Ms. Suarez whose native home is in Cuba but currently lives as an immigrant in South Florida, USA. The client is reported to have two daughters aged 22 and 25 who also live in the same town as Ms. Suarez. Ms. Suarez has remained unmarried for twenty years after she divorced her husband, which led to complete break between her contacts with the spouse. Her husband is reported to have traveled back to their native land, Cuba, after the divorce.
Matilda Suarez seems to have had an unstable family relationship with her husband which led to their divorce about 20 years ago. This divorce came at a time when the two girls were about two years and five years. It is possible that the two daughters never enjoyed the presence of their father and were brought up by a single mother. From the available information, there is no link between mental illness and Ms. Suarez's family history. However, contrary information may be established from her native home in Cuba. Apart from the divorce with her husband, recent years have seen the client distance herself from the society. She has preferred to stay alone in solitude and only allows few individuals to pay her a visit. Among the people authorized to visit her include her two daughters and father Michael Krane, her parish priest. Account of the client's personal information provided by the Parish priest indicates that the client has hardly walked outside her home for the past one and a half-decade. A visit by the social workers collected useful information that could inform of the loneliness situation of Ms. Suarez. The client replied that she could stay up to two weeks without interacting with anyone from the society. No records exist to indicate that Ms. Suarez previously sought medical attention to mental illness-related problems. No account of drug and substance abuse by the client exists since she is hardly in touch with the society making it impossible to access such. The client's main source of living is from working as a medical transcriber while at her home. Working as a medical transcriber implies that the client has undergone a formal education. Ms. Suarez has not worked under either of Cubas military or US military forces. Apart from her divorce that came over twenty years ago, she has had no legal history until now that the neighborhood improvement project is beckoning.
Description of the presenting problem
Ms. Suarez was divorced about twenty years ago which must have led to her agony up to now. Five years after the divorce, the client made a decision to remain confined in her house and detach herself from the society. She explains that she has had a problem interacting with people because of fear of being harmed by people. One account of her fear is manifested when she explains her visit to a doctor a situation that saw her run away after encountering many patients in the waiting. A home nurse pays a routine visit to ensure that Suarez is on constant medication for her varicose veins complication. Suarez also explains how she is unable to pick the morning newspaper forcing the paperboy to drop it by her door. For Suarez to go out, she needs the company of intimates such as one of her daughters, but all shopping needs are catered by her daughters. She has not a particular explanation for her fear, but Ms. Suarez seems to fear for the unknown.
The characteristics of the client imply that she is suffering from a unique mental disorder that detaches her from the society. This particular mental disorder leaves a person in a low mood for a longer time. Individuals like Ms. Suarez often have five of the suggested symptoms in DSM-V diagnosis criteria (Reynolds & Kamhaus, 2013). The client may exhibit a depressed mood for a better time of the day as well as week. Another important signal is in reduced interest to participate in social activities or to interact. Third, a client may exhibit a significant gain in weight or significant loss in weight. Four, an individual may have numerous instances of insomnia and to greater extents, hyper-insomnia. Five, an individual may exhibit symptoms of retardation or psychomotor agitation. Six, a client may exhibit daily expression or feeling of fatigue or reduced energy. Seven, a client may feel unworthy, guilt or suspicion of uncertainties. Eight, a person with a depression disorder may have a reduced concentration ability and lack of decisiveness. Finally, depression disorder can create recurrent thoughts of considering suicide.
It is evident that mental illness is a common complication that affects individuals regardless of their race, ethnicity, and culture (Gorry, 2013). However, specific aspects can be considered as predisposing factors that can be traced from culture. Most cases of mental illness have been attributed to the use with depression identified as the primary type of mental illness. The percentage of Cuban adults who smoke is about 25 percent with an almost similar figure for Cubans between the age of 15 and 24. It has also been established that the most Cubans are suffering from depression eventually settle on suicide as a way out. Despite the fact that drinking and smoking have been imprinted in the culture of the Cubans, these two practices were not part of Ms. Suarezs life. However, it would be necessary to rule out this two during further investigations on the patient.
Prolonged depression is likely to advance, and ten clients might develop devastating thoughts such as considering suicide. The paranoid nature of the patient is likely to cause anxiety which will be another mental health concern. Her current health condition is likely to increase her depression which may affect the client's response to medication. There is need to ensure that the client is in a position to cope with medication of both varicose veins and mental illness.
Clinical impression and prognosis
The patient might have been affected by the divorce from her husband over 20 years ago. It was established that Suarez detached from the society at about five years after the divorce and the situation has worsened. Her fear of the unknown or attack by people might also have been a factor in the divorce. According to Diagnostic and Statistical Manual of Mental Disorder (2013), prognostic factors for depressive disorder include temperamental, genetic factors and psychological factors. The patient I question has a psychological effect that causes the depressive mental disorder. The symptoms exhibited by the patient suggest that Ms. Suarez possibly has a depressive mental disorder. The client feels comfortable working alone and maintaining her personal space by only allowing visitation by four people. Ms. Suarez is not aware that she has gradually been developing a mental disorder that might affect her life in future. The fact that she has a miserable social life is a risk factor that makes people not to understand Suarez fully. The client believes that she has no friends that care about her and this is a major indicator of her depressive mood. Another source of depression is the fact that her house has been targeted for demolition in the proposed neighborhood upgrading project. She does not know where to run to or lean for help, and this might be a major blow to her current depressive mood.
The client has to be subjected to psychiatric management that includes educating the patient, her two daughters and the priest about depression (American Psychiatric Association, 2010). Patient's response will highly depend on the environment that will encourage client's sense of safety and confidence. There is need to develop a therapeutic alliance between the psychiatric and the client. To achieve this, the psychiatric must be able to take in the concerns of the patient such as fear of being attacked. Also, it is important to conduct a biopsychosocial assessment that will enable that warranting of the depressive disorder. A psychiatric should also establish the safety factors of the patients conditions. Coordination of the patients care approach with ongoing treatment of cardiovascular disease is paramount. The nurse in charge will be required to understand the psychiatric condition of the patient so that she can contribute to the treatment of the patient. Finally, monitoring of the patients progress, as well as changes in the psychiatric condition, would be required. Monitoring also helps in the identification of side effects that may resemble related mental disorders.
American Psychiatric Association. (2010). A Practice Guideline for the Treatment of Patients with Major Depressive Disorder. Retrieved January 29, 2017, from (Thrid Edition). American Psychiatric Association: http://www.psychiatryonline.com/pracGuide/pracGuideTopic_7.aspx
Association American Psychiatric. (2013). Diagnostic and Statistical Manual for Mental Disorder. Retrieved January 29, 2017, from (5th Edition). American Psychiatric Association: https://psicovalero.files.wordpress.com/2014/11/dsm-v-ingles-manual-diagnc3b3stico-y-estadc3adstico-de-los-trastornos-mentales.pdf
Gorry, C. (2013). Community Mental Health Services in Cuba. Retrieved January 29, 2017, from MEDICC Review, Vol 15, No 4: http://www.scielosp.org/pdf/medicc/v15n4/04.pdf
Reynolds, C. R., & Kamhaus, R. W. (2013). Major Depressive Disorder: DSM 5TM Diagnostic Criteria. Retrieved January 29, 2017, from American Psychiatric Association: http://images.pearsonclinical.com/images/assets/basc-3/basc3resources/DSM5_DiagnosticCriteria_MajorDepressiveDisorder.pdf
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