Ultrabrief Electroconvulsive Therapy For Manic Episodes

HLT301, Semester 1, 2020
GROUP 2
Assessment Task 1: Nursing, Midwifery and other disciplines
Mental State Examination Workbook
50 Marks (1000-1500 words)
Due Date: Friday, April 10, 2020 (4 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
Nursing and Midwifery students: Watch the video titled “Psychiatric Interviews for
Teaching: Mania” that can be found in the Assessment Folder on Blackboard:
Answer each question in the workbook template. Please ensure that you include
both the question and its accompanying answer.
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You are required to respond to the questions in your own words. You may use direct
quotes from the video (i.e. the person’s statement may be quoted as long as it is
relevant, fits into your word count and helps to explain your application of theoretical
understanding to the practice video).
Each question includes a guide for the maximum number of words expected for the
response. Keep within this word limit, although there is a +/- 10% leeway provided.
Supporting literature to answer the questions:
You need to demonstrate you have used the most appropriate source for your
responses e.g. policy documents, journal article, textbook etc. Not all the answers
require a citation, however you are expected to use a variety of sources eg textbook,
journal articles, credible websites etc.
Academic sources should be published within the last 5 years.
Reference List:
At the end of the paper you need to provide the full reference details 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 Harvard
guide by going to Portal – USC Community – Academic skills – Referencing.
The completed workbook assignment will contribute to 30% of your overall grade
mark and is due to be submitted through SafeAssign.
HLT301 Assessment Task 1: Workbook 30%
1. Define the mental state assessment, describe when it is to be used and
describe why it is a useful tool for nursing or midwifery practice (max 100
words) 5 marks
A mental state examination (MSE) gives you a snapshot of a patient's emotions,
thoughts, and behavior at the time of observation. Mental state assessment helps
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Nurse identify the presence and the extremity of the mental state of the patient in
conjunction with the risk patient poses to himself or others around him. The main use
of the Mental state assessment is in order to get appropriate data from the patient to
create a suitable diagnosis and assessment of disorder and response to treatment.
Since nurses and midwives are the first people that come in contact with the patient
earlier detection is possible by the behavior that can give you clues about their
mental state.
2. Describe John’s appearance and behaviour during the initial assessment
(100 words) 3 marks
John appears confused and stressed out seeing a psychiatrist and he is upset that
he cannot talk to the GP and GP doesn’t enough time for John. He is confused and
he does not answer the questions that the psychiatrist has put in forward to him.
John is distracted very easily by the surrounding. John isn’t able to answer any
question that has been put forward to him straightly he is chatty and is getting
distracted and is just expressing his feelings with the environment, paper, and the
magazines.
3. Differentiate between mood and affect, and then describe affect as it relates
to John (max 50 -100 words) 3 marks
Ekkekakis (2012) defined affect as a "neurophysiological state consciously
accessible as a simple primitive non-reflective feeling most evident in mood and
emotion but always available to consciousness". In case of mood, it's complicated as
the mood is an emotional state that may last anywhere from a few minutes to several
weeks but mood also varies depending on situation, environment or persons. The
mood can also be associated with feelings such as exhilaration, happiness, terror or
despair (Thagard, 2018). John at the start of the conversation seems to be sad and
anxious that his GP doesn't have time for him but he also showed behaviors
associated with euphoria.
4. Discuss John’s speech (max 50 -100 words) 3 marks
John in the whole duration of the video has been talkative and has been talking for a
wide variety of the topic from the magazine he is holding to curing cancer. He has
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rapid speech and thinking. He is loud and has a fast rate of the deliverance of
speech. John mostly has fluency in his words but since he started to describe the
cure of cancer he became incoherent his words started to get quite confusing and
unclear.
5. What signs or symptoms associated with an episode of mania can you identify
in the interview with John? (max 100 - 150 words) 5 marks
According to Queensland Mind Essentials (2012), Mania is a state of extreme
physical and emotional elation. John has increased energy and is very active in the
video. We can see he isn't listening to the psychiatrist but he is talkative and
expressing his feelings and explaining to the psychiatrist since the beginning of the
video. John may become angry and irritated with those who disagree with or dismiss
his or her sometimes unrealistic plans or ideas. The main symptom we saw in the
video was Grandiose plans and beliefs. John also stated he doesn't sleep and also
he doesn't need sleep since he has lots of energy within him. and this riddle has
been keeping him awake to cure cancer. John has a lack of insight into how other
people see his or her ideas and actions as inappropriate, reckless or irrational. He
seems very confident and finds himself more clever and intellectual than other
people.
6. What tests might Dr Beddi request at the end of the consult with John, and
why are these important in the context of symptoms consistent with self-
harm? (max 100 words) 3 marks
Dr.Beddi may perform a physical exam and order lab tests, including a thyroid
function test and urine analyses to get a better understanding of the Of more clinical
pertinence is the use of daily mood charts, which are widely used in clinical settings.
(Mitchell et al., 2010). These charts allow patients and thereby their clinicians to
monitor daily changes in mood, specific target symptoms, stress, activity levels, and
daily routines
Appropriate medication such as using mood stabilizers such as Cariprazine,
antidepressants such as Zoloft or antipsychotics such as risperidone as needed.
Mood-stabilizing agents such as lithium carbonate or sodium valproate and an
antipsychotic may be needed to treat psychotic symptoms, agitation, thought
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disorder and sleeping difficulties related to John (Queensland Mind Essentials,
2012). John’s mania risk management, particularly the recognition of suicidal, is a
crucial responsibility for the GP. John’s loss of insight during manic episodes poses
particular problems for families and carers, as patients may deny their illness and
resist treatment. Patients may engage in behavior with severe future ramifications,
such as embarking on unwise business schemes, spending large amounts of money,
or becoming aggressive with the potential of physical harm to others.
7. Dr Beddi assesses John’s thought and perception. What might she document
in the progress notes? (max 50-150 words) 5 marks
From the interview, it is clear that John has a lot of thoughts. In the assessment of
John’s thought process and perception, Dr. Beddi can document that John’s
perception exhibit delusions. John thinks that he is getting a cure for cancer and he
has some clues that he aims to bring together to come up with the cure. The doctor
can also document that John is not suicidal because he has not given any
indications that he could commit suicide. Dr. Beddi can also document that John’s
thoughts are goal-oriented because he aims to find a cure for cancer but they are
illogical.
8. What is John’s insight into his current situation? What are the likely outcomes
associated with this level of insight? Please comment on his overall
judgement as well. (max 50-100 words) 3 marks
John seems to misunderstand his situation. He seems to understand what he wants
but there is a real possibility that he does not understand what he is going through.
He thinks that his situation is normal and that his research on cancer and his
knowledge are inspired by good. These delusional thoughts can affect patient
outcomes because the patent does not want to accept that they have a problem.
Delusions can lead to a patient refusing psychiatric help like is the case with John
when he refuses to engage Dr. Beddi any further. Therefore, one of the likely
outcomes is the refusal of psychiatric help.
9. Looking at John’s presentation overall, what risks does he currently present
with? Are there risks that you have excluded? Provide evidence for all your
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responses. Please give consideration to her physical health as well as all
other possible risks. (max 150-250 words) 5 marks
One of the risks that John presents with is delusional disorder. One of the most
common symptoms of mania is delusional thoughts (Mitchell et al., 2010). The
provided interview between John and Dr. Beddi shows that John is deluded because
he thinks he has a cure for cancer. In most cases, a delusional patient may not know
that they are delusional because of their unshakable belief on something that is not
real. With proper care, however, this disorder can go away within one month.
Another risk John presents with currently is mania. He even says that people call him
a manic mechanic. Mania can be characterized by increased levels of energy and
confidence. Mitchell et al. (2010) also state that manic patients tend to talk very fast
and require less sleep time. In the interview, John tends to speak very fast and
continuously without giving Dr. Beddi enough time to respond. Additionally, he states
that he does not need sleep. Mania is a bipolar disorder and John could be
potentially at risk of having this condition.
John also faces the risk of developing obesity and high blood pressure due to his
lack of sleep. He clearly states in the interview that he does not need sleep. Sleep is
important in repairing heart vessels; implying that sleep deprivation can lead to
hypertension.
10. John is diagnosed with an episode of mania. What interventions/treatment
and care pathways/options would be appropriate for his care? Give
consideration to the setting in which this care might be provided. Provide
rationales for your plans. You will need to read the relevant chapters in your
textbook, as well as look for other academic sources (max 300-350 words) 10
marks
Clinical manifestations of mania include exaggerated self-esteem, sleeplessness,
euphoria, and increased energy among others. According to Anand (2016), episodes
of mania can be managed through psychotherapy andilelectroconvulsive therapy.
However, nursing interventions have proven to be very effective in the management
of episodes of mania. One of the interventions is the provision of therapeutic
communication. This intervention is important because manic patients have very
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short attention spans. They are always distracted by their delusional thoughts. It is
therefore important that the nurse uses clear and direct sentences when
communicating. This care is mainly provided in situations when the patient may not
be able to process several pieces of information at once. The nurse therefore breaks
the information down for the patient.
Meeting the psychological needs of the patient is another nursing intervention that
can help in managing manic episodes. This is done by keeping a quiet environment
and removing triggers such as radios and televisions. Patients can sometimes be
overwhelemed by their manic episodes thus potentially harming themselves or
others (Mitchell et al., 2010). It is also important to avoid confrontational
converstaions that may irritate the patient and make their manic episodes worse.
This is because a patient can view such arguments as judgments and use them as a
justification to escalate mania.
Adjunctive therapy can also be used to manage manic episodes. This type of
intervention is where another treatment is used in combination with the initial
treatment. It is important to note that mania is potentially destructive and it may
require an immediate intervention that can allow the patient to regain control of their
actions and behaviors (Crowe and Porter, 2014). The use of adjunctive therapy is thus
important particularly in sleep and circadian regulation. Through this intervation, the
patient’s regular daily rhythms are controlled thus managing mania.
Task 3 Mark Allocation
Question 1 5 marks
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Question 2 3 marks
Question 3 3 marks
Question 4 3 marks
Question 5 5 marks
Question 6 3 marks
Question 7 5 marks
Question 8 3 marks
Question 9 5 marks
Question 10 10 marks
Written presentation including structure and
grammar, and application of the Harvard referencing
protocol.
5 marks
/50 marks
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References
Anand, S., 2016. Ultrabrief electroconvulsive therapy for manic episodes of bipolar
disorder. The journal of ECT, 32(4), pp.267-269.
Crowe, M. and Porter, R., 2014. Inpatient treatment for mania: A review and
rationale for adjunctive interventions. Australian & New Zealand Journal of
Psychiatry, 48(8), pp.716-721.
Ekkekakis, P., 2012. Affect, mood, and emotion. Measurement in sport and exercise
psychology, 321.
Health.qld.gov.au. 2012. Queensland Mind Essentials. [online] Available at:
https://www.health.qld.gov.au/__data/assets/pdf_file/0029/444773/mindessentialsfin
al.pdf [Accessed 10 April 2020].
Mitchell, P.B., Loo, C.K. and Gould, B.M., 2010. Diagnosis and monitoring of bipolar
disorder in general practice. Medical journal of Australia, 193, pp.S10-S13.
Thagard, P., 2018. What Are Moods?. [online] Psychology Today. Available at:
https://www.psychologytoday.com/au/blog/hot-thought/201805/what-are-moods
[Accessed 10 April 2020].
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