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Thought Content and Form Assessment using the Mental State Exam

Discuss about the Nursing for Mental State Exam.

The consistent and logical thought formation is defined as the thought form in Mental State Exam (MSE). A person’s expression of ideas through speech results in the thought process or form. The study of thought form is important in a person and is characterized by derailment, extreme vagueness and tangible thinking (Kowalski and Conn 2017). The derailment could be explained in a way when a person shows aloofness or loose connections with its surroundings. The person makes irrelevant and oblique comments. There is a tendency to change topics showing flight of ideas or tangible thinking. Moreover, there is extreme vagueness that indicated circumstantial thinking. The thought racing or blocking are also some of the phenomena. The person has halted speech or use nonsense words.

The thought content or nature is the evaluation of thinking process of a person. It is the false beliefs and overvalued ideas called delusions that are rigidly accepted and followed by a person that are highly irrelevant to his or her nature and background (Coleman 2014). The person experience highly depressive thoughts and their minds are preoccupied. They experience fear about a catastrophic outcome that makes them behave compulsively. They have a tendency to self-harm, homicidal ideation, suicide and aggression. They also experience anxiety and fear.

Annabelle in the given study suffers from disturbances in her thought form and content. Her behavior explained her anxiety and constant fear about some unexplained outcome. When she arrived at the emergency department, she was wringing her hands reflecting constant danger. She showed loose associations with her surroundings and constantly changed her topic. She smiled, muttered during the interview and showed the sores on her arms. She was constantly picking up the sores causing self-harm. Suddenly, she changed her topic to falling of planets depicting extreme fear (Fernando and Carter 2016). She became disappointed and sobbed in distress shouting that the children are hurt and crying for help. This indicated fear about a catastrophic outcome.

Perceptions, as explained by Mental State Exam, are the sensory experiences. These sensory experiences are in the form of hallucinations and illusions that are important to screen to monitor the mood disorders, anxiety that depicts the mental health conditions (Huline-Dickens et al. 2014). The hallucinations are in the form of auditory in which a person hears voices that do not exist in reality. They could hear inner voices and does self-talk. There are also dissociative symptoms where there is depersonalization and feels that the surroundings are not real and shows detachment. Moreover, a person may also experience illusions that make a person accept things in an unrealistic manner.

Perceptions Assessment using the Mental State Exam

Annabelle experienced strong hallucinations in the form of visual and auditory perceptions that are not real. She constantly looked up at the ceiling shouting in distress as if she could visualize any awful event. During the interview with her mother, she looked at the ceiling shouting that the children are getting hurt and slumped on the floor shouting.  These experiences of Annabelle depicted that she experienced auditory hallucinations (Huline-Dickens et al. 2014). Moreover, she showed detachment from her family and friends. While interviewing her mother, she said that she used to lock herself in the room and spoke to herself as if someone is there in the room with her. Again, during the interview, she cried sliding against the wall and said to forgive her. She also experienced visual hallucinations when she looked up at the ceiling and shouted that the planet is falling. This showed that she could see some catastrophic event taking place that is making her scared and be under constant fear.

According to Mental State Exam, the term “affect” and “mood” are two important aspects that need to be assessed. They hold an intricate relationship explaining the emotions and its responses. The mood is defined as one’s emotional experiences over a prolonged period (Lineweaver and Brolsma 2014). The immediate response to the emotions is defined as affect. The state of happiness, irritability and stability describes the mood of a person. The lowered, depressed, ecstatic or elevated are the forms of happiness. The calmness or aggressiveness of a person shows irritability. The mood of person can be explained in simple terms like happy, angry, anxious, apathetic or euphoric.

The apparent emotions of a person that are conveyed ion a non-verbal manner are the affect. It has certain parameters that describe the affect. The intensity, reactivity, range, appropriateness and mobility are the parameters that describe affect (Hategan and Bourgeois 2016). The expansive, blunt, flat or restricted forms explain range. The congruency, appropriateness or inappropriateness regarding appropriateness along with stable or labile condition explains stability defining affect.

Annabelle’s mood fluctuated from happiness to sadness and distress. She showed wide differences in her effect. When she arrived at the emergency department, she was in fear and paced down the corridor wringing her hand. She got alert to every sound around her and looked up at the ceiling with fear. She turned hostile and then again showed sadness and distress. She seemed unrelated to her surroundings and showed incongruence. She showed heightened or flat intensity that described her range of effect (Koocher, Norcross and Greene 2013). During the whole interview process, she looked up at the ceiling with dilated pupils, sweating arms and extreme fear explaining her heightened range. Moreover, she smiled indicating happiness and next moment distress explaining her mood. She was highly unstable and was not able to sit still for a while. She did not care about the woman next to her who was trying to relax her depicting incongruence.  She also experienced explosive mood when she denoted that she could hear children crying while seeking help.

Affect and Mood Assessment using the Mental State Exam

Behavior, as explained by Mental State Exam, is also an important descriptor that includes gestures, mannerisms, eye contact, expression, compulsions and ability to follow commands. The behavior is also described in the form of abnormalities in activity (Taylor 2013). The abnormal movements of the eye, the level of activity, arousal and body language also indicate abnormal behavior. The abnormalities in behavior are screened for the assessment of any neurological disorder, stereotypy, echopraxia, akathisia and psychomotor agitation. The examining of eye movements like side and repeated glancing is also important to screen for any delusions that the person might be experiencing. Moreover, the lack of eye contact also indicates autism or depression in a person. The abnormalities of activity are also assessed to examine medical conditions like dementia, Parkinson’s disease, schizophrenia, delirium or mania. 

Appearance is another factor that is screened during the Mental State Exam. Along with the assessment of mental conditions, physical aspects are also important to assess for the clinicians that include height, weight, age, posture, grooming, clothing and gait (Forbes and Watt 2015). There are certain parameters that explain conditions like mania, depression, malnutrition, abuse or intoxication. For example, bizarre clothing indicates mania; dirty clothes indicate depression or schizophrenia. The accessories indicate the personality of a person, dental erosion, needle tracks, odor that might suggest poor hygiene, weight loss and physical illness indicate depression or anxiety.

Annabelle showed abnormalities in her activities during the interview and also her appearance was an important factor to mark as she arrived at the emergency department. Her look was intense and showed alertness in her gaze and mannerism as she responded instantly to every sound in the surrounding. During the interview, she looked abnormally and intensely at the ceiling indicating abnormal behavior (Butcher, Mineka and Hooley 2013). There were disparities in expressions that range from happiness to extreme distress. During the interview, she smiled, muttered and then suddenly shouted in fear looking up at the ceiling. Her pupils were dilated and her palms were sweating when she arrived at the ED.

Her appearance was also not proper when she arrived at the ED. She wore dirty jeans and was barefoot. She had body piercing in her nose, on eyebrows and lips. Her hair was colored blue and pink and was in a disheveled state. Her manner of walking was also not proper and she did not sit still for a while. She was 22 years old and she lost a lot of weight indicating malnutrition and depression. Her mother said that her room was dirty and unkempt that indicated poor hygiene (Kamp 2013). Moreover, her gaze was not normal and ranged from being afraid to hostile.

References

Butcher, J.N., Mineka, S. and Hooley, J.M., 2013. Abnormal psychology. New York: Pearson.

Coleman, C.A., 2014. Patient-Centered, Culturally Appropriate Care Models. Patient Assessment in Pharmacy: a Culturally Competent Approach, p.215.

Fernando, I. and Carter, G., 2016. A case report using the mental state examination scale (MSES): a tool for measuring change in mental state. Australasian Psychiatry, 24(1), pp.76-80.

Forbes, H. and Watt, E., 2015. Jarvis's Physical Examination and Health Assessment. Elsevier Health Sciences.

Hategan, A. and Bourgeois, J.A., 2016. Psychiatric Examination. In On-Call Geriatric Psychiatry (pp. 3-15). Springer International Publishing.

Huline-Dickens, S., Heffernan, E., Bradley, P. and Coombes, L., 2014. Teaching and learning the mental state exam in an integrated medical school. Part I: Student perceptions. Psychiatric Bulletin, 38(5), pp.236-242.

Huline-Dickens, S., Heffernan, E., Bradley, P. and Coombes, L., 2014. Teaching and learning the mental state exam in an integrated medical school. Part II: Student performance. Psychiatric Bulletin, 38(5), pp.243-248.

Kamp, H., 2013. Context, thought and communication. In Meaning and the Dynamics of Interpretation (pp. 371-392). Brill.

Koocher, G.P., Norcross, J.C. and Greene, B.A., 2013. Psychologists' desk reference. Oxford University Press.

Kowalski, C. and Conn, R., 2017. Medical students’ perceptions of the use of feature films to teach the mental state examination. BMJ Simulation and Technology Enhanced Learning, pp.bmjstel-2016.

Lineweaver, T.T. and Brolsma, J.W., 2014. How you ask matters: An experimental investigation of the influence of mood on memory self-perceptions and their relationship with objective memory. Memory, 22(8), pp.1103-1115.

Taylor, M.A., 2013. The neuropsychiatric mental status examination. Elsevier.

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