Thought Form and Content
Discuss about the Mental State Exam Process.
According to Mental State Exam (MSE), the thought form or process is the formation of thoughts that are logical and consistent (Akiskal 2016). These thoughts are inferred through a person’s expression of ideas and speech. There are many characteristics that help to study the thought form in a person. Firstly, the person makes comments that are highly irrelevant showing derailment or loose associations. Secondly, there is tangible thinking or flight of ideas that shows change of topics. Thirdly, there is circumstantial thinking reflecting extreme vagueness. Fourthly, the person use nonsense words and use of halted speech. There is also blocking or thought racing (Arevalo?Rodriguez et al. 2015).
The evaluation of a person’s thinking according to their thought nature or content. It is characterized by delusions like the false beliefs are rigidly held that are not consistent or relevant to a person’s background (Hom et al. 2015). They have unreasonable belief or overvalued ideas. They are preoccupied and experience depressive thoughts. They are inclined to homicidal ideation, aggression, self-harm or suicidal attitude. They have repetitive thoughts about a catastrophic outcome accompanied by compulsive behavior. They also suffer from having heightened or generalized anxiety with unexplained reasons (Haller et al. 2014).
In the given case study, Annabelle showed disturbances in her thought content and form. She wringed her hands and paced showing that she is in constant danger or fear indicating anxiety. While interviewing her, she frequently interrupted and changed topic showing tangential thinking signifying problems in thought form. During the interview, she smiled, muttered and said that it is in her veins showing sores on her arms that she was constantly picking up indicating self harm. She also showed derailment or loose associations with the reality when she changed her topic from sores on her arms to falling of the planet. She showed sudden disappointment and sob in distress saying that the children are getting hurt that indicated obsession about a catastrophic outcome.
According to MSE, perceptions are sensory experiences that include disturbances like hallucinations, illusions or dissociative characters (Fénelon 2013). The screening is important to detect mental health conditions like mood disorders, severe anxiety or psychosis. The auditory hallucinations are widely known in which a person does self talk or hear inner voice. A person also hears instructive voices telling them to do something. In some cases, hallucinations are accompanied by extreme distress or fear. Illusions are also experienced in which a person perceives things in an unusual or unrealistic manner. The dissociative symptoms consist of the depersonalization and derealization in which a person feels that the surrounding objects are not real and feels detached from one respectively.
In the given case study, Annabelle has disturbances in both visual and auditory senses experiencing hallucinations with false auditory and visual perceptions. During the interview with her mother, she stared at the ceiling and then shouted in distress saying shut up as if she heard a loud noise. Again she looked up at the ceiling she could hear children being hurt and on hearing that she slumped to the floor shouting in distress. This is related to auditory hallucinations experienced by Annabelle. In the meanwhile, she stopped screaming and slides down the hall saying to forgive her and she does not mean to hurt anyone. As said by her mother, she locked herself in the room and spoke to herself indicating auditory hallucination in which she could hear voices talking to her. She also showed dissociative symptoms as she locked herself in the room showing loose associations with her family and friends. Her looking at the ceiling terrified indicates that she experienced visual hallucinations.
The affect and mood are one of the domains that are assessed during the mental state examination (Cumming et al. 2013). According to MSE, relationship between mood and emotional effect is like the weather and the season. The emotional experiences of a person over a prolonged period of time are defined as mood (Godefroy et al. 2011). The affects is defined as the immediate response or expressions related to emotions. The mood can be explained by happiness in terms of lowered, elevated, depressed or ecstatic. The irritability could be explained by explosive or calmness. Stability also defines mood of a person. A patient describes mood in their own words in terms like anxious, angry, euphoric or apathetic.
Affect is the non verbal form of behavior described by apparent emotions conveyed by a person. It could be measured by many parameters like range, reactivity, intensity, mobility or in terms of appropriateness. It may also be described by the range in terms of flat, blunt, restricted or expansive. The appropriateness is assessed in terms of congruence, inappropriateness or appropriateness. The labile or stable with regard to stability defines affect (Andreassi 2013).
Annabelle’s mood is very fluctuating and there are disparities in the range and intensity of her effect. She showed extreme sadness and distress while she was brought to the Emergency Department. At the first instance, she showed pangs of fear while she was pacing down the corridor and wringed her wrist. Her gaze and manner ranged from fear to being hostile. Her intensity of the effect is incongruous as she was not in harmony with her surroundings. She also showed flat or heightened intensity describing her range of effect. At times she showed heightened range while looking at the ceiling intensely, sweating palms and dilated pupils. And the next moment she was blunt showing reduction in the range effect. During her interview, she approached with a smile indicating happy mood and the next moment she looked terrified. She showed explosive mood while she denotes that she could hear children’s voices seeking help. She was unstable as she could not sit still for a while and was incongruent towards the older women trying to relax her.
Affect and Mood
Abnormalities in terms of activity that includes abnormal movements, level of activity in a person, arousal and observations of the patient’s eye movements (Andreassi 2013). The attention to one’s behavior is important during an examination especially to non verbal communication. The MSE examination provides information about Annabelle’s emotional attitude, behavior and her appearance.
Annabelle’s behavior was quiet weird. When she arrived she was odd in her dressing. She was dishevelled and dirty. Initially after entering the cubicle she appeared to be scared, terrified with sweating palms and showed a feeling of suspicion. Her behavior was confusing as in one moment she smiled and then muttered in herself in the next moment. Her behavior demonstrated a tendency of self harm as wringed her wrist and picked up sores in her hand. Movement of her eyes was denoting a state of heightened level of anxiety. She had difficulty in concentrating over one thing as she was switching topics before any of it could be well understood or interpreted. Moreover her speech was disorganized that made the communication with her more difficult. It was clearly evident that the client had distorted perception. After arriving the cubicle her behavior changed into several forms and her face expressed variety of feelings from happy, sad, depressed, stress, despair, and furious. Her sudden transition to aggressive and agitated form by screaming and sliding down the wall was irrational. Again transforming soon into distressed and despair girl crying for hurting children without any explaining were clear symptoms of psychosis. Her behavior and responses were suspicious. It was not realistic as she appeared to feel, see, hear things that were not existing. Whatever she spoke was completely disorganized and appeared to based on false beliefs. Either she was hyperresponsive or unresponsive. Overall her behavior was odd and erratic which indicated her experiencing hallucinations, delusions which are the clear symptoms of psychosis.
Akiskal, H.S., 2016. The mental status examination. In The Medical Basis of Psychiatry (pp. 3-16). Springer New York.
Andreassi, J.L., 2013. Psychophysiology: Human behavior & physiological response. Psychology Press.
Arevalo?Rodriguez, I., Smailagic, N., Roqué i Figuls, M., Ciapponi, A., Sanchez?Perez, E., Giannakou, A., Pedraza, O.L., Bonfill Cosp, X. and Cullum, S., 2015. Mini?Mental State Examination (MMSE) for the detection of Alzheimer's disease and other dementias in people with mild cognitive impairment (MCI). The Cochrane Library.
Cumming, T.B., Churilov, L., Lindén, T. and Bernhardt, J., 2013. Montreal Cognitive Assessment and Mini–Mental State Examination are both valid cognitive tools in stroke. Acta Neurologica Scandinavica, 128(2), pp.122-129.
Fénelon, G., 2013. Hallucinations associated with neurological disorders and sensory loss. In The Neuroscience of Hallucinations (pp. 59-83). Springer New York.
Godefroy, O., Fickl, A., Roussel, M., Auribault, C., Bugnicourt, J.M., Lamy, C., Canaple, S. and Petitnicolas, G., 2011. Is the Montreal Cognitive Assessment superior to the Mini-Mental State Examination to detect poststroke cognitive impairment? A study with neuropsychological evaluation. Stroke, 42(6), pp.1712-1716.
Haller, H., Cramer, H., Lauche, R., Gass, F. and Dobos, G.J., 2014. The prevalence and burden of subthreshold generalized anxiety disorder: a systematic review. BMC psychiatry, 14(1), p.1.
Hom, M.A., Stanley, I.H. and Joiner, T.E., 2015. Evaluating factors and interventions that influence help-seeking and mental health service utilization among suicidal individuals: a review of the literature. Clinical psychology review, 40, pp.28-39.
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