Top Case Studies and Assessments in the MHR2520 / MHR3520 Complex Mental Health ModuleThe MHR2520 / MHR3520 Complex Mental Health module addresses advanced clinical reasoning, assessment tools, and evidence-based interventions for people with complex mental health needs. This article presents a curated set of high-yield case studies, step-by-step assessment approaches, and practical reflections designed for students and clinicians preparing for exams or clinical placements. Each case ties to specific assessment tools, formulation frameworks, and intervention considerations that map to typical learning outcomes for this module.
Why case studies matter in complex mental health
Case studies translate theory into practice. They require integration of diagnostic reasoning, risk assessment, biopsychosocial formulation, ethics, and interprofessional collaboration. In learning contexts such as MHR2520 / MHR3520, well-constructed cases help learners:
- Practice differential diagnosis under uncertainty.
- Apply validated assessment instruments.
- Develop risk management plans and safety planning.
- Build person-centered formulations that guide interventions.
- Reflect on professional boundaries, cultural competence, and ethical dilemmas.
Clinical skills and assessment tools covered
This section lists core competencies and common assessment instruments referenced throughout the case studies:
- Mental state examination (MSE)
- Risk assessment for suicide and violence (e.g., Columbia-Suicide Severity Rating Scale — C-SSRS)
- Cognitive screening (e.g., Montreal Cognitive Assessment — MoCA; Mini-Mental State Examination — MMSE)
- Functional assessment and activities of daily living (ADL) scales
- Substance use screening (e.g., AUDIT, DUDIT)
- Trauma screening (e.g., PC-PTSD-5)
- Personality assessment considerations (structured clinical interview and collateral history)
- Standardized measures for symptom severity and outcome monitoring (e.g., PHQ-9, GAD-7, PANSS for psychosis)
- HoNOS (Health of the Nation Outcome Scales) for service-level outcomes
- Carer and family assessments, strengths-based and recovery-oriented tools
Case 1 — Complex depression with suicidality and substance use
Presentation: A 28-year-old presenting after an overdose attempt with a history of recurrent depressive episodes, escalating alcohol use, and recent relationship breakdown.
Assessment focus:
- Conduct a focused MSE noting affect, thought content (suicidal ideation), cognition, and insight.
- Use C-SSRS for suicidal ideation/behavior severity and history.
- Screen for alcohol dependence with AUDIT; consider blood tests for hepatic function and intoxication.
- Complete a biopsychosocial formulation including precipitating factors (relationship loss), perpetuating factors (alcohol use), and protective factors (family contact).
Key management points:
- Immediate safety planning, consider admission if high imminent risk.
- Consider brief motivational interviewing for substance use and referral to dual-diagnosis services.
- Initiate evidence-based pharmacotherapy for depression if indicated and arrange psychotherapy (CBT, DBT skills for crisis management).
- Document collateral history and coordinate care with social services for housing/support needs.
Case 2 — Older adult with late-life psychosis and cognitive impairment
Presentation: A 72-year-old referred from primary care for new-onset paranoid delusions, increasing forgetfulness, and declining ADLs.
Assessment focus:
- Comprehensive MSE and cognitive testing (MoCA/MMSE) to quantify cognitive impairment.
- Rule out delirium and reversible causes: blood tests (electrolytes, B12, thyroid), urinalysis, and medication review.
- Use PANSS or brief psychosis measures for symptom baseline; HoNOS for outcome tracking.
- Consider neuroimaging (MRI) if focal deficits or atypical presentation.
Key management points:
- Evaluate capacity for treatment decisions; involve family and consider best-interests planning if capacity lacking.
- Start low-dose antipsychotic with careful monitoring for side effects (esp. in elderly) only if risk/ distress severe.
- Engage occupational therapy for ADL support and make environmental adaptations to manage cognitive decline.
- Plan for long-term care needs, advance care planning, and coordinate with neurology/gerontology.
Case 3 — Complex trauma and dissociation in a young adult
Presentation: A 24-year-old with a history of childhood abuse, recurrent dissociative episodes, self-harm, and unstable relationships.
Assessment focus:
- Trauma-informed interview; use PC-PTSD-5 and structured history to map dissociation episodes.
- Screen for comorbidities: mood disorders, borderline personality features, substance use.
- Safety assessment for self-harm and impulsivity; record triggers and warning signs.
- Formulation emphasizing attachment, developmental trauma, and current relational patterns.
Key management points:
- Stabilization first: build safety skills, grounding techniques, and crisis plan.
- Refer to trauma-focused therapies (TF-CBT, EMDR) once stabilized; consider DBT for emotion regulation and skills training.
- Coordinate multidisciplinary care (psychology, psychiatry, social work) and involve peer support if available.
- Address social determinants: housing, employment, legal needs.
Case 4 — Early psychosis with functional decline in a university student
Presentation: A 19-year-old with social withdrawal, auditory hallucinations, drop in academic performance, and intermittent cannabis use.
Assessment focus:
- Early psychosis detection: detailed MSE, substance use history, and family history of psychotic disorders.
- Use structured tools for early intervention teams (e.g., CAARMS — Comprehensive Assessment of At Risk Mental States).
- Assess vocational/educational impact and social support networks.
Key management points:
- Rapid access to early psychosis intervention services; consider low-dose antipsychotic when necessary.
- Combine pharmacotherapy with psychosocial interventions: CBT for psychosis, family psychoeducation, supported education/employment.
- Address substance use with harm-minimization strategies and counseling.
- Monitor for metabolic side effects and ensure baseline physical health checks.
Case 5 — Complex bipolar disorder with borderline personality features
Presentation: A 34-year-old with mood instability, recurrent hospitalizations for mania and depression, impulsive behaviors, and unstable interpersonal relationships.
Assessment focus:
- Mood charting and collateral history to distinguish bipolar mood episodes from personality-driven mood lability.
- Use standardized mood scales (YMRS for mania, PHQ-9 for depression) and personality assessment tools as needed.
- Risk assessment for impulsivity, self-harm, and potential for medication non-adherence.
Key management points:
- Consider mood stabilizers (lithium, valproate) with careful monitoring; evaluate suitability and monitor for adherence.
- Offer DBT or schema-focused therapy to address personality-level difficulties alongside mood stabilization.
- Coordinate crisis plans, involve family in psychoeducation, and create relapse prevention strategies.
Ethical, cultural, and systemic considerations
- Always approach assessments with cultural humility; symptoms and risk expressions vary across cultures.
- Be aware of stigma and power dynamics; obtain informed consent and discuss limits of confidentiality transparently.
- Consider systemic barriers: access to services, socioeconomic factors, and intersectional vulnerabilities.
Practical tips for assessment write-ups and exams
- Structure your answers: presenting complaint, history (including social, developmental, substance), MSE, risk assessment, formulation, differential diagnosis, management plan, and follow-up.
- Use evidence-based instruments when named; justify why each tool is chosen briefly.
- Include measurable outcomes (e.g., PHQ-9 score reduction, HoNOS improvement) and realistic timelines for interventions.
- Reflect on limitations and signpost when you would seek senior advice or refer to specialist teams.
Suggested further reading and resources
- Trauma-informed care toolkits and local early psychosis service guidelines.
- NICE guidelines on depression, bipolar disorder, psychosis, self-harm, and older adult mental health.
- Manuals for C-SSRS, AUDIT, MoCA, PANSS, and DBT treatment manuals.
This set of case studies and assessments provides a practical scaffold for approaching the complex presentations commonly covered in MHR2520 / MHR3520. Use them as templates: adapt details to local protocols, the patient’s cultural context, and the specifics of clinical placement or examination requirements.
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