Running Head: NATIONAL ALLIANCE ON MENTAL ILLNESS
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Clinical Journal: Mental Illness
Student’s Name
Institution Affiliation
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Clinical Journal 9
Mental illness refers to a wide range of mental health conditions that affect a person's mood, thinking,
and behavior. These conditions can be mild or severe, and can impact a person's ability to function in
daily life.
There are many different types of mental illnesses, including anxiety disorders, mood disorders (such as
depression and bipolar disorder), personality disorders, psychotic disorders (such as schizophrenia),
eating disorders, and substance use disorders.
The causes of mental illness are complex and can be a combination of genetic, environmental, and
psychological factors. Treatment for mental illness can include medication, psychotherapy, or a
combination of both. It's important for individuals with mental illness to seek help from a mental health
professional and to have a strong support system.
1. What were the highlights of this week's clinical? Describe a particular patient,
patient interaction, or disease process that stood out to you
During the week, I came across a patient who exhibited symptoms of insomnia, visual
hallucinations, nausea, headache, agitation, nervousness and arms tremors. Pt was with a long
history of heavy drunker and that the symptoms started the day before after his last cup of wine.
He was unable to purchase more wine due to the loss of his job and does not have money. I
consulted with my preceptor, who immediately recognized the condition as alcohol withdrawal
syndrome.CIWA-Ar score ≥10 for significant alcohol withdrawal. The patient was hospitalized
for detoxification (Benzodiazepines as needed, hydration and vitamin B6 infusion to avoid
Wernicke encephalopathy was part of the initiated treatment)
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2. Reflect on a situation or a patient presentation that you were unfamiliar with during
clinical this week (i.e., the disorder and symptoms the patient was exhibiting).
Describe how you handled this unfamiliar situation/case.
During clinical this week, I came across a case that was unfamiliar to me. It was a case of a man
who had an injured leg. At first, I thought the man was the survivor of an accident. After
inquiring, I learned that the man had amputated his leg. After researching further and in
consultation with my preceptor, I learnt that this was a special mental disorder called
apotemnophilia. This conditioned makes an individual want to amputate or injure his healthy
parts. We admitted the patient to cognitive behavioral therapy to treat the situation (WHO,
2017). Generalized anxiety disorder, bipolar disorder, schizophrenia, schizoaffective disorder,
and major depressive disorder are all mental health disorders that can have significant impacts
on an individual's quality of life.
Generalized anxiety disorder (GAD) is a condition characterized by excessive and persistent
worry and anxiety about various events or activities. People with GAD often have difficulty
controlling their worry and may experience physical symptoms such as restlessness, fatigue,
irritability, and muscle tension.
Bipolar disorder is a mood disorder characterized by episodes of depression and mania (or
hypomania). During manic episodes, individuals may experience elevated or irritable moods,
increased energy, decreased need for sleep, racing thoughts, and impulsive behavior. During
depressive episodes, individuals may experience feelings of sadness, hopelessness, and
worthlessness, as well as physical symptoms such as changes in appetite and sleep patterns.
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Schizophrenia is a chronic and severe mental illness that affects how a person thinks, feels, and
behaves. Symptoms can include hallucinations, delusions, disorganized thinking and speech,
and difficulty with daily activities.
Schizoaffective disorder is a mental health disorder that combines symptoms of schizophrenia
and mood disorders such as bipolar disorder or depression. People with schizoaffective disorder
experience psychotic symptoms such as hallucinations and delusions, as well as mood
symptoms such as depression or mania.
Major depressive disorder (MDD), also known as clinical depression, is a mental illness
characterized by persistent feelings of sadness and loss of interest in activities that were once
enjoyed. Other symptoms may include changes in appetite and sleep patterns, fatigue, feelings
of worthlessness or guilt, and difficulty concentrating.
It is important to note that each of these disorders requires a different treatment approach and
should be diagnosed and treated by a qualified mental health professional.
3. Describe a situation or encounter from this week that led you to a new
understanding of a specific mental health condition.
One of the exciting cases encountered this week was a patient of 33-year-old women with a
history of schizophrenia, and current psychosis who was agitated and received haloperidolIM,
she was in seclusion with restraint for 24 hours. Nursing staff call to the office notifying that the
pt. was with slurring of speech, disoriented to time and place, fever of 102°F, elevate BP and
HR. I consulted with my preceptor, who immediately recognized the condition as Neuroleptic
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Malignant syndrome. Neuroleptic malignant syndrome (NMS) is an uncommon, idiosyncratic,
life-threatening complication of treatment with antipsychotic medications. NMS has also been
associated with other psychotropic agents that block central dopamine pathways (e.g.,
metoclopramide). It is characterized by altered mental state, increased muscle tone or frank
rigidity, alterations in the autonomic nervous system, hyperactivity, and hyperthermia.=
(American Psychiatric Association,2013)
4. Discuss any interactions with patients that you observed, either in therapy or a
medication management session that were missing some of the concepts you have
been learning about regarding therapeutic relationships and communication.
As I interacted with patients, I observed that some concepts were missing in regards to my study
about therapeutic relationship and communication. Patients are expected to express how they feel
so that a doctor can give appropriate advice. However, some patients were so stubborn to share
how they felt. Some of them were not willing to receive counseling advice once they had been
diagnosed with a particular mental problem. This negates the relationship between caregivers
and the patients that requires them to be open to each other.
5. How did you apply the content learned in your online courses to your clinical setting
this week?
In my clinical setting this week, I learned that more women than men are likely to suffer trauma.
I learnt that trauma is caused by an event or a sequence of events that pose a threat to someone's
life. Trauma leads to increased substance abuse. I applied my knowledge to help trauma victims
by offering psycho-education and counseling sessions to the victims (WHO, 2017).
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6. Which chief complaints did you see most often this week? Provide details about how
you felt about developing your preliminary differential diagnoses lists for these
patients based on the complaints/symptoms they expressed
The majority of patients complained of having hallucinations, delusions, distorted thinking as
well as forgetting easily. After thorough interrogation, I found out the majority were drug
addicts. Some were active drug users while others had just withdrawn from drug use. My initial
diagnosis shows that these patients are suffering from psychotic disorders or schizophrenia.
7. Given the most frequent psychiatric disorders you encountered in your clinical
rotation this week, what is the most useful set of guidelines (i.e., depression
guidelines, Beer's criteria, etc.) to refer to for additional information for prescribing
and/or psychotherapy
With many patients suffering from psychiatric disorders, there are several prescriptions for them
to heal from psychiatric disorders depending on the specific disorder. Patients are likely to be
subjected to psychotherapy as well as take medications such as antidepressants, anti-anxiety
medications, anti-psychotic medication among others.
8. Thinking about the common mental health conditions you saw in your clinical this
week (see question #7), did you feel that you had adequate knowledge to discuss
these diagnoses with your preceptor? If not, what preparation work do you have
planned to help you feel more confident about the upcoming clinical week?
Some of the commonly reported mental health conditions were schizophrenia, depressive
disorders, anxiety disorders, trauma disorders among others. On these, I had adequate knowledge
to discuss with my preceptor. However, in some special cases like apotemnophilia, I did not have
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adequate knowledge to discuss with my preceptor. However, I'm still researching to ensure I'm
confident in the following week.
9. List a brief plan of care for one of the patients you saw this week. Include your
preceptor's plan, too. Discuss, briefly, whether or not you agree with your
preceptor's plan of care. If not, describe what you would have done differently and
why.
One of the patients we handed was a woman who was suffering from both trauma, substance
abuse as well as mental disorder. My preceptor's plan is to have an integrated treatment plan to
cure al these challenges simultaneously. However, I plan that each problem should be solved
independently of the other. Psychotherapy should be administered to treat mental disorders,
antidepressants taken to treat trauma and so on (Cramer et al., 2017)
10. What situation or patient presentation did you see in your clinical setting this week
that has not yet been covered in your online psychiatric courses?
During my interaction with patients, I came across a patient with a rare condition that we are yet
to cover in our course work. It is called alien hand syndrome. This is a condition where someone
believes a section of their body does not belong to them. It is caused by stroke and damage to the
corpus callosum (Borsboom, 2017).
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Somatization and Depression
Somatization and depression are two mental health conditions that are closely linked.
Somatization is a condition in which a person experiences physical symptoms without any
medical explanation, while depression is a mood disorder that causes persistent feelings of
sadness, hopelessness, and a loss of interest in life.
The link between somatization and depression has been recognized by mental health
professionals for many years. In fact, it is not uncommon for patients with somatization to also
have a diagnosis of depression or anxiety.
People with somatization disorder may experience a wide range of physical symptoms,
including pain, fatigue, gastrointestinal problems, and other physical complaints. These
symptoms can be distressing and may interfere with a person's ability to function in daily life.
However, despite the presence of these physical symptoms, medical tests often fail to find any
underlying medical cause.
On the other hand, depression can cause physical symptoms such as changes in appetite, sleep
disturbances, and fatigue. However, these symptoms are usually accompanied by a persistent
feeling of sadness, hopelessness, and a loss of interest in activities that the person previously
enjoyed. Depression can also cause physical symptoms that may mimic those of other medical
conditions, such as headaches, digestive problems, and muscle pain.
The link between somatization and depression is not entirely understood, but it is thought that
both conditions may be caused by a combination of genetic, environmental, and psychological
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factors. For example, people who experience chronic stress, trauma, or abuse may be more
likely to develop both somatization and depression.
One theory is that somatization and depression may be linked through the concept of
"somatosensory amplification." This is the idea that people with these conditions may
experience physical sensations more intensely than others. As a result, minor physical
sensations may be perceived as more severe, which can lead to heightened anxiety and
distress.
The treatment of somatization and depression often involves a combination of medication and
psychotherapy. Antidepressants may be prescribed to help alleviate the symptoms of
depression, while psychotherapy can help patients develop coping skills to manage the physical
symptoms of somatization.
Cognitive-behavioral therapy (CBT) is a common type of therapy used to treat somatization and
depression. CBT involves identifying negative thought patterns and behaviors that may be
contributing to the physical symptoms and replacing them with more positive, productive ones.
In addition to medication and psychotherapy, self-care strategies can also be helpful for
managing somatization and depression. These may include exercise, healthy eating habits,
stress reduction techniques (such as meditation and yoga), and relaxation techniques (such as
deep breathing and progressive muscle relaxation).
In conclusion, somatization and depression are two mental health conditions that are closely
linked. People with somatization disorder may experience physical symptoms without any
medical explanation, while depression causes persistent feelings of sadness, hopelessness, and
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a loss of interest in life. The link between these conditions is not entirely understood, but it is
thought that both may be caused by a combination of genetic, environmental, and
psychological factors. Treatment often involves a combination of medication and
psychotherapy, along with self-care strategies to manage symptoms. It is important for
individuals experiencing somatic symptoms or depression to seek help from a mental health
professional.
Thank you for your research and presentation of the information regarding somatization and
depression in children and adolescents. The articles that you listed provided me with background
knowledge that is evidence-based in the diagnosis and treatment of this disorder. The DSM-5
acknowledged that the new category of somatic symptoms and related disorders was changed from
the DSM-IV somatoform disorder due to the emphasis of positive signs and symptoms (APA., 2013).
These signs and symptoms not only involved distressing somatic symptoms but in addition,
individuals complained of abnormal thoughts, feelings, and behaviors (APA., 2013).
Some of the most common symptoms of somatic symptom disorder (SSD) that were reported
in children and adolescents were fatigue, pain, nausea, and faintness (Heimann, P., Herpertz-
Dahlmann,B., Buning , J., Wagner, N., Peschgens, C.S., Dempfle, A. &von Polier, G.G., 2018).
Persistent pain is the most common type of somatoform disorder in children and adolescents with
recurrent abdominal pain, musculoskeletal pain, and headaches being the most common somatic
symptoms (Heimann et al, 2018). The key in diagnosing these disorders begin with a thorough
psychiatric evaluation (Mahapatra, S., Deo, S.J.K., Satapathy, A., & Rath, N., 2014). The Children’s
Somatization Inventory (CSI) is a 35 item self-report scale that has both child and parent versions
and the screening tool helps to provide information about the child’s symptoms over the past 2
weeks and it may be used in children as young as 7 (Mahapatra et al, 2014). The Functional
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Disability Inventory (FDI) can also be used as an additional tool in conjunction with the CSI to help
assess severity of symptoms and the FDI correlates with school absences and somatic symptoms
reports (Mahapatra et al, 2014).
Some strategies for managing SSD are: make efforts to understand the family’s belief system
about the child’s illness; acknowledge the reality of the illness and how it impacts their lives or the
lives of their family; do not question the reality of the symptoms; discuss both physiological
mechanisms that may contribute to the symptoms as well as physical concerns of the family;
emphasize that recovery may be prolonged but the majority of young people do well; and help the
family and child develop ways to cope with the symptoms to decrease functional impairment
(Mahapatra et al, 2014).
There is, unfortunately, a lack of evidence-based treatment plans for SSD in children and
adolescents (Mahapatra et al, 2014). However, a recent German, naturalistic study assessed the
effectiveness of inpatient multidisciplinary treatment of children and adolescents with SSD using
CBT strategies (Heimann et al, 2018). The inpatient approach was found to decrease somatic
complaints, increase school attendance, and help to develop adaptive coping strategies and improve
psychiatric co-morbidity (Heimann et al, 2018). Untreated somatic symptoms may result in long-term
impairment in affected children and adolescents so it is important for clinicians, parents, and
teachers to recognize and seek the necessary treatment to decrease the duration of the illness and
provide professional treatment options as soon as possible.
I understand that this disorder may or may not be associated with another medical condition
(APA., 2013). They will also tend to have high worry levels and often think the worst about their
health. The question that I would like to know is what does the literature say about other
psychotherapies or complementary therapy to help with their complaints of pain?
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Respectfully submitted,
Portia Nunley
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References
American Psychiatric Association (2013).Diagnostic and Statistical Manual of Mental
Disorders(5thed.). Washington: DC, American Psychiatric Association Publishing
Heimann, P., Herpertz-Dahlmann ,B., Buning ,J., Wagner, N., Peschgens, C.S., Dempfle, A. &von
Polier, G.G (2018).Somatic symptom and related disorders in children and adolescents: evaluation
of a naturalistic inpatient multidisciplinary treatment.Child Adolesc Psychiatry Ment Health.2018;
12: 34. Retrieved from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6022439/
Mahapatra, S., Deo, S.J.K., Satapathy, A., & Rath, N (2014). Somatoform Disorders in Children and
Adolescents.German Journal of Psychiatry, 2014. Retrieved
from:researchgate.net/publication/261925817_Somatoform_Disorders_in_Children_and_Adolescen
ts
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References
Borsboom, D. (2017). A network theory of mental disorders.=World Psychiatry,=16(1), 5-13.
https://onlinelibrary.wiley.com/doi/abs/10.1002/wps.20375
Fried, E. I., van Borkulo, C. D., Cramer, A. O., Boschloo, L., Schoevers, R. A., & Borsboom, D.
(2017). Mental disorders as networks of problems: a review of recent insights.=Social
Psychiatry and Psychiatric Epidemiology,=52(1), 1-10.
https://link.springer.com/article/10.1007/s00127-016-1319-z
World Health Organization. (2017).=Depression and other common mental disorders: global
health estimates=(No. WHO/MSD/MER/2017.2). World Health Organization.
https://apps.who.int/iris/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-
eng.pdf
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