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The Mental Status Examination (MSE)

Discuss about the Holistic Assessment and Planning for Bipolar Disorder.

In the presented case study, the 42 years old male patient experienced bipolar disorder manifested with the manic episode. The reason for patient’s admission in the medical facility attributes to his psychological outbursts and aberrant behavior that eventually resulted in his transfer to the mental health setting by the local police. Patient’s clinical history revealed the elevated intensity of his psychosocial deterioration warranting the administration of person-centered, holistic and culturally appropriate nursing care interventions for the systematic enhancement of his psychosocial outcomes. The systematic analysis of this case study includes the description of the mental status examination, clinical formulation table, nursing plan, clinical handover, pattern of therapeutic relationship with the treated patient, cultural safety convention and recovery-oriented nursing care interventions. The case analysis considered the conventions of cultural safety that requires implementation for the enhancement of the mental health of the admitted patient. The barriers to the establishment of mental well-being as well as the key-mental issues of the patient are discussed in length in accordance with the standards of mental health practice.

Attributes

Description

Level of consciousness

Patient appeared occupied with uncontrolled emotions outside the field of his consciousness. His level of his emotional activation and behavioral imbalance was evident by pressure of speech and irrational thoughts (Lee, Kim, & Lee, 2016).  

Appearance and general behavior

Patient presented in shorts and a bright multi-colored shirt. He appeared overwhelmed and influenced with positive emotions.

Speech and motor activity

Patient exhibited the pattern of abrupt conversation and severe mood variability that evidently indicated his motor hyperactivity pattern (Krane-Gartiser, et al., 2016).

Affect and mood

Patient appeared in a dysregulated mood as well as euthymic state, reflected by his functional disturbances (Kumar, Sinha, & Mondal, 2016).

Thought and perception

Patient exhibited the pattern of disturbed thought process reflected by the unscrambling of negative sentences that evidentially indicated the existence of his negative cognition (Miklowitz, Alatiq, Geddes, Goodwin, & Williams, 2010).

Attitude and insight

Patient’s stereotypical attitude was exhibited the pattern of his aggressive, illogical and dangerous behavior. Patient’s manic state was indicative of his unmet personal needs (Hajda, et al., 2016). Patient exhibited impaired insight substantiated with the state of hypersexuality, humor, euphoria and grandiosity (Cassidy, 2010).

Attention 

The patient appeared influenced by the pattern of sustained attention interrupted by euthymic periods, thereby indicating his cognitive vulnerability (Ancín, et al., 2010).

Language 

Patient reportedly made personal and offensive comments to the medical staff and appeared violent and loud in speech.

Memory 

Patient reportedly exhibit the pattern of memory loss during MSE

Constructional ability and praxis 

Normal

Abstract reasoning 

Normal

Attributes

Biological

Psychological

Social

Predisposing

Patient did not exhibit family history of any psychological disorder.

Unremarkable family history of any psychological stress.

Patient did not experience any social manifestation.

Precipitating

No known history of utilization of psychotropic drugs. However, the state of patient’s sleeplessness increased his psychological stress and disrupted the sleep physiology. This psychosomatic disturbance appeared to precipitate his bipolar disorder.

Patient experienced the pattern of distress under the influence of psychosocial circumstances. His desire of gaining sexual gains and false claims apparently exhibited the state of his uncontrolled emotions that proved to be the precipitating factors of his bipolar manifestations.

Patient experienced the risk of losing his present job because of recession and major restructuring in his company

Perpetuating

No apparent perpetuating factor noticed during the clinical investigation.

Inconsistent insight and aberrant behavior. The state of patient’s euphoria and illusion substantially perpetuates his bipolar manifestations.

Emotional and physical distances from the spouse. The absence of a strong family support system appeared to be the perpetuating factor of patient’s bipolar complications.   

Protective

No apparent protective factor recorded during the clinical investigation.

Patient appears educated with a well-to-do social and professional background.

Stable pattern of the social circle and relationship with spouse.

Nursing Care Needs

Explanation

Nursing Intervention

Rationale

Ineffective coping and absence of self-esteem

The pattern of euphoria and abrupt behavioral pattern exhibited by the patient indicates the state of his mental imbalance as well as disturbance of thoughts that significantly perpetuate his bipolar disease complications. Resultantly, patient experiences reduction in self-esteem and fails to cope with the emotional inconsistencies. Resultantly, these psychosocial deficits require systematic mitigation on highest priority.  

The nurse professional requires undertaking systematic exploration of patient’s perceptions and beliefs, economic circumstances, problem solving skills and deteriorated self-concept. Accordingly, the nurse needs to administer various physical and mental interventions for encouraging patient’s participation in various social activities like exercise, outing and excursion.  

The emotional and psychosocial interventions substantially improve coping skills and enhance the pattern of patient’s self-esteem across the community environment (Labrague, McEnroe-Petitte, Al , Fronda , & Obeidat, 2017).

Self-directed risk of aggression, violence and resultant injury

Patient’s manic state substantiates the pattern of his irritation, mood deterioration, anger and frustration. Resultantly, the patient remains occupied with the offensive tendency of attacking himself or other people in his immediate surroundings. Therefore, this psychological condition requires mitigation on highest priority. 

The nurse professional requires administering cognitive behavioral therapy (CBT) for controlling the state of patient’s self-directed violence.

CBT proves to be a highly influential technique requiring administration for controlling the pattern of patient’s self-directed aggression and the resultant risk of trauma (Chen , et al., 2014). 

Luis is a 42 years old male who is a known case of bipolar disorder and admitted to the mental health facility because of his manic episode. The patient experiences the state of mental inconsistency substantiated by the pattern of his behavioural and emotional imbalances and pressured speech pattern. The serious and abrupt mood variations of the patient are indicative of his negative emotional pattern and facilitate the pattern of his aggressive and violent behaviour. The patient appears euthymic and focuses too much on his self-perceived notions. His deleterious thoughts evidentially elevate the risk of self-inflicted injuries. The patient lacks effective coping skills warranted for dealing with his psychosocial circumstances and exhibits diminished pattern of self-esteem. He does not exhibit any family history of psychological disorder and remains socially connected with his friends and peers. The marital relationship of the patient with his wife remains at risk because of his false apprehensions and abnormal behavior. Patient needs to comply effectively on the prescribed medications and requires regular nursing care for controlling his psychological symptoms.

The nurse professional requires establishing the pattern of a therapeutic alliance with the treated patient in the context of improving the level of his trust, confidence and satisfaction on the recommended psychotherapeutic interventions (Sylvia, et al., 2013). In the presented clinical scenario, the nurse professional needs to identify the individual perceptions, culture, concerns, beliefs, difficulties, treatment challenges and environmental constraints faced by the patient while configuring a protective environment. Accordingly, nurse professionals need to dominate the thought process of the patient with the utilization of motivational interventions in the context of overcoming his psychosocial deficits and associated mental manifestations (Manetta, Gentile, & Gillig, 2011). Registered nurse understanding the pattern of patient’s resistant behavior and psychosocial conflicts through the utilization of a therapeutic relationship. The nurse professional must administer a therapeutic dialogue with the treated patient in the context of evaluating the causative factors of his behavioral disruptions and enhancing his compliance to the recommended therapeutic interventions. The nurse professional requires understanding the pattern of patient’s violent behavior and his individualized psychosocial requirements through the systematic utilization of therapeutic communication. The assessment of patient’s dangerous indicators, safety risks, social support system, opinions and strengths are highly required by the nurse professional in the context of administering holistic healthcare interventions for reducing the risk of self-inflicted injuries (Usta & Taleb, 2014). The nurse professional requires utilizing therapeutic communication for the effective administration of cognitive behavioral intervention to the treated patient (Ardito & Rabellino, 2011). The cognitive intervention with the configuration of the therapeutic relationship assists the nurse professional in reducing the orientation of the treated patient towards practicing violent approaches that substantially decrease the risk of experiencing self-inflicted injuries.

Clinical Formulation Table

Culturally safe nursing interventions require utilization with the objective of preserving the beliefs and practices of the treated patients while effectively including them in the process of their medical decision-making (Vogel, 2015). In the presented case scenario, the patient might prove to be overenthusiastic in terms of disclosing personal matters in front of public. Dysfunctional beliefs of the patient might also prove to be the greatest barrier in administering goal oriented nursing care interventions in the mental healthcare setting (Geddes & Miklowitz, 2013). The nurse professional in the presented case scenario would require developing the pattern of cultural connectedness with the treated patient. This cultural connectedness is evidentially warranted for the systematic administration of culturally competent biopsychosocial interventions in the context of acquiring the desirable treatment outcomes. In the presented case scenario, the nurse professional needs to consider the cultural background of the treated patient for customizing the nursing interventions in accordance with his individualized requirements and self-care needs. Accordingly, the nurse professional would enhance the activities of daily living of the treated patient while effectively increasing his trust and confidence on the recommended psychosocial and therapeutic remediation. This will substantially influence patient’s thought process and assist in reducing the intensity of his bipolar manifestations.

The recovery-oriented nursing care model effectively considers entire aspects of patient’s healthcare with the objective of developing the pattern of self-sufficiency and self-efficacy in the treated patient (Cleary, Lees, Molloy, Escott, & Sayers, 2017). The nurse professional requires exploring the social support systems of the treated patient (in the presented case scenario) with the objective of enhancing the power of patient’s medical decision-making. The registered nurse needs to increase the confidence of the treated patient and develop the elements of self-confidence, accountability and reliability with the systematic utilization of value-driven behavioral strategies (AGDOH, 2017). The nurse professional requires undertaking the systematic evaluation of the pattern of patient’s psychological strengths and weaknesses as well as social engagement and familial controversies. The assessment of these attributes is necessarily required for enhancing the pattern of patient’s positive belief and adding value and meaning in his life to the desirable extent (AGDOH, 2017). The utilization of person-centered, holistic and culturally appropriate nursing care interventions is necessarily required for enhancing the pattern of patient’s individual autonomy for improving the pattern of his self-perception and associated psychosocial outcomes. The development of a positive healing culture for the treated patient is highly warranted for improving his speech and communication pattern, rights and attitudes and respect and dignity in the context of effectively controlling his behavioral outcomes. The systematic partnering of the treated patient, his friends and family members in the process of medical decision making is necessarily required for providing him the best treatment choices in the mental healthcare setting (AGDOH, 2017). The eventual empowerment of the treated patient would assist him in making calculated healthcare choices for the systematic acquisition of the goal oriented mental health outcomes. Accordingly, the patient would be able to control and mitigate the perpetuating and precipitating factors of his bipolar disorder (AGDOH, 2017). The pattern of courteous interactions with the treated patient would assist in the systematic evaluation of the recovery process and enhance his quality of life and associated wellness-outcomes. The periodic discussion regarding the social matters, family relationships, economic constraints and behavioral constraints with the treated patient will eventually create a sense of recovery in the treated patient (AGDOH, 2017). Resultantly, the patient will attempt to develop purpose and focus in life while systematically mitigating the bipolar symptomatology.

Nursing Care Plan

AGDOH. (2017). Principles of recovery oriented mental health practice. Retrieved from https://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-n-servst10-toc~mental-pubs-n-servst10-pri

Ancín , I., Santos , J. L., Teijeira , C., Sánchez-Morla , E. M., Bescós, M. J., Argudo , I., . . . Cabranes-Díaz , J. A. (2010). Sustained attention as a potential endophenotype for bipolar disorder. Acta Psychiatrica Scandinavica, 235-245. doi:10.1111/j.1600-0447.2009.01532.x

Ardito, R. B., & Rabellino, D. (2011). Therapeutic Alliance and Outcome of Psychotherapy: Historical Excursus, Measurements, and Prospects for Research. Frontiers in Psychology. doi:10.3389/fpsyg.2011.00270

Cassidy, F. (2010). Insight in bipolar disorder: relationship to episode subtypes and symptom dimensions. Neuropsychiatric Disease and Treatment, 627-631. doi:10.2147/NDT.S12663

Chen , C., Li, C., Wang, H., Ou, J. J., Zhou, J. S., & Wang , S. P. (2014). Cognitive behavioral therapy to reduce overt aggression behavior in Chinese young male violent offenders. Aggressive Behavior, 40(4), 329-336. doi:10.1002/ab.21521

Cleary, M., Lees, D., Molloy, L., Escott, P., & Sayers, J. (2017). Recovery-oriented Care and Leadership in Mental Health Nursing. Issues in Mental Health Nursing. Retrieved from https://www.tandfonline.com/doi/abs/10.1080/01612840.2017.1314738?journalCode=imhn20

Geddes, J. R., & Miklowitz, D. J. (2013). Treatment of bipolar disorder. Lancet, 381(9878). doi:10.1016/S0140-6736(13)60857-0

Hajda, M., Prasko, J., Latalova, K., Hruby, R., Ociskova, M., Holubova, M., . . . Mainerova, B. (2016). Unmet needs of bipolar disorder patients. Neuropsychiatric Disease and Treatment, 1561-1570. doi:10.2147/NDT.S105728

Krane-Gartiser , K., Steinan , M. K., Langsrud , K., Vestvik , V., Sand , T., Fasmer, O. B., . . . Morken, G. (2016). Mood and motor activity in euthymic bipolar disorder with sleep disturbance. Journal of Affective Disorders, 23-31. doi:10.1016/j.jad.2016.05.012

Kumar, M., Sinha, V. K., & Mondal, A. (2016). Subjective Symptoms in Euthymic Bipolar Disorder and Remitted Schizophrenia Patients: A Comparative Study. Indian Journal of Psychological Medicine, 38(2), 109-113. doi:10.4103/0253-7176.178771

Labrague , L. J., McEnroe-Petitte , D. M., Al , A. M., Fronda , D. C., & Obeidat, A. A. (2017). An integrative review on coping skills in nursing students: implications for policymaking. International Nursing Review. doi:10.1111/inr.12393

Lee, S. A., Kim, C. Y., & Lee, S. H. (2016). Non-Conscious Perception of Emotions in Psychiatric Disorders: The Unsolved Puzzle of Psychopathology. Psychiatry Investigation, 165-173.

Manetta, C. T., Gentile, J. P., & Gillig, P. M. (2011). Examining the Therapeutic Relationship and Confronting Resistances in Psychodynamic Psychotherapyx`. Innovations in Clinical Neuroscience, 8(5), 35-40. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3115766/

Miklowitz, D. J., Alatiq, Y., Geddes, J. R., Goodwin, G. M., & Williams, J. M. (2010). Thought Suppression in Patients With Bipolar Disorder. Journal of Abnormal Psychology, 119(2), 355-365. doi:10.1037/a0018613

Sylvia, L. G., Hay, A., Ostacher, M. J., Miklowitz, D. J., Nierenberg, A. A., Thase, M. E., . . . Perlis, R. H. (2013). Association Between Therapeutic Alliance, Care Satisfaction, and Pharmacological Adherence in Bipolar Disorder. Journal of Clinical Psychopharmacology, 33(3). doi:10.1097/JCP.0b013e3182900c6f

Usta, J., & Taleb, R. (2014). Addressing domestic violence in primary care: what the physician needs to know. Libyan Journal of Medicine. doi:10.3402/ljm.v9.23527

Vogel, L. (2015). Is your hospital culturally safe? CMAJ, 187(1). doi:10.1503/cmaj.109-4953

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