Mental Health Status Assessment

Mental Status
Part A: Case Study, Mental Status Checklist, Narrative, Sample of MSE, BDI, BAI
Case Study
Barbara Allen (BA), 39, a female professor at a local university, is brought by the partner who fears that the BA is schizophrenic. BA demonstrates paranoia about what the nurses and doctors and doing and keeps saying that she is being sabotaged by her enemies at her workplace. BA appears to refuse to answer questions initially, but when she does speak, she exhibits disordered thinking and confused speech. Her train of thought rambles briefly and incoherently between ideas. She shows an inability to concentrate; her face expresses a great deal of pain and anguish over her awareness of this inability. She says she does not know what is wrong with her intermittently while also saying that “they” are out to get her, while rising out her seat. Her partner tries to comfort her but by the end of the presentation, BA requires restraints. She “sees” on of “them” at the door and alternately in the room as well as something ominous on the ceiling over her, which causes her to launch into a fit of hysterics. Her partner says that this has been occurring off and on for the past two years but that it has worsened during the past six months because of some stress in her workplace. Diagnosis is schizophrenia.
Word Count: 210
Mental Status Checklist
General appearance—disheveled
Behavior—erratic
Thought process and content—has no consistent train of thought; content is incoherent, rambling, distrustful, paranoid, hallucinatory
Affect—patient requires restraint
Impulse control—poor
Insight—alternating between aware and unaware of self
Cognitive functioning—poor
Intelligence—evident from what partner says but not displayed to any great degree by patient
Reality testing—alternating with pass and failure
Suicidal or homicidal ideation—none
Judgment—poor, hallucinatory, paranoid
Narrative: See Appendix
Sample MSE
The Mental Status Exam found at:
https://athealth.com/wp-content/uploads/2014/03/Mental_status_B8506_03-14.pdf
is similar to the one provided by Sands and Gellis (2012) in the textbook. It provides examples of the type of terminology to use when filling out the examination.
BAI and BDI
The Beck Anxiety Inventory is available at: http://bluemtassociates.com/wp-content/uploads/2011/12/Beck-Anxiety-Inventroy.pdf. The BDI is available at: https://www.psychcongress.com/saundras-corner/scales-screenersdepression/beck-depression-inventory-ii-bdi-ii.
Two reasons self-assessments are beneficial is that they allow the care provider to see the extent to which the patient is aware of symptoms and the assessment also helps the patient to think more about symptoms. So the assessment raises awareness of what the patient is experiencing for both the patient and the provider. Limitations of self-assessments are that they tend to be too subjective, as they are conducted by the patient, and so data is not going to be entirely objective. Likewise, the patient may alter responses out of fear of being perceived as weak.
Part B: Paper
Conducting assessments of clients and patients is required of HUS professionals in order to have a firm idea of the issues and problems troubling the client or patient. In this paper, the reasons that assessments are important tools for HUS professionals will be examined. The merits of conducting an MSE and the value of completing a narrative MSE will also be examined. The rationale explaining the MSE chosen will also be supplied and the reasons that HUS professionals need to comprehensively assess clients in order to properly assist them and why this means they can benefit from using a variety of assessments will be discussed. Finally, a detailed explanation of the reasons the MSE/Mental Status Checklist and other assessments are valuable tools and a detailed discussion of additional important and necessary information that needs to be collected in order to complete a comprehensive assessment of a client so that a reasoned and supported plan of action can be determined will be provided. Specifically, the diagnosis used in my case study will be used as a reference point.
The importance of using assessment in diagnosis and treatment planning for mental health clients in HUS professional settings is based on the idea that the clearer the picture and understanding of the patient’s issues, the more exact the diagnosis can be and the more robust a treatment plan can be developed (De Los Reyes et al., 2015). As Sands and Gellis (2012) point out, the mental health assessment provides data that can be cross-referenced with the DSM-V to allow a suitable diagnosis to be delivered based on the evidence obtained from the assessment. Treatment, then, is based on the diagnosis and formulated according to the needs of the patient.
The merits, in particular, of conducting an MSE are that it is a “key component of a complete neurologic examination” as Grossman and Irwin (2016) point out. It provides greater understanding of the components of the patient’s cerebral activity and which components are affected most by the disorder, and what that means in the larger context of inputs obtained from the patient and other providers of data. The value of completing a narrative MSE is that it puts in more vivid detail the actual experience of meeting with the patient so that the reader can obtain a better understanding in concrete terms and examples of how the patient exhibited specific symptoms. It is more objective and less subjective overall.
Three reasons I chose the MSE provided by LaBruzza in the DSM is that (a) it gives appropriate points for guiding the assessment process, (b) it provides an example of how the process should be employed, and (c) it is extremely thorough and leaves nothing out that might possibly add to the assessment. As Grossman and Irwin (2016) note, the MSE should provide key information that can be used to obtain an overall adequate assessment of the patient. The MSE I have chosen has a lengthy outline to follow and covers extensively several different components that help to develop a good picture of the patient’s mental health. Developing this picture is the most important step in diagnosing and treating the patient (De Los Reyes et al., 2016).
HUS professionals need to comprehensively asses clients in order to properly assist them because without a comprehensive assessment, the assistance given is based on an incomplete picture of the patient’s problems and issues and thus will not be holistically helping the patient (De Los Reyes et al., 2016). The assessment has to give a complete picture—but because no single assessment is perfect, using multiple assessments is a recommended method (Grossman & Irwin, 2016). Multiple assessments allow the HUS professional to develop a picture of the patient from various perspectives and approaches. For example, the self-assessment can be coupled with the HUS professional’s MSE to obtain a better idea of the patient’s own sense of self or how the patient is experiencing the issues. Different MSE’s moreover can help to fill in any assessment gaps so that a complete picture is used when diagnosing and treating the patient.
The MSE/Mental Status Checklist and other assessments are valuable tools but only provide some of the important components of a comprehensive assessment. It is also important to obtain a mental health history of the patient so that it can be seen what issues have troubled the patient in the past, whether this is a reoccurrence of an old problem, and so on (Marenco & Weinberger, 2000). A family history is also helpful, as are other input streams from other people who know the patient: they can provide a perspective on the problem as well. In the diagnosis of my case study, the inputs of the patient’s partner were helpful, especially as he was the one who brought her in and helped to provide context to her issues. From him we learned that she was a teacher, that she had been having these symptoms for at least 6 months, and that because of this she fit the criteria of the DSM-V for schizophrenia. Without his inputs, the right diagnosis would have been much more difficult to make.
References
De Los Reyes, A., Augenstein, T. M., Wang, M., Thomas, S. A., Drabick, D. A., Burgers,
D. E., & Rabinowitz, J. (2015). The validity of the multi-informant approach to assessing child and adolescent mental health. Psychological Bulletin, 141(4), 858.
Grossman, M., & Irwin, D. J. (2016). The mental status examination in patients with
suspected dementia. Continuum: Lifelong Learning in Neurology, 22(2), 385.
Leucht, S., Cipriani, A., Spineli, L., Mavridis, D., Örey, D., Richter, F., Samara, M.,
Barbui, C., Engel, R.R., Geddes, J.R. and Kissling, W. (2013). Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis. The Lancet, 382(9896), 951-962.
Marenco, S. & Weinberger, D. (2000). The neurodevelopmental hypothesis of
schizophrenia: Following a trail of evidence from cradle to grave. Development and Psychopathology, 12(3): 501-527.
Sands, R. & Gellis, Z. (2012). Clinical Social Work Practice in Behavorial Mental
Health, 3rd edition. Pearson Publishing
Turkington, D., Kingdon, D., & Turner, T. (2002). Effectiveness of a brief cognitive—
behavioural therapy intervention in the treatment of schizophrenia. The British Journal of Psychiatry, 180(6), 523-527.
Zink, M., Englisch, S., & Meyer-Lindenberg, A. (2010). Polypharmacy in
schizophrenia. Current Opinion in Psychiatry, 23(2), 103-111.
Appendix: Narrative
General Appearance and Attitude
Barbara is tall but frumpy in appearance. She is 39 and her hair is long with strands of gray. Her hair is in a disheveled French bun. She wears glasses, but removes them frequently as though she cannot decide whether she sees better with them on or off. Her attitude is like that of someone who does not trust those around her.
Behavior and Motor Activity
Barbara’s eyes darted back and forth and are not restful. There was a great deal of nervous energy about her, which worsened into hysteria by the end of the presentation. She could not sit still for very long and soon needed to be restrained.
Speech and Language
Barbara spoke confusedly and could not control or command her native language, English. Her thoughts were jumbled and incoherent.
Feeling, Affect, and Mood
Barbara came across as someone trying to be in control but failing miserably. She did not like that she was the subject of scrutiny. She felt that others were trying to harm her. She demonstrated paranoia and hallucination, seeing people who weren’t there and suspecting the nurses and doctors of being against her. She was finally irritated to the brink of hysteria.
Thought Content and Processes
Barbara demonstrated incoherent thinking. She could not say what her job at work was or who was after her, just that someone was. She could not answer questions and could not state a complete thought. She muttered to herself constantly.
Intelligence and Cognition
Barbara’s partner explained that she was a teacher. At one moment, she chimed in that she was a professor of politics and that she had to prepare for midterms before Dr. Schultz stole her chair. Other than that, she did not show awareness of who are where she was.
Perception or Sensory Experiences
Barbara perceived people and things that were not there. Some hallucination on the ceiling frightened her into a fit of hysteria. This was consistent with her overall paranoia.
Impulsivity
Barbara was disoriented and distracted as impulses randomly came to her and she responded to them. She seemed connected to and controlled by some inner rhythm in her head.
Judgment and Insight
Barbara could not discern that we were there to help or that her partner was concerned. She alternated between being aware of her condition and being unaware that she had any condition at all.
Plan of Action
Patient requires restraints initially and a neuroleptic to stabilize mood. This is an antipsychotic drug that can calm her down so that a proper discussion can be had with her. As Leucht, Cipriani, Spineli et al. (2013) show, there are a number of neuroleptics available for treating schizophrenia. Another option is polypharmacy, if a co-morbidity is found (Zink, Englisch & Meyer-Lindenberg, 2010). Cognitive behavioral therapy is recommended as well once the patient is in a better mind frame for engaging with a counselor (Sands & Gellis, 2012; Turkington, Kingdon & Turner, 2002).