Case Study: Mental State Assessment Essay

Questions:

1. Identify and describe the following four(4) key components of the mental state, as they relate to Ellen’s presentation.
2. Identify and describe two (2) areas of risk for Ellen in relation to her current presentation.
3. Discuss four (4) nursing care priorities for Ellen and provide a nursing intervention and a rational for each intervention identified.
4. Identify one (1) recovery principle (as per the National Framework for Recovery-Oriented Mental Health Services).

Answers:

1. Mood: Mood of the patient is called as the pervasive subjective state. According to the study of Carniaux-Moran (2008), the visible affect of the patient’s mood is called as the affect. Mood of a patient is determined through examining the range, depth and fluctuations in the emotional expression. Moods are described in various terms such as labile (changing mood rapidly), euthymic (normal), angry, depressed, irritable, frightened or empty (Hirschfeld et al, 2010). Ellen’s mood during the interview was found to be elevated and labile. Ellen’s affect is determined to be congruent to her mood. Congruity and in-congruity are important to determine, because sometimes the depressed patients may look depressed, but in some cases depressed patients may look euthymic (Perron et al, 2009).

Thought Content: The patient suffering with mental disorders may have different kind of thought contents. The bipolar disorder is also called as maniac-depressive illness. The patient suffers with unusual shift in the mood (Carniaux-Moran, 2008). Generally it has been observed that people suffering with bipolar disorder have racing thoughts or even the flight of different ideas. For the accurate diagnosis of the problem it is important to assess thought content. Thought content of Ellen display derailment. Content of the thoughts are also thoughts are grandiose, flirtatious and underlying sexual innuendo (Hirschfeld et al, 2010). The though content explains about the goal focused activities of the patient.

Thought form: Thought form is called as the process in which the patient thinks. Thought form of the patient are determined through there speech. The patient suffering with bipolar disorder, often have distracted thought process and rapidly changes their thought process. Flight of ideas is the general thought form seen in patients of bipolar disorder. The speech is rapid and patient changes topics rapidly. The topics can be associated or may not, but the patient display excessive talking and sometimes nonsensical choice of words. In the case of Ellen she also displays rapid, loud, pressured and slurred speech.

Insight: Insight is considered as the extent to which patient is aware of his or her illness. In the case of mental disorders, patient may have poor or limited insight about their illness, as in the case of Ellen she has very limited insight to her illness and she considered that nothing is wrong with her. Sometimes the patients stop taking medication, as they believe that they are not ill. This situation display lack of insight about the illness and poor judgement (Carniaux-Moran, 2008). Ellen also display this behaviour, by stating that she do not require medication, as drug do not allow her to enjoy her life and brings her down. Thus, she has poor insight and impaired judgement.

2 i) Disturbed Thought Process: Disturbed thought process could be a major risk factor for the patient like Ellen. The thought process of the bipolar disorder patient is often disturbed. This problem is displayed in the case of Ellen through disorientation, rapid and pressured speech, flight of thought and ideas. Loose association of the thoughts is also associated with this risk factor (Kendall et al, 2014). Ellen had displayed loose and poorly associated thoughts and ideas. Poor level concentration is also identified in case of Ellen.

ii) Defensive coping: Defensive coping is another risk factor associated with condition of Ellen. She repeatedly displays false positive evaluation of self. Her self evaluation is based on the patter of protecting and defending self. Defensive coping risk factors are assessed though identifying the level of insight and judgement (Kendall et al, 2014). Ellen display grandiosity, flirtatious and seductive behaviour through her speech. She also displayed flamboyant and bizarre dressing and make-up. She also displays sexual behaviour in conversation, and denied to take medication to defend herself, which is a threat to her positive self.


3. Intervention for disrupted thought content:

The first nursing intervention for such behavior is limiting the destructive and adverse behavior of the patient. The nurse must provide the safe environment to the patient. The environment stimuli, which trigger the aggressive behavior, will be identified and removed; this can be done by keeping the patient in isolation and in a private room.

Rational: Safe environment is important, so that patient may not harm herself or other during flights of thoughts. The physical safety of staff and other patients is also important. Ellen’s ability to deal with the stimuli is impaired thus, keep her in isolation is correct intervention.

Second intervention must focus on re-orientation of the Ellen. For this, she must be called by her name repeatedly. Nurse should also tell her name to patient, and nurse should also inform the patient about place, date and time.

Rational: Re-orientation is important for Ellen, as due to distracted thought process, she has been disoriented and had a loose thought process. (Connolly, & Thase, 2011). For bringing her to stability, repeated presentation of the reality is very essential. This will further help in concrete reinforcement of the reality.

Intervention for Defensive Coping

The first intervention for such behaviour is that, nurse must withdraw or ignore the attention from the bizarre clothing, make-up and appearance of the patient. Nurse should also avoid sexual acting-out behaviour. The limit regarding the inappropriate behaviour must be set (Beentjes, Goossens, & Jongerden, 2015).

Rational: Ignoring the inappropriate behaviour of the patient and defensive coping strategies are more effective to reduce unacceptable behaviour. Reinforcement of the If the patient is asked to stop such behaviour that they may do it more.

Her insight and judgement are poor. She does not have awareness towards her illness. Due to poor judgement, her inappropriate behaviour should be maintained by setting few limits. Nurse should inform the patient about expected mannerism (Connolly, & Thase, 2011).

Rational: It is very important that patient should know that what is being expected from them (Geddes & Miklowitz, 2013). Maintaining the limits is important for the patient to learn appropriate manners and behaviour.


4. The principles of recovery oriented mental health practice are important for every individual suffering with mental disorders. These principles value the perspective of the mentally ill people are set according to the abilities and disabilities of every individual. The first principle of the National Framework for Recovery-Oriented Mental Health Services is “uniqueness of the individual”. This principle is best suited in the case of Ellen. According to this principle, recovery of a patient is not considered just as a cure from illness but it provides the opportunity to the individuals to make meaningful choices and living a purposeful life (Principles of recovery oriented mental health practice, 2010). The outcomes of the recovery are different and unique for every individual, and thus, main focus should be on the quality of life and social inclusion. Ellen, also require support in improving her quality of life and also needs empowerment, so that she can understand that she is at the centre of care.

References

Beentjes, T. A., Goossens, P. J., & Jongerden, I. P. (2015). Nurses' Experience of Maintaining

Their Therapeutic Relationship With Outpatients With Bipolar Disorder and Their Caregivers During Different Stages of a Manic Episode: A Qualitative Study. Perspectives in psychiatric care.

Carniaux-Moran, C. (2008). The psychiatric nursing assessment. Psychiatric mental health nursing: An introduction to theory and practice, 41-43.

Connolly, K. R., & Thase, M. E. (2011). The clinical management of bipolar disorder: a review

of evidence-based guidelines. Prim Care Companion CNS Disord, 13(4), pii-PCC.

Geddes, J. R., & Miklowitz, D. J. (2013). Treatment of bipolar disorder. The Lancet, 381(9878),1672-1682.

Hirschfeld, R. M., Bowden, C. L., Gitlin, M. J., Keck, P. E., Suppes, T., Thase, M. E., ... & Perlis, R. H. (2010). Treatment of patients with bipolar disorder. APA Practice Guidelines 2002.

Kendall, T., Morriss, R., Mayo-Wilson, E., Marcus, E., Jones, S., & Guideline Development Group. (2014). Assessment and management of bipolar disorder: summary of updated NICE guidance. BMJ, 349.

Perron, B. E., Howard, M. O., Nienhuis, J. K., Bauer, M. S., Woodward, A. T., & Kilbourne, A. (2009). Prevalence and Burden of General Medical Conditions Among Adults With Bipolar I Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions [CME]. The Journal of clinical psychiatry, 70(10), 1407-1415.

Principles of recovery oriented mental health practice. (2010). Australian Government Department of Health. Retrieved From:

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