Mental State Examination (MSE)

The Mental State Examination (MSE) is defined as a therapeutic evaluation encompassing the methodical assessment of the patient’s psychological status (O’brien, 2017). A mental status evaluation evaluates a patient’s psychomotor behavior, speech, appearance, contemplating and perception, emotional state such as affect and mood, comprehension and thought process, knowledge, sensorium, contemplation and fixation, and memory (O’brien, 2017). The fundamental components evaluated during a mental state evaluation are appearance and behavior, mood and affect, perception, and perception (Bak, Diest, & Ruijter, 2012). It is essential to take note of the patient’s condition since this can give helpful information on the status of self-mind, day by day living aptitudes and way of life of the patient (Petrie & La Trobe University, 2010). In essence, mental status indicators are critical to record as they can give much understanding into the patient’s mental health and outlook (Eppel, 2017). Consequently, a mental status evaluation is an essential procedure in deciding a patient’s ability to make or not autonomous medicinal services choices and gives the vital help to better the patient’s welfare (Zimmerman, 2013).

The effective clinician must build up a style in which a significant part of the mental status examination is performed through generally unstructured observations made amid the standard history and physical (Cummings, 1993). The manner by which the patient relates the historical backdrop of the present problem will uncover much about outward presentation and conduct, readiness, speech, action, influence, and state of mind (Burgess, 2013). An essential strategy, at that point, in mental status testing is the inconvenience of some structure on these observations and raising them from the level of subliminal impressions to clinically helpful portrayals of conduct (Markson and Allen, 1976). The current case involves a young woman brought to the facility by her mother. She looks and behaves so hostile and disturbed. The following is an analysis of her mental status.

Question 1: Thought Form and Thought Content

In a mental state evaluation process, thought form and content are utilized to achieve a comprehension of the clients thought process, particularly how they think (frame) and what they are considering (content) (Trzepacz and Baker, 1993). In essence, the thought form is the amount, rate, rhythm and coherent intelligence of a man’s thoughts. The thought frame may incorporate exceedingly immaterial remarks, constant changes in subject and constrained or ended speech (Kaufman and Zun, 1995). Interestingly, thought content alludes to specific thought (concentrate on a particular theme), distraction or overstated concern (fixations, impulses and neurosis) and twisting or disregarding reality (fabrications, mental trips and fancies) (Cummings, 2013).

Amid Annabelle’s interview, various sentences suggest exasperated thought content, for example, ’You know isn’t that right? You know it’s in my veins!’ and ’Each one of us is falling – the entire planet is falling!’. Annabelle’s outcries are cases of unverified reasoning and are conceivably part of a deception. The thought type of such outcries is disrupted, quickly changing starting with one point then onto the next, “they’re in my veins”, “the entire planet is falling!”, Shut up shut up shut up!!” and ‘Forgive me! Forgive me!’!!“ While the particular thought changes, there is an intermittent subject to Annabelle’s thought content, grievous, liable and frightful circumstances that are outside her ability to control. It is clear in view of the insignificant themes and unverified reasoning witnessed in Annabelle’s speech that her thought content is quite disturbed. Annabelle’s thought form additionally seems aggravated as shown by the ’flight of idea’s’ she encounters and her powerlessness to concentrate on a significant theme inside the setting of the circumstance.

Question 2: Perception

Listening or hearing, is in the list the five human common senses. It entails just perceives sound (sensations) by means of the ear. In essence, hearing only is a subliminal procedure and occurs consequently. A research study paper gives a compact meaning of the contrast between listening and hearing. Listening implies being present for the patients though hearing entails being physically there with the patients (Trzepacz and Baker, 1993). So as to direct powerful undivided attention and exchange communicate with the client, a health professional should have the required listening aptitudes. Actually, there are five classes of hearing abilities; perceiving; deciphering; reviewing; and attending and watching that will be explained in connection to Annabelle’s case (Hjørland, 2007). Perception from the health professional is imperative for Annabelle’s situation as much information can be learnt essentially from watching her conduct. Watching includes giving careful consideration to what is communicated and how it is communicated (Hjørland, 2007). Non-verbal prompts, for example, outward appearance, eye to eye contact, body stance and developments convey enthusiastic and social information (Hagen et al., 2003) that can advise the clinician of Annabelle’s sentiments and enthusiastic state.

The clinician sees that Annabelle ’wringing her hands now and again’, which may indicate that she, is feeling apprehensive and restless. This is a case of perception, by giving careful consideration to Annabelle’s non-verbal signals (hand wringing), the clinician has an expanded familiarity with Annabelle’s emotions. Annabelle’s eyes ’gaze seriously either into the roof above or at staff individuals’, the clinician may translate this as an indication of doubt and suspicion. Utilizing this learning, the clinician perceives the nonappearance of trust and can address this in his reaction to come to a conclusion (Shiber and Santana, 2006).

Even though watching and translating the patient’s non-verbal signs is critical, it is similarly imperative for the clinician to give their own particular non-verbal signals for the patient to decipher (Petrie & La Trobe University, 2010). This is alluded to as attending to. A typical memory helper utilized for this is SOLER (Sit decisively, Open stance, Lean forward, Eye-contact, Relaxed) (Norris, Clark, & Shipley, 2016). Consolation, for example, calm mumbling (”Mmm“) and head gesturing is likewise used to indicate mindfulness and receptiveness, enabling the patient to feel understood. In spite of numerous strategies for support and understanding, the clinician may at present discover obstructions with specific patients (Taylor, 2013). For Annabelle’s situation, a few obstructions may incorporate the patient’s evident lack of attention to her condition, she might be unable to tune in or recognize the clinician, and for example, when she is gazing at the roof. Annabelle’s mind flights can possibly disturb or keep any compatible discussion and misshape her reactions. In sum, perception and attending are critical aptitudes in listening as they seem to be ’crucial in setting up powerful connections’ (Stein-Parbury, 2013). Utilizing listening abilities to build up a complete comprehension of Annabelle’s circumstance, the clinician can react as needs be in a way that matches the patient’s needs.

Question 3: ‘Affect’ and ‘Mood’

Mood is an unavoidable and supported feeling, subjectively experienced and revealed by an individual and saw by others. Customers ought to be urged to portray their enthusiastic state in their own particular words (Kaufman and Zun, 1995). If not immediately detailed, the questioner should expressly get some information about mood, logically utilizing more mandates addressing if important. Customers ought to be urged to write about both the force of their feeling and whether it is common for them (Strub et al., 2005. Mood is frequently depicted as euthymic, dysthymic, discouraged/miserable, glad, aloof, on edge, irate, euphoric, hyper, hypomanic (Henry et al., 2012). In portraying mood, it is likewise imperative to give an account of any related changes in vegetative capacities: vitality, hunger, charisma, and rest (Hagen, Psychotherapy.net, & Murder Incorporated Film Company, 2015). The coinciding of mood and thought content ought to likewise be noted.

Affect is the observed articulation of feeling. A man’s affective state comprises of a few segments, which are unbiasedly watched and can’t be evoked by coordinate addressing (Marcovitch, 2009). It ought to be observed all through the meeting, and its coinciding with thought content ought to be noted. Composed portrayal of affect in the psychological status examination ought to be described as far as its range, change example, force, and fittingness (National Patient safety Agency, 2014).

Annabelle when asked ‘Forgive you for what, Annabelle? What have you done?’ she looks up to the ceiling and says, ”Can’t you hear what they’re saying?! All the children have been hurt…” She then falls down and starts sobbing uncontrollably. She also exhibited a nervous tone when talking about her hallucinations and dysphoric tone when pertaining to painful events. On the other hand, even in the verge of talking about unfortunate events, she failed to pull herself back and broke down in tears.

Question 4: Annabelle’s Behaviour and her Appearance

Appearance refers to the underlying understanding into Annabelle’s appearance happens as the paramedic group arrive, discovering her sitting upright, looking stupefied and on edge with shortness of breath. It is evident that Annabelle seems upset, befuddled and on edge enough to make her wind up noticeably dyspnoeic (shortness of breath). Annabelle is a young lady with colored, chaotic and tangled hair who presents with a poor level of individual cleanliness and self-mind. Annabelle has numerous facial piercings, her pupils are to a great degree widened and her arms are canvassed in injuries. Ensuing to Annabelle’s landing in the emergency department (ED) she seems exceptionally tense and her outward appearances change quickly from grinning to panicking. Annabelle’s mother re-reported that Annabelle ’gets back home dishevelled and dirty’,’, and that she has ’lost a ton of weight’.

On the other hand, Annabelle’s behaviour is quite disturbing. Following the handover to the clinician at the doctor’s facility, it is watched that Annabelle has all the earmarks of suffering a level of psychomotor tumult as she seems to be ’extremely tense… pacing all over the passage wringing her hands’. Annabelle seems unfit to concentrate exhibited by anomalous and whimsical eye developments, ’her eyes gaze seriously either into the roof above or at staff members’. Annabelle has all the characteristics of being suspicious of and doubt staff members as she separates herself but as much as could reasonably be expected from any physical contact and goes into the room ’like she’s going to enter a trap’.

Similarly, her mother explains that Annabelle has not been in her normal state ever since she dropped out of university 12 months earlier. She claims that her daughter has gradually lost contact with almost all her friends and increasingly become separated from the real life. According to her, Annabelle currently listens to very loud music while locked up in her room, thus refusing to talk about her status with any of her parents. For the past few months, Annabelle’s behaviour has changed from bad to worse. She now spends more time indoors alone or goes out even for days without letting her parents know her whereabouts. For instance, Annabelle does not say where she is going, who accompanies her or what she is going to do. She returns home dirty and dishevelled. For this reason, she has lost a lot of weight with the past few months and sometimes does not eat for more than one day. In fact, Annabelle has been heard talking loudly to herself inside her room and has also been found shouting as though she was with someone.

Amid the interview Annabelle shouts ’They’re all around. All over the place… under my skin!’. Annabelle has all the signs of someone experiencing tactile hallucinations. She accepts there is something underneath her skin, when there is not. Annabelle additionally seems, by all accounts, to be encountering sound-related sensation (voices) without legitimate (genuine) jolt, which are sound-related visualizations. This is viewed as she gazes toward the roof shouting ‘Shut up shut up shut up !!!!!! at that point upset, continues to shout and hold her ears as though to hinder an uproarious commotion’ and besides, ’Why am I here???!!! You won’t reveal to her anything will you?’. Annabelle discusses ’her’, which might allude to her mother, yet it might likewise be alluding to another person.

Bibliography

Bak, M., Diest, R. ., & Ruijter, M. . (2012). The psychiatric interview: The mental status examination. Maastricht: Mediview.

Burgess, W. (2013). Mental status examination: 52 challenging cases, DSM & ICD-10 interviews, questionnaires & cognitive tests for diagnosis and treatment. Mental Staus Examination, 1.

Burgess, W. (2013). Mental status examination for personality disorders: 32 challenging cases, DSM-5 & ICD-10 model interviews, questionnaires & cognitive tests for diagnosis and treatment. San Bernardino, CA: publisher not identified.

Cummings, J. L. (January 01, 1993). The mental status examination. Hospital Practice (office Ed.), 28, 56-8.

Cummings, J. L. (June 24, 2015). The Mental Status Examination. Hospital Practice, 28, 56-68.

Eppel, A. B. (April 26, 2017). Mental Status Examination. The Canadian Journal of Psychiatry, 25, 2, 198-199.

Fitzgerald, N. (2016). Mental Status Examination: A comprehensive core skills guide for all health professionals. S.l.: Createspace Indep Pub.

Hagen, B., Psychotherapy.net,, & Murder Incorporated Film Company,. (2015). Conducting a mental status examination. [Mill Valley, California] : Psychotherapy.net.

Hagen, B., Murder Incorporated Film Company., University of Lethbridge., Distribution Access (Firm), & ACCESS the Education Station. (2003). Mental status assessment: Client with diagnosis of borderline personality. Bellingham, Wash.: Distribution Access.

Henry, S.G., Fuhrel-Forbis, A., Rogers, M.A.M., et al., 2012. Association between nonverbal communication during clinical interactions and outcomes and outcomes: a systematic review and meta-analysis. Patient Education and Counselling 86, 297-315.

Hjørland, B. (2007). Information: Objective or subjective/situational?. J. Am. Soc. Inf. Sci., 58:1448–1456. doi:10.1002/asi.20620

Kaufman, D. and Zun, L. (1995). A quantifiable, Brief Mental Status Examination for emergency patients.The Journal of emergency medicine, 13(4), pp.449--456.

Marcovitch, H. (2009). Cognition. In:Black’s Medical Dictionary, 42nd ed. A & C Black.

Markson, E. W., & Allen, D. F. (1976). Trends in mental health evaluation. Lexington, Mass: Lexington Books.

National Patient safety Agency, (2014). As cited inSafe handover: safe patients. London: British Medical Association, p.7.

Norris, D., Clark, M. S., & Shipley, S. (January 01, 2016). The Mental Status Examination. American Family Physician, 94, 8, 635-641.

O’brien, J. V. (April 26, 2017). Mental Status Examination. The Canadian Journal of Psychiatry, 25, 3, 275-276.

Petrie, E., & La Trobe University. (2010). Mental status examination. Bundoora, Victoria: La Trobe University, Faculty of Health Sciences.

Shiber, J. and Santana, J. (2006). Dyspnea.Medical Clinics of North America, 90(3), pp.453-479.

Stein-Parbury, J. (2013).Patient and person. 5th ed. Sydney: Elsevier Churchill Livingstone.

Strub, R. L., Black, F. W., Geschwind, N., & Strub, A. C. (2005). The mental status examination in neurology. Philadelphia: F.A. Davis Company.

Taylor, M. A. (2013). The Neuropsychiatric Mental Status Examination. Saint Louis: Elsevier Science.

Trzepacz, P. and Baker, R. (1993).The Psychiatric Mental Status Examination. 1st ed. New York: Oxford University Press.

Zimmerman, M. (2013). Interview guide for evaluating DSM-5 psychiatric disorders and the mental status examination. East Greenwich, RI: Psych Products Press.