Understanding Mental State Examination: Evaluation And Intervention

Key domains used to assess patient's mental state during Mental State Examination (MSE)

Question:

Discuss About The Interventions If Mse Findings Are Finding?

Mental State Examination (MSE) is the comprehensive way of observing and describing individual patient’s state of mind. Mental state examination forms the fundamental assessment for mental disorders, especially on the symptoms. Mental state examination banks on observations and the use of questionnaires or interview to determine the sound ability of the patient to score on the symptoms of mental disorders.  There are key domains that are used to assess or evaluate the patient or client. The appearance of the patient may be emotionally generated that initiating behavior assessment as an element of MSE (Recupero, 2010). The appearance of the patient is another check, for the patient may seem to deviate from the normal behavior showing some mental depression. Other domains that are also used in the evaluation are perception, insight, cognition, thought, and speech. As registered nurse officer, when assessing the patient for mental problems, observation and capacity of the patient to show symptoms of mental health problems forms the basis. Any concerns of the behavior change or misbehavior that may also be identifiable from the dressing or general behaviors are key to mental disorders. In addition, MSE uses other mental health evaluation tools such as depression anxiety stress scale (DASS) to assess anxiety, stress or depression as critical signs of mental problems (Khoury, Lecomte & Fortin et al, 2013).

As a registered nurse, there are critical domains that are used to assess the mental health of the patients. These domains form the foundation or the basis of the mental state examination. The MSE reveals the mental condition that is associated with certain domains and when observed or patient is interviewed the nursing officer can see the mental status of the patient. Some of the main domains that are normally used in evaluation and assessment of patient are appearance, thought, mood and affect, insight, behavior, cognition, perception, and speech (Saks, 2007).

Appearance is a domain that makes use of physical aspects of the patients with a focus on elements such as dressing, age, weight, and height. Clinicians use physical appearance that may include discrepancies between physical appearance and age symbol of chronic poor self-care. Dirty clothes, on the other hand, may show patients suffering from depression as compared to bizarre clothing that may use to show mania condition of the patient. Body weight loss is also another aspect of appearance domain that is used to assess illness or depressive disorder among mental patients (Mohatt, Bennett & Walkup, 2014).

Importance of observation in MSE evaluations for identifying behavioral changes

Behaviour domain of mental state examination is used to assess abnormal behaviors that may result from a mental disorder. Behaviors such as gestures, eye contact, gait, and expression are used to assess the abdominal behavior resulting from mental disorders. For instance, the ability of the patient to follow or act according to the instruction shows a particular behavior. This may be used to indicate the mental status of the patient. Secondly, lack of eye contact may be used to indicate depression within patient’s mental health (Recupero, 2010).

Speech or speech content of patient gives the clinician spontaneous speech to assess the speech functioning. Speech reveals the thought content or thought form which are two important aspects of speech functioning used in assessing mental state. Speech content can be used to assess language disorders such as clustering, mutism or stuttering hence effect on the patient’s mental state. Spontaneity and latency of speech are two important elements of speech functioning that express the state of the mind of the patient (Nutt, King, Saulsbury & Blakemore, 2007).

The internal emotional state of an individual may be express in terms of mood and is closely related to affect. The mood is expressed in a dynamic external state that directly represents the internal predominant state. Affect is readily confused by mood since the two almost represent similar phenomenon and explains one’s state of mind. Mood and affect are directly related to the emotional state of the mind and as nurse examining or observing the mood of the patient has clear indication of the state of mind of the patient (Zhao et al, 2016).

Thought domain is another aspect of the mental state examination that shows the patient’s thinking and is generally evaluated based on the reasonability of the patient. Aggressive, self-harm and obsession are some of the elements that can be used to evaluate the thought domain of patient. For instance, observing the aggression of the patient especially when the patient tries to self-harm is a good indication that the patient has a mental problem that needs care. The thought of the patient is related to mind processing and the ability of the patient to think and therefore, should be used to assess the rational ability of the patient (Varcarolis, 2010)

Assessing perception of an individual is another area that shows the mental health status of the patient and forms part of the mental state examination. Perception can be used to detect mental disorder such as psychosis and substance abuse or trauma. Perceptual disturbance can also be used to assess severe anxiety or mood problems. In order to assess perception, symptoms that are indicated by perception examinations are feeling the surrounding is not real or feeling detached from yourself (National Collaborating Centre for Mental Health, 2009).

Domains used to evaluate physical appearance, behavior, speech, mood and affect, cognition, perception, and thought

Cognition is the ability of an individual to process information hence is sensitive to mental disorders. The cognition is also connected to the state of consciousness and assessed based intoxication, drowsy, alert and stuporose. In addition, cognition is also shown the orientation of reality that is expressed person in connection to the ability of the patient to correctly identify place or time. Lastly, cognition is also important for the patient’s memory functioning, visuospatial processing that is assessed in the ability of the patient to remember or see thing the way they are (Fusar-Poli, et al. 2012).

Insight is another important triaging psychiatric decisions that are used to acknowledge or identify mental problems. Insight also encompasses the judgmental ability of the person in a practical dilemma. When assessing insight some signs such as hallucination or suicidal impulses can be used as symptoms. When the patient show signs of loss of insight there is an indication that patient has some mental impairment that results in the inability of the patient to make some rational judgment (Owen & Harland, 2007).

Anxiety and depression are symptoms that can be identified by the domains that are observed. The domains that assessment may show these signs are appearance, mood, speech, and behavior. Firstly, the Anxiety and depression originate from the psychological functioning of a patient and can be reflected in their appearance. The internal emotional state is displayed in the appearance of an individual (Shibayama, 2011). And as for nursing officer, it will be good to note the appearance of the patient, especially in their dressing.  Anxiety and depression are evidence of internal emotional disturbance in a patient that can be seen externally in their behavior. The mood of the patient is also connected to their psychological state and can be cheerful or sad.  Those patients with severe depression have also speech problem and can express this in the way they speak or refuse to speak (Aspden, 2012).

The psychotic disorder is a condition of schizophrenia and can affect the speech, cognition, mood and behavior domains that are used in MSE assessment. This is because the psychotic disorder is signs of schizophrenia that has an effect on such domain mentally. The psychotic disorder has some invisible signs such as hallucinations, disorganized auditory, speech, and behavior. This leaves the patient with abnormal behavior usually observed when assessing the domains of MSE. According to Bennet (2008), a patient with schizophrenia will have a neurocognitive deficit that has an effect on the personal organization and abstract. The disorder may also affect the speech of an individual leading to loss of interest or drive in something. Moreover, the mood of the patient is normally difficult to understand with a mixture of cheerful and sad mood. Therefore, the noncontributory physical examination is recommended as the baseline before any medication is prescribed (Nordqvist, 2016).

Interventions for MSE findings that are concerning or positive

Findings from the MSE need interventions that are part of nursing care service that needs to given to the patient. Some of the elements that need to be considered on the interventions include person centered care, cultural appropriateness, multidisciplinary team and psychotropic medication.

Person centered care approach is one of the nursing care approaches that involve the family of the patient in caring for the patient. This follows close in the intervention immediately after the results or findings of the MSE are found to be concerning or positive (National Collaborating Centre for Mental Health, 2009).

Cultural appropriateness is another aspect or factor that can be considered when deciding on the intervention to offer to those patients that the MSE findings are concerning. The culture of the patient plays an important role in the nursing care and their ability to assist mental health patients. An intervention that will immediately require after conduction MSE assessment is cultural understanding where the nursing officer will explore cultural beliefs of the patient to comply with their cultural alienation as an ethical requirement. Understanding the culture is important for a reconciliation of behaviors and mental health putting into consideration the patient’s culture (Yuhas, 2013).

A multidisciplinary team will take immediate care with members such as clinicians, nurses, physicians, pharmacists and laboratory officers. The team will aim as assisting the patient with any medication that may be required or rehabilitation of the patient to restore their mental health to a normal state. As a nursing office, I will involve other medical practitioners in assessing the extent of the mental health problem and the measures needed to correct them. To do this effectively, multidisciplinary team will be the great deal in nursing care (World Health Organization, 2009).

Psychotropic medication is a medication that is given to a patient with mental health problems with the view to correct the mental disorders. Psychotropic medication will be recommended especially where the patient MSE findings show the possibility of the patient suffering from depression and anxiety emotional related problems. For instance, the MSE finding may show schizophrenia in the patient which the medication is given for stabilizing and safety of mental health (Freudenreich, 2012).

The depression anxiety stress scale (DASS) is a mental assessment tool that focuses on assessing the three main aspects of MSE and these are depression, anxiety, and stress. The scale is designed with 42 items to explore and assess the level of emotional expression that is reflected the depression, stress, and anxiety. Psychometric adequacy standards are utilized in the scale that mainly focuses on symptoms of mental disorders or mental health (National Collaborating Centre for Mental Health, 2009).

Person-centered care approach for MSE interventions

Depression is scored on the scale that focuses on hopelessness, devaluation of life, dysphoria, anhedonia, lack of interest/involvement, self-deprecation and inertia. Depression follows questionnaires that are filled expressing patient’s depression is the score. For instance, hopelessness can show the level of depression that patient is going to an extent of devaluating life. The assessment serves to identify elements of depression that will show the emotional disturbance (Murray, Buttner & Price, 2012).

Anxiety is one of the three points that are scored on the DASS scale which explains or assess the anxiety of patient as a reflection of mental health. Under the anxiety, the scale situational anxiety skeletal muscle effects, autonomic arousal and subjective experience of anxious affect. Anxiety part of the scale still point to the 0.7 thresholds that certify clinical applications, and is still near to the 0.9 identified by research (Khouzam, 2009).

Stress is another basic sign of emotional expression of mental health and forms part of DASS scale. Unnecessary stress may indicate that the patient is internally depressed and the result is emotional stress. This stress may also indicate the mental health status of the client (Ost, 2014).

There are some legal and ethical considerations that need to be considered when conducting mental state examination. Patient’s cultural norms need to be considered, the age of the patient, firstly, patient’s cultural norms dictate certain appearance or behaviors differently as compared to other culture. This may hind behavioral or appearance assessment of patient where there are cultural disparities between clinician and patient. Secondly, the age of the patient may also vary changing the overall assessment’s structure. For instance, children behave differently from grown up patients. The legal aspect of the assessment requires clinicians to first seek permission from the patient before conducting examination (Gross & Schâfer, 2011). The permission is also necessary from the family members of the patient before performing an evaluation or assessments on an individual. In addition, ethical standards also dictate the manner in which the nursing officer should handle the patient since mental health problem may sometimes be aggressive. As a registered nurse, more care is needed for this patient since their level of depression or stress may be concerning and most likely to resist or misbehave while doing an evaluation. Lastly, the ethical standard should consider the speech content as the patient with cognition problems may spew negative utterances (National Collaborating Centre for Mental Health, 2009).

Importance of cultural appropriateness in MSE interventions

The result of the Depression Anxiety and Stress Scale if are concerning there is a need for immediate action to the patient. There are some interventions that will be done to the patient or client that aim at caring for the patient and some of these actions are discussed below.

• Person centered care

Person centered care is an important nursing care that is offered to mental patients especially when the assessment turns positive for mental disorders. Some of the interventions that will be done in the area of person centered care include informing the family members of the patient concerning the score of the DASS test. This is basically to utilize the key aspect of family involvement in the care of mental health patient. Secondly, I ensure that the patient gets the necessary care the patient need when the patient needs that care.

• Cultural appropriateness

The cultural factor plays a critical role in mental health care especially when the DASS result is concerning. The manner and way that the patient is treated or care for are important and I would consider the cultural norms of the patient to plan for the care of the mental patient.

• The multidisciplinary team

When the health state of mind of the patient is concerning there is a need for a multidisciplinary team that consists of many different clinical officers who can treat and care for patients. The team that basically consists of nurses, physicians, psychologists, and pharmacists, will counsel or treat the patient and the family. After DASS findings the scale or severity of the mental health will also assist the team to find the right action or medication (World Health Organization, 2009).

• Psychotropic medication

Psychotropic medication will be administered to the patient with the help of clinical officers, physicians or pharmacists.  The psychotropic medication aims to try restores or alters the emotional expression that is responsible for depression, stress or anxiety that substantiate mental health problems of the patient (Murray, Buttner & Price, 2012).

Conclusion

In conclusion, the Mental State Examination is an important nursing assessment that can be used to evaluate the mental health of the patient that is showing abnormal behaviors. There is also some domain that is used to assess the mental health of a patient that show some signs or symptoms of mental disorder. Some of these domains are behavior, insight, appearance, speech content, perception, mood and affect, thought and cognition. There are also some other mental health assessment tools that are also used to evaluate the mental health of the patient and this is Depression Anxiety Stress Scale (DASS).

How a multidisciplinary team can assist with MSE interventions

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