Mental State Assessment and Care Pathways for Major Depressive Disorder

This document provides information about mental state assessment and the appropriate interventions and care pathways for major depressive disorder. It discusses the process of assessing a person's emotional and cognitive functioning in different healthcare contexts and highlights the importance of this assessment in understanding and supporting the person's mental health needs. The document also includes a workbook with questions and instructions for completing the assessment.

HLT301, Semester 1, 2019
Assessment Task 3 Workbook 60 Marks Due Date: Friday, May 31, 2019 (5 pm)
Description
This task provides you with an opportunity to develop and demonstrate knowledge of processes
associated with assessing a person’s mental state in different health care contexts, and supporting
the person to navigate to a place of recovery.
Assessment Criteria
The workbook responses will be assessed according to the following criteria:
 Use of evidence to interpret and analyse the mental state assessment, including an
assessment of risk
 Interpret and use evidence to plan care to support the mental health needs of the person in
diverse health settings
 Critical appraisal of principles of equity, rights and access
 Information literacy skills: use of sources and citations
 Written presentation including structure, grammar, application of referencing protocol
Harvard
Workbook Format
The workbook contains 10 questions about mental health assessment, and strategies to work with
people with mental illness. You must adhere to the word limit provided for each response.
Workbook Instructions
 Watch the video titled “Psychiatric Interview for teaching: Depression” that can be found in
the Assessment Folder on Blackboard https://www.youtube.com/watch?v=4YhpWZCdiZc
 Answer each question in the workbook template using the space provided as they relate to
this video.
 The template is set at 1 ½ line spacing and Calibri font size 11. Do not change the formatting.
 You are required to respond to the questions in your own words. Do not use direct quotes.
 Each question includes a guide for the maximum number of words expected for the
response. Keep within this word limit.
Supporting literature to answer the questions:
For each answer, provide in text citations (references) that demonstrate you have used the most
appropriate source for your response e.g. policy documents, journal article, textbook etc. You must
include at least one citation (reference) for each answer, and you are expected to use a variety of
sources eg textbook, journal articles, credible websites etc.
Reference List:
At the end of the paper you need to provide the full reference details, in alphabetical order, of each
citation (reference) you have used in your responses. You are asked to use the Harvard Referencing
style according to the guide provided by USC.
You will find the guide by going to Portal – USC Community – Academic skills – Referencing.
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The completed workbook assignment will contribute to 40% of your overall grade mark and is due
on Friday May 31, 2019 (5 pm)
HLT301 Assessment Task 2: Workbook 40%
1. Define a mental state assessment and describe why it is a useful tool in understanding a
person’s emotional and cognitive functioning (100 words)
Mental state assessment is the process of structured assessment of patients cognitive
and behavioural function by observing and analysing different domains like
appearance, mood, affect, speech, behaviour, thought pattern and content, cognition,
insight and perception. It is an effective tool for identifying person’s emotional and
cognitive functioning as it helps to identify change in status of patients in relation to
emotion and cognition by observing the above mentioned domains. For example,
review of symptoms like alertness, level of consciousness and memory can give idea
about cognition, whereas though patterns and beliefs can give idea about mental
state of the person. It can help to differentiate between variety of mental health
conditions (Norris et al. 2016).
/6 marks
2. Describe Alison’s appearance and behaviour (100 words)
The analysis of Alison’s appearance and behaviour has been done by review of posture,
level of alertness, facial expression and cooperation during the interview. The physical
appearance shows Alison is well dressed with neat and tidy clothing. However, her hair is
not properly combed. She is alert and conscious as she is responding well to the question.
However, she takes a pause in between. She is making eye contact occasionally and her
facial expression shows she is sad and unhappy. During the interview, she was found to
be in tears too at some moment.
/5 marks
3. Differentiate between mood and affect, and then describe affect as it relates to Alison.
(100 words)
The key difference between mood and affect is that mood is a reflection of emotional
state of client by review of overall emotional makeup of the client’s personality. In
contrast, affect is evaluated by observing patient’s immediate expression of emotion
(Renn and John 2019). Alison is found to be dysphoric evidenced by depressed
expression. She also has blunted affect as she is restricting her emotions and does not
intensified her expression of sadness and tears all the time. At no point, she gave
immediate expression of grief or job. She was restricting her emotions throughout the
interview process.
/3 marks
4. Discuss Alison’s speech. (50 words)
Alison’s volume of speech is soft. The content of the speech is fluent and well articulated
as Alison is responding to all questions well with complete answers. No latency is seen
during response and there is no pause between questions. Alison is responding well on
time to the interviewer’s question.
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/3 marks
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5. What physiological signs or symptoms associated with a depressive episode can you identify
in the interview with Alison? (100 words)
During the interview with Alidon, many signs and symptoms of depressive episode has been
identified. This includes lack of interest or pleasures in activities that she enjoyed, suicide
attempts, poor engagement in activities of daily living, depressed mood, lack of social interaction
with family members, decreased energy level and exhaustion, sleeping disturbance and poor
social relationship. She has stopped going out and engaging in social interaction with her
children and family. Kendler (2016) gives the evidence that people with depressive episode
experience poor mood, sleep problem, exhaustion, poor concentration, lack of interest in daily
6. Dr Taylor assesses Alison’s thought. Describe how you think she might describe and document
her findings? (100 words)
Dr. Taylor can assess Alison’s thought process by reviewing whether her response is coherent
and logical or not. Her thought pattern is found to be normal as she was giving organized and
coherent response. She was not giving too much unnecessary details and neither shifting from
the topic. However, one repitittion observed in her thought was that she expressed that she was
a burden to everybody. Hence, in brief, it can be defined that her thought process is normal, no
hallucination is observed and few repetition of thought is seen. Her though content revealed
suisuicide ideation and misinterpretation of events.
7. Consider Alison’s disclosure that she overdosed on Paracetamol tablets and alcohol 4 years
earlier. Why is this information vitally important to explore in the context of a mental state
assessment? Additionally, what information is important to collect in Alison’s presentation
today? (150 words)
The information regarding Alison’s disclosure that she overdoes on Paracetamol tablet is
necessary because to get idea about thought content of Alison and identify symptom of suicide
ideation in patient. This information is vital to detect the severity of her depressive symptoms
and understand future risk of harm to patient. Chu et al. (2015) gives the evidence that
assessment of suicide ideation is crucial to determine whether the patient the patient is at
immediate risk of self-destructive behaviour or not. While collecting data related to this area, it
is necessary to ask about frequency, intensity and quality of suicide attempts. Ms. Taylor did this
by asking how many tables did Alison took and her intention to harm others.
However, to judge Taylor’s current risk of commiting suicide, additional information that can be
collected regarding current judgment about the suicide attempt behaviour and intention to
repeat the act again.
/4 marks
8. How would you assess Alison’s insight into her current emotional and cognitive state? What
are the likely outcomes related to these states? Please comment on her overall judgement as
well. (150 words)
The current cognitive state of Alison can be judged by assessment of level of consciousness,
memory and concentration and interpretation of ideas. This can be done by observing client as
well as aksing questions to understand level of memory and concentration. Asking about birth
date and time of completion of schooling can give idea about memory. In addition,
consciousness and communication can be judged by assessing patient’s ability to remain
focused during concentration and not getting lost during the interview. In addition,
assessment of current emotional state of Alison can be done by assessment of her thought
content. The questions that would help to assess her emotional state includes ‘What are your
future plans in life’, ‘what things motivate you and makes u feel happy?’, ‘what is your current

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9. Looking at Alison’s presentation overall, what risks does she currently present with? Are
there risks that you have excluded? Provide evidence for all your responses. Please give
consideration to her physical health as well as all other possible risks. (250 words)
/5 marks
Based on review of all symptoms of Alison, she is found to be suffering from low mood,
fatigue, guilt, hopelessness, loss of appetite, loss of interest in daily activities, poor interaction
with family, sleep difficulty and suicide ideation. Her symptom is similar to the sysmptom of
major depressive disorder she has majority of symptoms as listed in DSM V criteria for major
depressive disorder. Hence, she currently present with the risk of developing depression. As
she has poor coping abilities and she feels fatigued at work, it might create risk of losing job.
Mandal, Ayyagariand Gallo (2011) gives the evidence that depression is a major cause behind
job loss as depressed employees are vulnerable to poor performance and absenteeism.
In addition, loss of interest in daily life activities and poor sleep patterns may expose her to
physical risk too. This is said because lack of social engagement and lack of interest in things of
pleasures may increase sedentary time for Alison and lead to risk of obesity and other ailments
like hypertension, diabetes and heart disease. Bélair et al. (2018) gives the evidence that
physical inactivity and sedentary behaviour increases risk factors for many diseases and there
is association between physical activity, sedentary behaviour and symptoms of depression.
The review of symptoms also suggest patient is at risk of nutritional deficit because of lack of
appetite. As she is socially isolated and her poor relationship with her partner, she is at risk of
self-harm too. There is a highlihood for her to commit suicide again. Kazan, Calear and
Batterham (2016) supports that intimate partner relationship strongly predicts suicidal
thoughts and behaviours.
10. Alison is diagnosed with major depressive disorder. What interventions/treatment and care
pathways/options would be appropriate for her care? Give consideration to the setting in
which this care might be provided. Provide rationales for your plans. (400 words)
As Alison has been diagnosed with major depressive disorder, she needs both pharmacological
as well as psychological interventions for recovery. Some pathological medications that can help
to reduce the severity of depressive symptoms for Alison includes use of antipsychotics,
antidepressants, anticonvulsants and mood stabilisers (Shim et al. 2018). Pharmacological
intervention like use of antidepressants is useful in treatment to relieved symptoms of
depression such exhaustion and low mood. This can provide immediate relief to patients.
Alison’s symptoms of sleep disturbance, suicidal thoughts, reslesness and low mood can be
minimized by initiation of pharmacological treatment (Bazire 2019).
Other treatment option for Alison is to provide psychological intervention like cognitive
behavioural therapy (CBT), mindfulness therapy and social support intervention. CBT is a type of
psychological therapt that explores negative thoughts and feelings of people and support
patients to find new ways to change their thought patterns and overcome life stressors. CBT is a
widely used intervention for patient with depression and Cuijpers et al. (2016) gives the
evidence that CBT is effective in addressing depression and anxiety. In addition, the role of
mindfulness-based cognitive therapy in depression is that it is a non-judgmental approach to
treatment that supports patients to become aware about their thoughts, emotions and body
sensations by mindfulness exercise. The uniqueness of this intervention is that it helps
therapists to understand ruminative thoughts and negative thoughts and implement strategies
that engage patients from dysfynctional processes to reduce depressive symptoms (MacKenzie,
Abbott, and Kocovski, 2018). Hence, Alison’s ruminative thoughts related to feelings of
worthlessness and low motivation can be resolved by the use of this treatment.
Other treatment options available for her includes social support intervention to

Task 3 Mark Allocation
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Reference List
Bazire, S., 2019. Why antidepressants are still the best treatment for
depression. Suicide, 14, p.20.
Bélair, M.A., Kohen, D.E., Kingsbury, M. and Colman, I., 2018. Relationship between
leisure time physical activity, sedentary behaviour and symptoms of depression and
anxiety: evidence from a population-based sample of Canadian adolescents. BMJ
open, 8(10), p.e021119.
Chu, C., Klein, K.M., Buchman‐Schmitt, J.M., Hom, M.A., Hagan, C.R. and Joiner, T.E.,
2015. Routinized assessment of suicide risk in clinical practice: An empirically informed
update. Journal of clinical psychology, 71(12), pp.1186-1200.
Cuijpers, P., Cristea, I.A., Karyotaki, E., Reijnders, M. and Huibers, M.J., 2016. How
effective are cognitive behavior therapies for major depression and anxiety disorders? A
meta‐analytic update of the evidence. World Psychiatry, 15(3), pp.245-258.
Kazan, D., Calear, A. L., & Batterham, P. J. (2016). The impact of intimate partner
relationships on suicidal thoughts and behaviours: A systematic review. Journal of
affective disorders, 190, 585-598.
Kendler, K.S., 2016. The phenomenology of major depression and the
representativeness and nature of DSM criteria. American Journal of Psychiatry, 173(8),
pp.771-780.
MacKenzie, M.B., Abbott, K.A. and Kocovski, N.L., 2018. Mindfulness-based cognitive
therapy in patients with depression: Current perspectives. Neuropsychiatric disease and
treatment, 14, p.1599.
Mandal, B., Ayyagari, P. and Gallo, W.T., 2011. Job loss and depression: The role of
subjective expectations. Social Science & Medicine, 72(4), pp.576-583.
Norris, D. R., Clark, M. S., Shipley, S., and Norris, D. (2016). The Mental Status
Examination. American family physician, 94(8).
Renn, B. N., and John, S. E. (2019). Mental Status Examination. In Diagnostic
Interviewing (pp. 77-102). Springer, New York, NY.
Shim, I.H., Bahk, W.M., Woo, Y.S. and Yoon, B.H., 2018. Pharmacological Treatment of
Major Depressive Episodes with Mixed Features: A Systematic Review. Clinical
Psychopharmacology and Neuroscience, 16(4), p.376.

Question 1 6 marks
Question 2 5 marks
Question 3 3 marks
Question 4 3 marks
Question 5 4 marks
Question 6 4 marks
Question 7 4 marks
Question 8 5 marks
Question 9 5 marks
Question 10 15 marks
Written presentation including structure and grammar,
and application of the Harvard referencing protocol.
6 marks
/60 marks
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