusion of concession, but at the same time, firmly and persistently demand that she carries out all necessary measures and obeys the existing rules.

It is noteworthy that the algorithm for performing any manipulation always begins with establishing a trusting relationship with the patient, explaining the essence of the conversation. According to Briant and Freshwater (1998), this is due to the importance of the psychotherapeutic effect of communication between the nurse and the patient. The basis of interpersonal interaction is respect for the person, his or her health and dignity, which is the philosophy of nursing. Through communication, the individual characteristics of Diana and the professional characteristics of the nurse will be manifested. The interaction with the patient without taking into account her mental, social and spiritual spheres mechanises the process of helping the patient (Evans, 2007). To establish a better interaction between the nurse and the patient, the nurse must have a high communication culture, paying attention to the characteristics of the patient’s age, sexuality, gender, ethnicity and culture.

The therapeutic use of self is another vital point nurses should take into account to provide effective services. It refers to remaining aware of personal thoughts and feelings to work consciously. It is necessary to speak clearly, slowly, with the maximum manifestation of friendliness, checking whether Diana correctly understands the meaning of what was said. Nurses should try to conduct a conversation taking into account the individual age and personality characteristics, tastes and desires of the patient (Clarke and Clarke 2014). During the conversation, a mutual understanding of the patient and the medical professional should arise. The art of communication, knowledge of psychological characteristics and the use of psychological methods are extremely necessary for specialists whose work is associated with constant contacts with people (Moloney et al., 2018).

Once the patient would feel safer, it is possible to shift to the second phase of exchanging information, which should be transparent, welcoming and patient-centred: the barriers, resources and strengths can be discussed. During this phase, the nurse assesses the patient from different perspectives and identifies all the important details. The model of motivational interviewing can be used to communicate with Diana to reinforce her understanding of herself and the need for treatment (Lewis, Larson and Korcuska, 2017; Mullen et al., 2020). It is essential to individualise the questions and strategies to fit the case of this particular patient. Ultimately, the phase of finding an agreement is clarifying what does Diana wants and what is required to achieve her goals. The National Institute for Health and Care Excellence (NICE) recommends “improving care through early recognition and treatment, and by focusing on long-term recovery. It also recommends checking for coexisting health problems and providing support for family members and carers” (Psychosis and schizophrenia in adults: prevention and management, 2017). In consistence with these guidelines, a comprehensive set of interventions should be offered to Diana by a multidisciplinary team.

The value of interdisciplinary working in the case of Diana is associated with the need for the ongoing evaluation and long-term treatment effectiveness. The integrated treatment model implementation will require the contribution of nurses, physicians, therapists, social workers, et cetera. For example, the use of the cognitive-behavioural therapy (CBT) can be suggested to teach Diana to manage stress and practice self-help strategies, including but not limited to breathing techniques and distraction exercises (Waller et al., 2014). While approaching fearful situations that were faced by this patient previously, it is important that the interdisciplinary team cooperates to constantly evaluate and treat the patient, which prioritises timely meetings and consultations among professionals.

Conclusion and Recommendations

To conclude, this paper determined that Diana has developed the combination of psychosis and cannabis abuse, which was evoked by her physical, emotional and social environment. The analysis of this case with regard to biopsychosocial theories allowed for revealing that the woman’s inability to build attachment and her previous failures related to family and friends are the key barriers to communication and relationship building. A combination of anxious-evading and ambivalent behaviour, as well as disorientation in life, caused inadequate self-attitude and misconceptions regarding other people. Having no support from other people, Diana practiced self-harming behaviours, which requires the implementation of the interdisciplinary approach. In addition to pharmacotherapy, psychotherapy and social integration are essential for the successful treatment of this patient. While working with this patient, nurses should not only apply the three-phase model of care but also consider the therapeutic use of self to stay aware of personal feelings and thoughts and provide the required services in a conscious manner. The ability to build relationships with patients, find a proper approach to them and guide them is especially necessary for nursing professional success.

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