The Mental State Examination


Case Study

Nuchada Srisittipoj


Tutor names: Ben McGarry and Deb Hunter

Word count:

Q1) The Mental State Examination – 253 words

· Appearance & behaviour

· Appearance

· Motor behaviour

· Attitude to situation and interviewer

Tom is 52-year-old Caucasian man. He was dressed in the same stained black shirt and pants as the previous visit. He appeared dishevelled and had tattoos on his arms. He had no eye contact; sitting facing away from the interviewing nurse. He appeared distracted during the conversation.
· Speech form

· Rate

· Volume

· Quantity of information

· Speech content

· Disturbance of meaning

· Disturbance of language

He had a poverty of speech as his responses were brief and monotone. He frequently paused mid-sentence and required questions to be repeated several times. There was no disturbance in meaning or language.
· Mood and Affect

· Mood

· Affect

· Congruency

He reported his mood as low. His affect was blunted and restricted in range. His mood and affect were congruent.
· Form of Thought

· Excess, absence, quality of thought

· Continuity of ideas

His form of thought was tangential. His responses were irrelevant to the questions. The continuity of ideas was not detected.
· Content of Thought

· Delusions

· Suicidal thoughts

· Other

There were no obvious delusions. He had suicidal thoughts.
· Perception

· Hallucinations

· Illusions

· Depersonalisation/derealisation

He reported experiencing auditory hallucinations; voices telling him to stay at home and not to trust anyone, and that he was “worthless” and “not good enough for other people.”
· Sensorium and Cognition

· Level of consciousness

· Memory:

· Orientation.

· Abstract thinking

He was conscious. He was able to engage in the assessment. His memory, orientation or abstract thinking were not observed.
· Insight & Judgement

· Extent of individual’s awareness of the problem

· Can they make rational decisions

He had poor insight as he did not recognise the nature of his disorder and did not feel as though he needed antipsychotic medications. His judgement was good as he accessed support and accepted referral to the hospital.
Risk Assessment

· Potential for harm to self

· Potential for harm to others

· Potential for absconding

He expressed ideation of self-harm and planned to act if having access to do so. There were no themes of wanting to harm others expressed. He had a low risk of absconding.

Q2) Clinical Formulation – 213 words

Summarize the pertinent information from case study
Presenting factors The local community mental health team has referred Tom to the hospital because of his low mood, poor concentration, auditory hallucinations and suicidal ideation.
Precipitating factors He has a diagnosis of schizophrenia. He self-ceased clozapine five days ago, claiming that it caused constipation and that he did not feel the need for antipsychotic medications. He has been hearing voices telling him to stay at home and not to trust other people.
Predisposing factors He has a family history of mental illness; his mother was diagnosed with schizophrenia and died from a heart attack; his aunt has bipolar affective disorder. He has a relationship breakdown with his wife and has no contact with his daughter or any other family members. He has a history of using amphetamines and heroin in his 20s. He last used methamphetamines two months ago. He is cognitively impaired, resulting from birth trauma.
Perpetuating factors Having been diagnosed with schizophrenia and hearing voices may cause him to isolate himself at home and make him avoid social situations. He is embarrassed by his cognitive impairment. He has minimal social support. He lacks motivation and is unemployed.
Protective factors He seeks help from the health care services and has good support from his care coordinator and local community mental health team, who brought him to the hospital.

Q3) Schizophrenia is a severe psychotic disorder which has a significant impact on how people live their lives because it affects a person’s ability to think, feel, perceive reality, and interact with others (Barut et al., 2016, p.1). The provision of a therapeutic relationship would be a priority for nurses when working with Tom as strong therapeutic alliance can lead to better patient health outcomes including symptom severity, hospital admissions, and increased adherence to medications and treatment. (Mucci et al., 2020, para 8). One of the strategies as part of the person-centred care to develop such relationship is to establish trust and work with respect (Goulding et al., 2018, para 8). The nurses should take the initiative to get to know the patient by introducing themselves. By getting to know one another and discussing about everything together, mutual trust can then be developed. (Molin et al., 2016, para 22). It is also crucial to ensure that the patient feels safe and comfortable so that he would open up and share his concerns. When the nurses have a thorough understanding of his needs and perspectives, they would then be able to provide him with the care he requires (Reynolds and Scott, 1999, as cited in Moreno‐Poyato et al., 2021, para 14). Some patients claim that they are not included in decision-making processes and that they are treated disrespectfully as if they were children (Molin et al., 2016, para 14). Such actions should be avoided as the nurses must create a culturally safe environment where patients and staff have equal power and where there is no denial of a person’s identity or needs (Cox et al., 2021, para 37-38). It is important to have mutual respect and engage the patient in an open communication so everyone can learn together with dignity and reflectively listen to one another in order to effectively respond to the patient’s need (Poon and Lee, 2019, para 7-9). – 320 words


4. Nursing care plan [700 words +/- 10%] Develop a nursing plan of care for the individual in the case study. Base your plan of care on information identified in your mental state examination, including your risk assessment and information identified in your clinical formulation. – List 2 priority problems in your nursing plan of care – For each priority problem, identify and describe one evidence-based (nonpharmacological) nursing intervention to address them. (Each intervention must identify how it will address the priority care area within a recovery orientated framework). – Identify what assessment data would indicate the interventions are positively impacting the individual in the case study. Academic paragraphs integrating evidence-based literature are expected.!\ ข้อ 4

Reference list

1 Barut, J. K., Dietrich, M. S., Zanoni, P. A., & Ridner, S. H. (2016). Sense of belonging and hope in the lives of persons with schizophrenia. Archives of Psychiatric Nursing, 30(2), 178-184.

2 Mucci, A., Kawohl, W., Maria, C., & Wooller, A. (2020). Treating schizophrenia: Open conversations and stronger relationships through psychoeducation and shared decision-making. Frontiers in Psychiatry, 11, 761. DOI: 10.3389/fpsyt.2020.00761

3 Goulding, A., Allerby, K., Ali, L., Gremyr, A., & Waern, M. (2018). Study protocol design and evaluation of a hospital-based multi-professional educational intervention: Person-Centred Psychosis Care (PCPC). BMC Psychiatry, 18(1), 1-8.

4 Molin, J., Graneheim, U. H., & Lindgren, B. M. (2016). Quality of interactions influences everyday life in psychiatric inpatient care—patients’ perspectives. International journal of qualitative studies on health and well-being, 11(1), 29897.

5 Moreno‐Poyato, A. R., Rodríguez‐Nogueira, Ó., & MiRTCIME. CAT Working Group. (2021). The association between empathy and the nurse–patient therapeutic relationship in mental health units: A cross‐sectional study. Journal of Psychiatric and Mental Health Nursing, 28(3), 335-343. DOI: 10.1111/jpm.12675

6 Cox, L., Taua, C., Drummond, A., & Kidd J. (2021). Enabling cultural safety. In K. Foster, P. Marks, A. J. O’Brien & T. Raeburn (Eds.), Mental health in nursing: Theory and practice for clinical settings (ANZ ed – 6th ed, pp. 49-83). Elsevier

7 Poon, A. W. C., & Lee, J. S. (2019). Carers of people with mental illness from culturally and linguistically diverse communities. Australian Social Work, 72(3), 312-324.

Week 5 ข้อ 4!!!!!!!

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