Mental health, Amir Daud case study
 

Later in your initial discussions with Amir you think he may be having an anxiety disorder. Identify the character of anxiety disorder Amir is likely to be experiencing and what constituents in his history indicate this type of upset.

Amir is highly likely to be experiencing Generalized Anxiety Disorder (GAD) which results from too much sympathetic activation of the neural system. It makes the person experiencing it gets constant nervousness that leads to a negative impact on both physical and emotional health status. It significantly interferes with the normal behavior path of the individual at its mercy. Amir spent two years in torturous detention in Afghanistan, which was a time of constant uncertainty and anxiety followed by a perilous journey to Australia. While he was in detention, he witnessed many episodes of self-harm by fellow detainees who had lost hope and pessimistic about their future welfare which have contributed to increasing Amir’s trauma and anxiety state. The fact that he felt powerless in his situation aggravated his stress levels because he lacked hope or someone or something that would help secure it in that hopeless state of personal business.
Amir is also battling with mild depression from worrying too much about the family he left behind as he says he feels guilty because he is aware they are still facing persecution. He blames himself for not being able to rescue them from that situation. In addition, Amir is required to secure himself employment, only he feels quite the opposite due to his impatience and poor absorption.

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The major symptoms of this disorder include restlessness, exaggerated startle response, sleep disturbance, difficulty in concentrating, irritability and tremor. The symptoms must have occurred days than not for at least 6months and must cause clinically important distress or impairment in social, occupational or other significant areas of functioning’ (APA, 2000). According to Sigmund Freud, His type falls under Neurotic category of which is defined as the anticipation of negative consequences that activate defensive processes. This is as a consequence of his experience in the detention which he says makes him sleep poorly and development of negative intrusive thoughts during his waking time in the morning.
Possible Treatments that could be administered to Amir include pharmaceutical medication (SSRIs and Benzodiazepines) or herbal extracts made from a relaxant made from the root of the kava plant (Hall, 1998).
References
Derek Hayes, A. G., Suhaini, M. J., & Kassim, K. K. (2014). Hope and Mental Health Nursing. LinkedIn Corporations.
Hall, R. H. (1998). Anxiety Disorders.
Psychiatryonline. (2014). Neurobiology of Anxiety Disorders. Retrieved March 31st, 2014, from www.psychiatryonline.org: http://psychiatryonline.org/content.aspx?bookid=29&sectionid=1361949
School, I. S. (2008). Neurobiology of Anxiety Disorders. In I. S. School. Russia: St. Petersburg.

Explain what is meant by the neurobiology of anxiety.

Anxiety is a psychological and a behavioral state commonly characterized by avoidance behavior which affects a patient emotionally and psychologically. Neurobiology of anxiety is the classification of all anxiety disorders that affect the brain emotional states. These emotional states could be anxiety about the future, fear of the present or depression about events that occurred in the past. There are many different categories of the neurobiology of anxiety as listed below.
Generalized anxiety disorder (GAD) which is most common in young adults like Amir. It’s the fear, anxiety and depression associated with reaction to any dangerous situation. (Psychiatryonline, 2014). GAD is more likely than not to be confused with other anxiety disorder types. For one to conclude that a patient has it, they must identify four symptoms from the first rank list and at least one from the second list.
First rank

Inability to relax or restlessness
Fatigueability
Exaggerated sudden response
Muscle tension
Poor sleeping habits
Poor concentration
Easily irritable

Second

Nausea or abdominal complaints
A Dry mouth
Tachycardia
Tremor

Stress disorders (Post traumatic stress disorder- PTSD) and Phobias which are divided into specific and social phobia. These are characterized by a general feeling of dissociation from reality.
Panic disorders (With or without agoraphobia) -Attributes are manifested by intense apprehension, terror, fear often associated with feelings of hopelessness and intense physical discomfort. Attacks usually last for a short while and rarely take hours. In case they are accompanied by agoraphobia, there is a fear of being in places or Situations from which escape might be hard or in which help might not be available in the event of a panic attack (Diagnostic and statistical manual of mental health, 2000)
Agoraphobia without history of panic disorder- The (Diagnostic and statistical manual of mental health, 2000) identifies the essential feature of this disorder as fear of being in places or situations from which escape might be difficult or in which help might not be available in the event of suddenly developing a symptom that could be incapacitating or extremely embarrassing.
Obsessive-Compulsive Disorder (OCD) –This is characterized by involuntary recurring thoughts or images that the patient is not able to dispense. The victims feel powerless despite them knowing that it’s irrational behavior. The four general categories are: counting, checking, cleaning and finally avoidance. They happen frequently, which consequently interferes with normal daily activities.
Acute Stress Disorder-It’s an anxiety disorder due to a general medical condition. Symptoms of are judged to be the direct physiological consequence of a general medical condition. They may include prominent generalized anxiety symptoms, panic attacks, or obsessions or compulsions (APA, 2000)
References
APA. (2000). Diagnostic and statistical manual of mental health (4th Ed.). DSM-IV-TR: American Psychiatric Assocaition press.
Psychiatryonline. (2014). Neurobiology of Anxiety Disorders. Retrieved March 31st, 2014, from www.psychiatryonline.org: http://psychiatryonline.org/content.aspx?bookid=29&sectionid=1361949
School, I. S. (2008). Neurobiology of Anxiety Disorders. In I. S. School. Russia: St. Petersburg.

Why is hope relevant in mental health nursing practice? How might you incorporate this concept in subsequent therapeutic communication with Amir? What other elements of communication might you employ?

Hope is a vital element in any human’s life and is a pivotal act in any mental health nurse. It helps people with any medical problem get assurance about their situation, whether or not the treatment or recovery is complete. Kylma and Vehvilainen-Julkunen (1997) described it as an experience, emotion or need. The term in nursing is regarded as being dynamic and helps in rebuilding a patient’s self-worth and how they regard themselves which acts as a complementary treatment.
Amir needs to be shown unconditional acceptance, understanding and tolerance to help him overcome his disorder condition. A patient who believes that their situation can change through professional guidance and hard work from their end does find a way out of their situation. The reason the placebo effect is important when dealing with patients like Amir. The nurse-client relationship with Amir’s case needs to be on a personal level, to breed trust and a sense of value. Recognizing that Amir’s case is difficult will be the first step to helping him since for him to feel inspired by the therapeutic communication; he must feel the same energy from the nurse. There are different ways in which one can inspire hope especially in Amir’s case. They include:
Educating Amir of his condition, treatment and assuring him that he can still achieve all his goals and objectives like any normal human being.
Group therapy –This is where the assessor tries to interact with the patient with a group of other patients with more or less similar anxiety disorders with the aid of a leader to help them resolve interpersonal problems. Groups bring a sense of security and trust that they not battling their condition alone. More often, this results in positive outcomes in almost all cases.
Humor-Using humor to help Amir arouse happy thoughts and avoid the negative thoughts he gets during his waking time. Humor results to laughter which has been proven to be therapeutic.
Spiritual aspect-Here one tries to introduce spirituality, faith in the patient, which is a form of faith in all religions.
Psychoanalysis-The main goal will be to reduce his anxiety and guilt through verbal processes.
Conduct Humanistic therapy to help him fulfill his full potential and improve self concept.
Conduct Behavior and cognitive therapy to help him change unwanted abnormal behaviors and acquire desirable ones through revising his thoughts and behavioral training.
Later, Amir can be engaged in the assessment of his hope level to monitor any progress. Use of Herth Hope Index (HHI) rating where higher rate shows a high level of hope and subsequent opposite are an indication of low self-worth and depression.
Amir detachment from the normal world could drive him to commit suicide and thus the nurse need to do a full assessment on his level of hope. Effective communication of the management plan and encouraging self-help strategies will also play a big role during management discussion with Amir.
References
Derek Hayes, A. G., Suhaini, M. J., & Kassim, K. K. (2014). Hope and Mental Health Nursing. LinkedIn Corporations.
Psychiatryonline. (2014). Neurobiology of Anxiety Disorders. Retrieved March 31st, 2014, from www.psychiatryonline.org: http://psychiatryonline.org/content.aspx?bookid=29&sectionid=1361949

Define what is meant by ethnicity. Given Amir’s ethnic background explain what cultural assessments you might make in planning his ongoing care.

Ethnicity refers to a state in which an individual belongs to a certain social group which happens to share common national, customs or cultural traditions. Amir is ethnic Hazara. The Hazara people have for a long time been the victim of discrimination in Afghanistan. At the refugee camp the people there are more likely to be of the same ethnicity with Amir. This will make it easier for Amir since he will feel a sense of belonging while interacting with people who share his cultural values and origin.
I would use a cultural assessment tool to help me get all the information about Amir cultural background. Details I would include in the assessment area include: –
The primary language spoken by Amir, how he communicates with other people who speak a different language, whether he requires an interpreter or not, the highest level of education he has attained, whether his condition has ever occurred before, if it did in what manner was it handled, what are his normal ways of coping with stress?
Let Amir describe his family living arrangements, the major decision maker in the family, his religious beliefs and any religious requirements or restrictions that may place limitation to his care, any special belief and practices that may vary from the conventional ways, from whom has the family been seeking help from.
Additionally, the following questions should help in cultural assessment.

Are there any topics that are particularly sensitive or unwilling to discuss (because of cultural taboos)
Are there any activities in which Amir is unwilling to participate (because of cultural customs or taboos)
What are the Amir’s personal feelings regarding touch?
What are his personal feelings regarding eye contact?
What is his personal orientation to time? (Past, present, future)
Any particular illnesses to which the Amir may be bioculturally susceptible?

All the above questions will help gather any possible information regarding the Hazara ethnic group which will help in treatment program recommended to Amir while he is in Australia. It will also help the employer of his religious and ethnic practices to avoid stigmatization.
References
Mary C.Townsend, D.-B. (2011). Nursing Diagnoses in Psychiatry Nursing (8th Edition Ed.). Philadelphia, 1915 Arch Street: F. A Davis Company.
Psychiatryonline. (2014). Neurobiology of Anxiety Disorders. Retrieved March 31st, 2014, from www.psychiatryonline.org: