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Identified and demonstrated exceptional knowledge and understanding of assessment using the relevant components of the mental state examination (MSE) how this was portrayed in the case study

  • Drawn upon excellent examples of the relevant components of the MSE from the case study to support your detailed critique
  • Identified and demonstrated a very good knowledge and understanding of assessment using the relevant components of the MSE how this was portrayed in the case study
  • Discussed various of the relevant components of the MSE from the case study to support your detailed critique
  • Identifies and demonstrated a good knowledge and understanding of assessment using the relevant components of the MSE how this was portrayed in the case study
  • Used some examples of the relevant components of the MSE from the case study to support your detailed critique
  • Identified and demonstrated a reasonable knowledge and understanding of assessment using the relevant components of the MSE how this was portrayed in the case study
  • Used general examples of the relevant components of the MSE from the case study to support your detailed critique

Overview of Mental State Examination

The present state of mind of a certain individual is observed and specifically described by a structured pattern that is commonly referred to as the Mental State Examination (MSE). This is considered as an essential criterion for clinically assessing a patient in psychiatric practice. The examination encompasses evaluation of the behaviour, appearance, attitude, orientation, mood, affect and level of consciousness of a particular individual (Feng et al. 2012).  Therefore, the MSE is considered imperative for an accurate diagnosis of the mental faculties of a person. It is generally performed when cognitive abnormalities are observed while interviewing a person or if any cortical function abnormalities arise. This examination describes thought content as the ability to maintain a directed and coherent train of thoughts. It refers to assessment of an individual’s thinking process (Larner 2012). There are several themes that are found to govern individual thoughts and perceptions. Therefore, it is necessary to have an accurate description of thought content in order to gather valuable information on the phobias, delusions, preoccupations, ideas and obsessions that are manifested by the concerned individual. It is most commonly found that people suffering from mental distress are often susceptible to experiencing fearful thoughts. These thoughts often manifest in the form of agitation, delirium and suicidal ideations that makes the individual inflict self-harm (Kaszás et al. 2012). Thus, creating provisions for an open-ended conversation will help to explore the mind and thought process of the person.

In addition, the MSE describes thought form as the way of expression of a person’s beliefs and thoughts in terms of his speech. Thus, thought form refers to the logical coherence of one’s thoughts. It involves the way of production of ideas, in conjunction with their quantity. Evaluating the logical flow of ideas helps to discern whether they are fragmented or disoriented (Oosterwijk et al. 2012). Thus, thought form helps to identify presence of echolalia (repetition of what is being said), perseveration (trouble in shifting to new ideas), and clang association (words similar in rhyming and sound follow each other). Thus, people suffering from mental difficulties often manifest derailment in the form of social withdrawal and apathy. Speech vagueness also gets emphasized by manifestation of circumstantialities and the concerned individuals fail to give specific and short answers (Akiskal 2016).


In the case scenario, the patient Annabelle is diagnosed with mental disorders in both thought content as well as thought form. She displays abnormal behaviour that is basically demonstrated by the constant fear and panic attacks (Carleton et al. 2013). She comes across as extremely agitated and afraid of some unreal events or entities. The factors that result in demonstration of such confused and fearful behaviour do not exist in the real world. She was seen continuously wringing her hands, upon admission to the emergency department. Wringing of hands usually display a worry or concern over some serious matter (Judd et al. 2012). Thus, the continuous grasping and squeezing of hands explained nervousness and agitation in the patient, probably due to fear. She was also found to change her topic of conversation, which in turn confirmed disoriented thoughts. There was a lack of logical coherence in her speech (Oosterwijk et al. 2012). The fact that she also suffers from suicidal ideations was confirmed by the sore marks on her arms (Kaszás et al. 2012). Furthermore, catastrophic thinking and being afraid of some impending danger was manifested when Annabelle displayed restlessness and suddenly started to shout and sob, during the interview. Therefore, it can be stated that her thought form and content were not under control.

Importance of Mental State Examination in Clinical Assessments

The MSE defines perceptions as the experience of a person of the outer world, through interpretation and senses. Thus, all forms of sensory experiences that are acquired by an individual are commonly referred to as perception. Abnormalities often arise in such perceptions that manifest in the form of several thought disorders such as, hallucinations, pseudo-hallucinations, delusions and illusions (Legault and Faubert 2012). Diagnosis or screening of mental abnormalities gets facilitated by manifestation of these perceptual abnormalities. Patients who are preoccupied with disordered thoughts are at an increased likelihood of suffering from hallucinations. These sensory perceptions occur when external stimuli are absent (Berking and Wupperman 2012). However, these stimuli are perceived by the patients as real. Assessment of hallucinations is of utmost importance as it helps to evaluate the risk to self as well as to surrounding people. Visual and auditory hallucinations are most commonly experienced by such people (Amad et al. 2014). Patients suffering from psychotic disorders often hear voices or commands that instruct them to perform certain tasks. Dissociative symptoms are also manifested by such patients that make them display indifference to situations, and they begin to consider the surrounding environment as unreal (McCarthy-Jones et al. 2012).

In this context, Annabelle was found manifesting hallucination symptoms in both visual and auditory forms. During the interview, she was constantly found to look up at the ceiling and suddenly began to shout. This demonstrated presence of emotional disturbances. This disoriented behaviour suggests that she was visualizing some terrifying event in front of her eyes that made her agitated and aggressive. These frightful visions resulted in development of anxiety symptoms and stress, which were further manifested in the form of continued wringing of the hands (Berking and Wupperman 2012). She was also found shouting for forgiveness during the interview. When she was persuaded to reveal the reason that makes her ask forgiveness, she said that there were several children who had been hurt. This added to her distress and she began sobbing (Amad et al. 2014). The terrified expression she demonstrated on looking up at the ceiling confirms that she hallucinated about some individual or spirit that made her afraid. Hallucinatory behaviour was further established when she blocked her ears and shouted, "You won’t tell her anything will you?”.

Annabelle also demonstrated social withdrawal as a primary symptom. On questioning her mother, it was known that social isolation developed after she dropped out from the university. This was soon followed by locking herself up in a room and speaking in a manner that suggested the probable coexistence of other objects or entities with her. Visual hallucinations made her believe that the planets were falling down upon her. These made her misinterpret the surroundings (Legault and Faubert 2012). To conclude, it can be stated that the auditory and visual hallucinations resulted in the foreboding of some unexplainable cataclysmic events that made her demonstrate emotional outburst and she became extremely afraid.  

Analysis of a Case Study

There are certain disagreements related to the description of mood and affect in the MSE. Mood is described a sustained and pervasive emotion, which is subjectively experienced. Following its experience, an individual reports these moods, which are observed by the surrounding people. Thus, the patient should describe the emotional states that are experienced in his/her own words, which will help in providing a clear explanation of the mood (Ekkekakis 2013). Thus, moods help to alter an individual’s perception about the surrounding environment. There are different terms such as, euphoric, angry, neutral, anxious, and apathetic, which demonstrate a wide range of observable moods (Farb, Anderson and Segal 2012). While the condition where an individual fails to experience pleasure sensation refers to anhedonia, people displaying an incapability of describing the mood’s subjective state demonstrate alexithymia (Cook et al. 2013). Absolute euphoria or a trance-like state (ecstasy), persistent loss of interest in daily activities (depression), stability, calm and composed behaviour, and sustained euphoria (elevation) are the other kinds of mood behaviour that can be demonstrated by an individual (Bijttebier et al. 2012).  Therefore, moods help in detection of the emotions that sustain over a long period of time.


Moreover, the MSE encompasses the concept of affect, which is the observed expression of a particular emotion that has recently been manifested. Thus, the nonverbal behavior of an individual, such as, happiness, sorrow or anxiety, conveys the apparent emotions that are labeled as affect. Hence, it can be defined as the emotional state or feeling that is inferred by an assessor, on the basis of the statements, behaviour and appearance of an individual. It helps in evaluating the appropriateness of a particular behaviour, with respect to the context (McLeod, Uemura and Rohrman 2012). It also facilitates determination of congruency of the behaviour with the though form and content of the said person. Most commonly observed affect include, anxious, depressed, euphoric and euthymic (Bora et al. 2013). While, euphoric affect is most commonly confirmed by the presence of an elevated mood, depression and apathy signify the presence of dysphoric affect. A reasonably positive and non-depressed mood is regarded as euthymic affect.

A fluctuation or sudden change was observed in Annabelle’s mood during the interview. Although she was smiling to herself at the beginning, which demonstrated a happy mood, she was found extremely distressed as the interview progressed, which was confirmed by her panic attacks and emotional outburst. Her admission to the emergency department was a fearful incident that made her display nervousness by continuously wringing her hands and pacing up and down the hospital corridor. This is confirmed by the fact that research evidences have established positive correlation between trauma, anxiety and the behavioural manifestation of pacing (Clauss and Blackford 2012). An individual resorts to this behaviour to cope with stressful conditions. She was found to get extremely frightened and alerted by all kinds of sounds around her, which in turn contributed to her violent behaviour and made her aggressive. Her sudden mood shift to grief signifies lack of congruence. Thus, it can be well understood that the thoughts and feelings that Annabelle experienced during the interview were in no way consistent with her actions (Bora et al. 2013). Furthermore, she also demonstrated a flat effect or near absence of expressed emotions when her feelings got suddenly heightened and were reduced the next moment (McLeod, Uemura and Rohrman 2012). To conclude, the sudden emotional outburst can be associated to emotional incontinence or pseudo-bulbar affect (PBA), which was characterized by her sudden emotional display of uncontrollable laughing and crying (Colamonico, Formella and Bradley 2012). Heightened fear and rage were further established by the presence of sweating arms and dilated pupils. Symptoms of restlessness were also supported by the fact that she failed to sit quietly throughout the interview.

Thought Content and Thought Form

Appearance helps in providing valuable clues related to the cognitive state, mood, and presence of persistent thought disorders, self-awareness, motor activity, and physical health. Descriptions of appearance in MSE includes unusual physical characteristics like tattoos or shaved head, obesity or thinness, hygiene and grooming, eye contact, apparent age, facial expression, and unusual clothing or make-up (Gillen 2015). Thus, it helps to determine how well groomed or dishevelled a person is. Colourful or bizarre clothing confirms that the individual is unkempt or dirty and probably suffers from mania. It also suggests possible existence of schizophrenia or severe depressive disorder. Poor care of self or ill-health is demonstrated by an apparent age that looks more than the actual chronological age.

Additionally, behaviour refers to description of the mental image of an individual. This reveals information about the muscle strength, mood, energy levels and general medical conditions of the person.  Behaviour is generally expressed by a person’s gestures and mannerisms and is most commonly described by abnormalities in arousal and activity levels (Kessler et al. 2014). An observation of the patient’s eye contact and gait also helps to establish the behaviour. Display of catatonia (psychomotor immobility that is manifested by stupor) and tics (repeated non-rhythmic muscular movements) are manifestations of abnormal behaviour (Keyes et al. 2012). Abnormalities in movements such as, choreoathetoid, choreiform and athetoid movements are also essential aspects of an individual’s behaviour. Delusions or hallucinations are demonstrated when an individual shows repeated side glancing (Akiskal 2016). Autism or depression is also confirmed by the absence of adequate eye contact in the individual.

Several abnormalities were manifested in Annabelle’s behaviour during the interview process. Upon admission to the hospital she was found in a pair of dirty jeans and walked barefoot. There were many piercings in her eyebrows, nose and the lips. Her hair was dyed pink and blue. This added to her dishevelled and dirty look (Gillen 2015). Annabelle was found restless and failed to sit quietly for a while. A disorganized gait was also observed. Her recent loss of weight suggested that her diet lacked adequate nutrients and she suffered from malnutrition. This can be correlated with presence of depressive symptoms (Halfon, Larson and Slusser 2013). Reports from her mother about keeping a dirty room also confirms presence of poor hygiene. Abnormal functioning of the higher mental faculties was portrayed by her hostile and aggressive behaviour. Thus, there was a total lack of contact with reality (Hasan et al. 2013). To conclude, it can be stated that the psychotic disorders that Annabelle was suffering from created hindrances in her emotional behaviour.

Perceptions

References

Akiskal, H.S., 2016. The mental status examination. In The Medical Basis of Psychiatry. Springer New York, pp.3-16.

Amad, A., Cachia, A., Gorwood, P., Pins, D., Delmaire, C., Rolland, B., Mondino, M., Thomas, P. and Jardri, R., 2014. The multimodal connectivity of the hippocampal complex in auditory and visual hallucinations. Molecular psychiatry, 19(2), pp.184-191.

Berking, M. and Wupperman, P., 2012. Emotion regulation and mental health: recent findings, current challenges, and future directions. Current opinion in psychiatry, 25(2), pp.128-134.

Bijttebier, P., Raes, F., Vasey, M.W. and Feldman, G.C., 2012. Responses to positive affect predict mood symptoms in children under conditions of stress: A prospective study. Journal of Abnormal Child Psychology, 40(3), pp.381-389.

Bora, E., Harrison, B.J., Yücel, M. and Pantelis, C., 2013. Cognitive impairment in euthymic major depressive disorder: a meta-analysis. Psychological medicine, 43(10), pp.2017-2026.

Carleton, R.N., Fetzner, M.G., Hackl, J.L. and McEvoy, P., 2013. Intolerance of uncertainty as a contributor to fear and avoidance symptoms of panic attacks. Cognitive behaviour therapy, 42(4), pp.328-341.

Clauss, J.A. and Blackford, J.U., 2012. Behavioral inhibition and risk for developing social anxiety disorder: a meta-analytic study. Journal of the American Academy of Child & Adolescent Psychiatry, 51(10), pp.1066-1075.

Colamonico, J., Formella, A. and Bradley, W., 2012. Pseudobulbar affect: burden of illness in the USA. Advances in therapy, 29(9), pp.775-798.

Cook, R., Brewer, R., Shah, P. and Bird, G., 2013. Alexithymia, not autism, predicts poor recognition of emotional facial expressions. Psychological Science, 24(5), pp.723-732.

Ekkekakis, P., 2013. The measurement of affect, mood, and emotion: A guide for health-behavioral research. Cambridge University Press, pp.33-52.

Farb, N.A., Anderson, A.K. and Segal, Z.V., 2012. The mindful brain and emotion regulation in mood disorders. The Canadian Journal of Psychiatry, 57(2), pp.70-77.

Feng, L., Chong, M.S., Lim, W.S. and Ng, T.P., 2012. The Modified Mini-Mental State Examination test: normative data for Singapore Chinese older adults and its performance in detecting early cognitive impairment. Singapore Med J, 53(7), pp.458-462.

Gillen, M.M., 2015. Associations between positive body image and indicators of men's and women's mental and physical health. Body Image, 13, pp.67-74.

Halfon, N., Larson, K. and Slusser, W., 2013. Associations between obesity and comorbid mental health, developmental, and physical health conditions in a nationally representative sample of US children aged 10 to 17. Academic pediatrics, 13(1), pp.6-13.

Hasan, Y., Bègue, L., Scharkow, M. and Bushman, B.J., 2013. The more you play, the more aggressive you become: A long-term experimental study of cumulative violent video game effects on hostile expectations and aggressive behavior. Journal of Experimental Social Psychology, 49(2), pp.224-227.

J Larner, A., 2012. Mini-Mental Parkinson (MMP) as a dementia screening test: comparison with the Mini-Mental State Examination (MMSE). Current aging science, 5(2), pp.136-139.

Judd, L.L., Schettler, P.J., Akiskal, H., Coryell, W., Fawcett, J., Fiedorowicz, J.G., Solomon, D.A. and Keller, M.B., 2012. Prevalence and clinical significance of subsyndromal manic symptoms, including irritability and psychomotor agitation, during bipolar major depressive episodes. Journal of affective disorders, 138(3), pp.440-448.

Kaszás, B., Kovács, N., Balás, I., Kállai, J., Aschermann, Z., Kerekes, Z., Komoly, S., Nagy, F., Janszky, J., Lucza, T. and Karádi, K., 2012. Sensitivity and specificity of addenbrooke’s cognitive examination, mattis dementia rating scale, frontal assessment battery and mini mental state examination for diagnosing dementia in Parkinson’s disease. Parkinsonism & related disorders, 18(5), pp.553-556.

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Keyes, C.L., Eisenberg, D., Perry, G.S., Dube, S.R., Kroenke, K. and Dhingra, S.S., 2012. The relationship of level of positive mental health with current mental disorders in predicting suicidal behavior and academic impairment in college students. Journal of American College Health, 60(2), pp.126-133.

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McCarthy-Jones, S., Trauer, T., Mackinnon, A., Sims, E., Thomas, N. and Copolov, D.L., 2012. A new phenomenological survey of auditory hallucinations: evidence for subtypes and implications for theory and practice. Schizophrenia bulletin, 40(1), pp.231-235.

McLeod, J.D., Uemura, R. and Rohrman, S., 2012. Adolescent mental health, behavior problems, and academic achievement. Journal of health and social behavior, 53(4), pp.482-497.

Oosterwijk, S., Lindquist, K.A., Anderson, E., Dautoff, R., Moriguchi, Y. and Barrett, L.F., 2012. States of mind: Emotions, body feelings, and thoughts share distributed neural networks. NeuroImage, 62(3), pp.2110-2128.

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