Delivery in day(s): 3
Mental Health Nursing Oz Assignments
The mental status examination is an important practice of the clinical assessment made in the psychiatric practice. It is, therefore, a sequential way to describe the psychological functioning of the patient under different domains such as appearance, behaviour, affect and mood, perception etc. Such examination allows the practitioner to make an accurate diagnosis of the patient’s condition and thereby helps them to formulate the correct treatment plan (Taylor, 2013). The following mental health assignment is the case study of a 22-year-old, female patient, Kerrie who visits the hospital and is accompanied by her mother.
1. Define thought form and thought content and the way to identify that Kerrie’s thoughts are disturbed:
Thought form can be defined as the set of ideas or presuppositions which can define the person’s thinking at the provided time period and region. When an individual has certain negative ideas in his mind or any thought disorder that continues for some length of time, then it may take more than the individual’s power to modify those thoughts and beliefs. This brings an inhibiting effect in mind which will allow their idea to center the brain and generate the thought form which is being passed into action. The thinking, connections between the ideas, and the ability to interpret information are all considered as elements of thought form. Individuals having thought disorder may have vague thinking that does not relate to the real world and also have difficulty in understanding the abstract ideas.
The thought content refers to the delusions, obsessions, preoccupied thoughts and phobias in the mind of an individual. Such thought content is established only after exploring the thoughts of a person in an open-ended conversation which should involve the salience, emotions, intensity of their ideas and the extent of their control on these thoughts (Qi, et al. 2015).
The following points should be examined to assess the disturbed thoughts of Kerrie:
Appearance: this can provide useful information about the person’s lifestyle, self-care ability, and regular living skills. Kerrie was found to have dirty and unkempt clothes which would suggest schizophrenia or depression. The clothing and accessories that the person carries may indicate the signs of personality that the person possesses. Further, she was malnourished and was found not to consume food continuously for several days. Weight loss is also an indication of chronic anxiety, depressive states of the mind, or physical illness.
The person’s behaviour is yet another important feature which provides the examiner the information about the person’s thinking ability. Her features such as facial expression, posture, body language, gestures, eye contact, arousal levels, agitated state, hyper movement, psychomotor activity, and other unusual features such as tremors are very important in accessing the disturbed thought process. The person’s mood is yet another important feature which describes the emotional experience that he/she undergoes over a period of time. Bouts of happiness or sadness and unstable mood are definitely indicative of unusual behaviours and signify some disturbance in the thought process (Steel, et al. 2014).
The person’s speech which includes the rate of speech, volume, tone, and quantity also deliver important information about their states of mind. Unusual speech is indicative of mood and anxiety disorders. The cognition levels, displayed by Kerrie, are also indicative of the abnormal thoughts and the important features to observe are the levels of consciousness, the immediate memory of the person, ability to concentrate and the individual’s orientation to reality in terms of the day, date, time, location, etc.
The person’ thoughts are also indicative of their preoccupied ideas and suicidal tendency. Kerrie’s anxiety and frightened state at the hospital was indicating her general condition. The perceptive thoughts are indicative of their thought disorders. Hallucination is a very common form of perceptual disturbance where the individual is found to speak with themselves and possess the fear of unknown objects or people.
2. Explain perception and describe the way to interpret the disturbed senses of Kerrie:
Perception is the process by which an individual recognizes and interprets the sensory stimuli and presents the same information or the environment. An individual having disturbed perceptual feelings includes hallucinations, illusions, and pseudo hallucinations. Perception involves the signals that are sent to the nervous system through stimuli generated by either physical or chemicals stimuli.
A hallucination can be described as a sensory though or the perception that occurs without any external stimuli and the subject experiences this feeling as real. Hallucinations may occur in any one of the five senses however the visual and auditory hallucinations are more common as compared to the other hallucinations. Auditory hallucinations are like psychosis where the patient hears third parson’s voice speaking to them or hear their thoughts aloud. They may also hear voices which threaten them or persuade them to commit suicide which is typically seen in cases of psychotic depression or schizophrenia (Lawrence, et al. 2013). Hallucinations may also occur in the form of commands and can be either auditory or within the person’s mind. Hallucinations may be either homicidal in nature or may compel the individual to do something that is not beneficial for the person. People who experience command hallucinations usually do not comply with those commands.
In this case, Kerrie has been heard talking to herself in her room, loudly and has also been found to shout as if on someone, however, she was alone in her room. Over the past few days, she has not consumed food or fluids enough for her survival and has also not had enough sleep. She has been found to wring her hands as if she is some danger. Out of some fear, she screamed at her father last night and suddenly stopped and went back to her bedroom. In the hospital, she shows abnormal behaviour which is indicative of disturbed senses. She has been observed talking to herself and was looking constantly at the ceiling. During the whole time, she was terrified and her pupils were dilated. She was interrupting the entire medical examination with unusual statements where she mentioned that the whole planet is falling. Also, her skin was entirely covered in sores that she was trying to pick at. She was found to giggle to herself and this was followed by sudden, vivid actions where she tries to scream loudly and covers her ears so as to block hearing of the loud noise. She was asking for forgiveness as she has heard voices telling her that ‘all the children have been hurt’. She feels responsible for this and admits that she never wanted to hurt anyone. She asks for forgiveness and falls on the floor in despair and begins to sob (Najman, et al. 2014).
Such unusual behaviour, statements, and actions indicate that her senses have been disturbed. In such a situation, it is always helpful to ask the patient about the voices that they hear. One should try to find out whose voices are being heard by the patient and ask the patient to avoid listening to those voices.
3. Describe affect and mood and explain Kerrie’s mood and range of affect:
Affect can be described as an outward expression one displays of their feelings or emotions. It can either be a smile, voice tone, laugh, frown, tear, pursed lips, crinkled forehead and furrowed eyebrows. It is the way people communicate with each other to hide their actual feelings about something. In psychology, it describes the manner in which patients behave with their psychologists to hide their actual feelings or the way they present themselves in a therapy session. After the therapy session, the psychologists always mention the details of the patient’s effect. The mood is an emotional state and it denotes the feelings that the patient describes. They have either positive or negative variation which people usually describe in terms of good mood and bad mood. Therefore mood is what the patient describes and affect is what the physician observes (Grossman and Cohen, 2017).
The mood which Kerrie exhibits is depressive in nature and she has shown characteristic feelings of anxiousness, fear, sadness, emptiness, lack of normal life routine. She has been found not to interact with anyone and has totally avoided her social contacts. She has developed feelings of guilt, helplessness, and pessimism which are making her feel responsible. She feels that she will be punished for the same and please for forgiveness (Hsieh, et al. 2015). Objectively her mood was dysphoric in nature where she has been found to display features loss of appetite, psychomotor agitation, weight loss, brooding, dysphoria, and problems in concentration. Such episodes are found to occur either in clusters or individually and may be separated by periods where they spend a normal life.
The range and intensity of affect that Kerrie displayed were blunt as there was a severe reduction in her emotional expressions and she failed to display her feelings, both verbally as well as non-verbally. Her emotional gestures were absent and there was a lack of animation in her facial expressions. Such an absolute reduction in the display of one’s feelings is usually seen in cases of schizophrenia, autism, and depression. Studies suggest that the absence of one’s feelings occurs due to the fact that there occurs a real loss of contact from the real world and the patient lives in an imaginary world where they are surrounded by auditory/visual hallucinations (Milner, et al. 2014). In the case of Kerrie, she was found to refuse to discuss her problems with her parents and she has been living an isolated life away from all her friends. She stays alone in her room and does not speak with her parents for days. While discussing the problems with Kerrie, she has been found to be speaking to herself and was terrified and responds to all the happenings at the Emergency Department. She was not comfortable to discuss the problems she was going through and tried to interrupt the examination with vague statements.
4. Describe her behaviour and appearance using examples from the case study:
Kerrie has been found to display disturbed behaviour and emotional feelings at home and at the Emergency Department. The characteristic behavior that was displayed by Kerrie includes hyperactivity which can be demonstrated by the way she continuously wrings her hand or paces within the department. She also responds to any movement within the department and she constantly gazes either at the ceiling or at the staff present there. Her mother constantly tries to console her however out of hyperactivity she is unable to sit still anytime (Brown, et al. 2013). She is also been found to display symptoms of withdrawal as she does not want to stay at the department and shrugs before entering the allotted cubicle. She also tries to maintain as much distance as possible from any kind of physical contact which the staff might attempt to make for examination. At her home, she spends all the time in her room alone and does not have any friends or social contacts left. She does not allow her parents to interfere in her life and moreover does not inform them where she goes and with whom. She also exhibits feelings of aggression where she was heard to be speaking loudly and shouting at someone in an alone room. She also screamed loudly at her father last night out of any reason. Along with this, she is distressed when she tries to scream loudly due to her pain and covers her ears to block the noise. She is also found to sob in despair as she considers herself to be responsible for hurting all the children. She displays mood swings where she is found to giggle to herself and this was followed by feelings of anger and anxiety. Her feelings of aggression can be seen by the way she picks at her skin and her entire hands are covered by sores.
Her appearance was found to be peculiar and she was dressed in dirty clothes and was barefoot. Her hair was left unkempt and looked matted and untidy. She had numerous piercings over her face at places such as eyebrow, nose, and lip. She looked tense from her expressions and was unsteady. She paced through the corridor of the Emergency department continuously and was alert to sounds or movements of any kind. She was afraid and hostile at being to the Emergency Department of the hospital and was uncomfortable seeing the daily events (Coates, et al. 2014). She was hyperactive and responded to even the slightest action or sound made by the staff. The kind of appearance she had reflected the fact that she was least bothered about herself and had no self-care instincts. She looked terrified by being at the hospital and was constantly looking either at the ceiling or at the staff present within the department.
The above assignment was the case presentation of Kerrie who was suffering from distinct symptoms of mental illness. She was presented at the hospital along with her mother for her mental state examination. In this assignment the essential components of Mental state examination are discussed such as thought form and process, perception, affect and mood as they help the practitioner to identify the illness. Further, Kerrie’s behaviour and appearance have been described in detail in this assignment.
Brown, B.M., Peiffer, J.J., Taddei, K., Lui, J.K., Laws, S.M., Gupta, V.B., Taddei, T., Ward, V.K., Rodrigues, M.A., Burnham, S. and Rainey-Smith, S.R., 2013. Physical activity and amyloid-β plasma and brain levels: results from the Australian Imaging, Biomarkers and Lifestyle Study of Ageing. Molecular Psychiatry, 18(8), p.875.
Coates, L., Haynes, K., O’Brien, J., McAneney, J., and de Oliveira, F.D., 2014. Exploring 167 years of vulnerability: An examination of extreme heat events in Australia 1844–2010. Environmental Science & Policy, 42, pp.33-44.
Grossman, S. and Cohen, A., 2017. Contributions to a gestalt quantitative research tradition: Establishing the Gestalt Mental Status Exam. Gestalt Journal of Australia and New Zealand, 13(2), p.29.
Hsieh, S., McGrory, S., Leslie, F., Dawson, K., Ahmed, S., Butler, C.R., Rowe, J.B., Mioshi, E. and Hodges, J.R., 2015. The Mini-Addenbrooke's Cognitive Examination: a new assessment tool for dementia. Dementia and geriatric cognitive disorders, 39(1-2), pp.1-11.
Lawrence, D., Hancock, K.J. and Kisely, S., 2013. The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: a retrospective analysis of population-based registers. Bmj, 346, p.f2539.
Milner, A., LaMontagne, A.D., Aitken, Z., Bentley, R., and Kavanagh, A.M., 2014. Employment status and mental health among persons with and without a disability: evidence from an Australian cohort study. J Epidemiol Community Health, pp.jech-2014.
Najman, J.M., Alati, R., Bor, W., Clavarino, A., Mamun, A., McGrath, J.J., McIntyre, D., O’Callaghan, M., Scott, J., Shuttlewood, G. and Williams, G.M., 2014. Cohort profile update: The Mater-University of Queensland study of pregnancy (MUSP). International journal of epidemiology, 44(1), pp.78-78f.
Qi, K., Reeve, E., Hilmer, S.N., Pearson, S.A., Matthews, S., and Gnjidic, D., 2015. Older peoples’ attitudes regarding polypharmacy, statin use and willingness to have statins deprescribed in Australia. International journal of clinical pharmacy, 37(5), pp.949-957.
Steel, Z., Marnane, C., Iranpour, C., Chey, T., Jackson, J.W., Patel, V. and Silove, D., 2014. The global prevalence of common mental disorders: a systematic review and meta-analysis 1980–2013. International journal of epidemiology, 43(2), pp.476-493.
Taylor, M.A., 2013. The neuropsychiatric mental status examination. Elsevier.