Introduction
Mental examination is an analogue of
physical examinations or consists of a series of tests and observations of
behaviour and perception. In this essay, I have discussed the case of a young
patient named Lisa. Lisa was a young woman with psychotic symptoms. She
reported hallucinations as she heard voices called by an ugly person and
recommended that she protect herself from her boyfriend. Lisa's perception
turned out to be distorted because she could not remember her address and
previous medications. After each MSE evaluation, Lisa was referred to mental
health services for further assessment and management.
The series of observation and examination
reveals the normal or pathological behaviour of the patient (Huisingh, Wadley, McGwin, & Owsley, 2018). The structured assessment of Mental Status
Examination comprised of the description of general behaviour, appearance,
level o consciousness, motor, speech activity, thought, perception, cognition,
attitude and insight (Kinuhata, Takemoto, Senda, Nakai, Tsumura, Otoshi,
Uchimoto, 2018).
The Mental Status Examination provides a
complete assessment of the patient and provides the direction for further
assessment as well as management steps (Palsetia, Rao, Tiwari, Lodha, & De Sousa, 2018) In the current assignment, Lisa has been
found cognitively or behaviourally unstable. All the associated terminology has
been elaborated through the case of Lisa. The massive body of researchers
highlights the effectiveness of the Mental Status Examination in the
psychiatric, neurological or psychological assessment (Huisingh et al., 2018).
Body
Lisa has been seen Jennie a counsellor in
the loco drug services for the last six months. She had a first to Psychiatric
admission last years and was discarded with the antipsychotic drugs. Lisa is a
regular cannabis user and occasional spad user. She recent moves away from her
parents to live with his boyfriend, Jhonner.
The first encounter of the patient gives
the behavioural disturbances and underlying mental and emotional states
(Huisingh et al., 2018). The appearance gives the counsellor an overall
impression of the patient. The physical appearance of the patient includes
apparent vs stated age, unkempt or immaculate grooming, riotous or subdued
dress, kyphotic or erect posture, and furtive or direct eye contact ((Bigler, 2015; Grossman, & Irwin, 2016). The
current case Lisa was found to be unhygienic, hairs were uncombed. Lisa
counsellor noted that she is not looking in her usual self, normally she looks
quite smart. When the client entered the session room, he was very anxious and
reluctant to respond to the question. The counsellor noted that usually, Liza
looks smart and active, but currently, she was looking dull and in unhygienic
condition.
Furthermore, Liza sat comfortably n the
chair but found to be lost and distracted. She was wearing a black t-shirt and
trousers, and she was assessed to be non-depressed but agitated. According to
the counsellor, Liza appearance was not appropriate that can be considered as pathology.
The behaviour of the patient plays a
significant role in the assessment of Mental status examination. The verbal and
non-verbal both behaviour depict the normal or pathology in the behaviours of
the patient (Huisingh et al., 2018). The eye movement (establishing eye
contact, maintain eye contact) body posture, gesture, hand movement, and
distracted behaviour provides a basis for pathology (Grossman, & Irwin,
2016). In the above Behavioral Observation was carried out to assess the client
interest, abilities and appearance, his verbal and non- verbal cues.
Behavioural Observation is a systematic way of recording the observable
responses of behaviour (Pellering, 2014).
The rationale of Behavioral Observation
was to assess the client nonverbal behaviour, her posture gesture, hygienic
condition and how he communicates with or without verbal communication (Trzepacz, Hochstetler, Wang, Walker,
&Saykin, 2015). The client was observed during the entire session. The client was a
young woman with weak physic. She sat anxiously on a chair and continued
rubbing her arm. The content of his speech was not coherent; he was taking much
time to answer the questions and answers were very brief. In the current case,
Lisa seems restless and agitated; she was continuously fidgeting in her chair.
At times, she was a disgrace and seemed to be respondents towards unseen
stimuli. Abnormal involuntary movements have also been observed in Lisa's
behaviour. She found to be distracted by unseen stimuli. The behavioural
observation of Lisa suggested that she has abnormal and restless behaviour. The
activity level of the patient was found to be inappropriate. The findings of
the overall observation showed that he was anxious, fearful, paranoid and
hopeless about his future.
Thought content refers to the presence or
absence of obsession or delusional thinking (Huisingh et al., 2018). The
delusion refers to the belief that is not reality based, and distort the normal
thinking pattern (Bigler, 2015). Also, indicate abnormal thinking in the thinking
content of the client. The delusions are not accounted for by any religion or
culture and level of intelligence. The key element of delusion means a degree
to which a person is convinced to that belief even without actual evidence. A
person with delusion firmly believes that her delusions are real. Delusions are
neurological, medical and mental disorder oriented such as psychotic,
schizophrenic, delusional, schizophreniform or mixed psychotic disorders, mood
or and substance-induced disorder (Kertesz&Harciarek, 2014). Different
types of delusions have been reported in the literature such as jealousy,
persecution, guilt, poverty, love and nihilism (Grossman, & Irwin, 2016).
The delusion of persecutory is the most common type of delusion, in which a
person believes that the erroneously another person is trying to harm (Kertesz&Harciarek,
2014). Such as Lisa has persecutory or paranoid and delusional thinking, she
feels that Jhonner has been making plans to destroy her. She feels unsafe in
the house. She is trying to protect herself by knife and sleep in the garden
shade which is cold and dark. She feels that in all the through cameras someone
is watching her. She also heard an unusual voice.
The inability to process information
accurately results in psychotic thinking (Putcha, and Tremont, 2016). The
incorrect perception of stimuli and the relevant response considered to be a
critical psychiatric assessment (Putcha, and Tremont, 2016). Hallucinations are
the perceptual disorientation that occurs in the absence of the sensory
stimuli. The auditory, visual, tactile, gustatory, olfactory and cereal are the
basic types of hallucination and patient usually experience and report such
hallucination (Huisingh et al., 2018). The sensory system which is involved in
hallucination must be noted for risk assessment (Bigler, 2015).
Hallucinations are the most significant
perceptual disturbances, without external stimuli. The two kinds of
hallucination have been reported in the current case, i.e. auditory and visual.
In the auditory hallucination, the patient hears voices that nobody else hears,
as Lisa hears someone calls her ugly, and commands her that she should protect
her from his boyfriend, Jhonner. The visual hallucination seeing objects that
are not present, such as Lisa sees hidden cameras in the entire house.
Furthermore, Lisa was experiencing both hypnopompic and hypnagogic
hallucination that depicted she see things in awakening as well as a sleeping
state.
The behavioural observation provided the
basis for the risk assessment of Lisa. Lisa was having the fear that someone is
watching her through cameras. She was tried to protect herself from honour, his
boyfriend. She also heard voices that shooter is trying to kill her. The
psychiatrist continued the risk assessment of her behaviour and continued
further assessment questions. The clinical interview was carried out to assess
the client problem and conflicting issues which lead toward drug abuse,
paranoid thinking and hallucination (Huisingh et al., 2018). A clinical
Interview is the main tool for gathering information from client, parents, and
other informants (Bigler, 2015). Clinical Interview was done to assess the client
own insight about his illness and problems which was very helpful to understand
her problems(Grossman, & Irwin, 2016). The client had no insight about the
harms of a drug; rather it’s a source of energy for the client. The counsellor
tried to investigate the core belief behind the illusions, hallucination and
paranoid thinking of the client. It was asked by the client through history
taking if Jhonner has hurt her or someone else. The client relied upon no;
Jhonner hasn’t hurt her or even to someone else. Her denial depicted that
either she has no insight about her problem, or must be experienced
unconsciously by the Jhonner or family members. Furthermore, memory and
cognition were also found to be distorted as the client was not able to recall
the name of the medicine; she was using in the past. The Lisa reported all the
experiences, apprehensions and problems to the counsellor and it was observed
that there was well rapport built between the client and the therapist.
The results of the above risk assessment
revealed that Lisa has a speech problem. She had cognitive distortion; such as
having the inability to recall new address and previous medication. The
orientation of time, space and location where appropriate. The roots of her
paranoid thinking were baseless as it was reported by the client that Jhonner
hasn’t hurt her throughout the relationship. The client also reported that her
parents had not developed a relationship with the patient.
It was also observed that Lisa has more
inclination towards self-harm, that could be dangerous for her and the other
petioles as well. In short, speech, cognition, paranoid thinking, hallucination
and agitated behaviour were found in Lisa behaviour and cognition (Yajima, Matsushita, Sumitomo,
Sakurai, Katayama, Kanno, & Nishimura2014).
The counsellor checked and understood Lisa
problem and hypothesised that
·
A relapse of their mental illness
·
There is a risk of harm to self or others
Therefore she was recommended for further
assessment by the counsellor with the collaboration of Liza.
After completing MSC, the following was observed
·
Speech and Language: Lisa ha Speech and
language problem.
·
Mood and affect: Lisa was not depressed
but showed agitated behaviour.
·
Cognition: Lisa does not remember her new
address and medication. Orientation: the orientation of time, space and
location were appropriate. Insight and judgment. She had insight into her
illness and treatment.
Mental Health Services were contacted for
further assessment.
After the completion of mental status
examination, the counsellor asked the patient if she need help to protect
herself from the jhonner or unfamiliar voices. The Lisa reluctantly answered
that yes she needs help and want to protect her from the entire painful
situation as to sleep under the shade in the dark and cold night is hard. The
counsellor called the mental health services and reported all the symptoms to
the mental health practitioner. Furthermore, the counsellor set an appointment
with the mental health practitioner for relapse prevention, assessment and
management of the client.
Conclusion
Lisa was a young lady diagnosed with psychotic symptoms. She reported hallucination as she hears voices that someone calls her ugly and recommend her to protect herself from Jhonner. Lisa strives for protecting herself and sleeps in a garden shade with a knife. The MSE was carried out to assess her behavioural and cognitive functioning. The appearance of Lisa was reported to be unusual; her hairs were uncombed. She was fidgeting on the chair and continued rubbing her arm. She was found to be distracted for unseen stimuli. Her speech was coherent, she was taking time to give answers, and her answers were very brief. She was lost and responding unusually. Through risk, assessment t was observed that Lisa has a hallucination that someone is seeing her through hidden cameras. She also reported auditory hallucination such as someone calls her ugly and recommended her to protect him from Jhonner. She also reported that Jhonner had inserted some instrument in her stomach. Lisa's cognition was found to be distorted as she was unable to recall her new address and medication. After all the assessment of MSE, Lisa was referred to Mental Health services for further assessment and management.