Mental Health and Cognitive Function

This assignment delves into the complex relationship between mental health and cognitive function. It examines research papers that investigate how factors like mood disorders, subsyndromal manic symptoms, and dementia screening tests influence cognitive performance. The papers also explore the sensitivity and specificity of different cognitive assessments in diagnosing conditions like dementia in Parkinson's disease.

Running head: MENTAL HEALTH- NURSING
Assessment Task 2- Written Case Study
Name of the Student
Name of the University
Author Note

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Answer 1
The present state of mind of a certain individual is observed and specifically described by
a structured pattern that is commonly referred to as the Mental State Examination (MSE). This is
considered as an essential criterion for clinically assessing a patient in psychiatric practice. The
examination encompasses evaluation of the behaviour, appearance, attitude, orientation, mood,
affect and level of consciousness of a particular individual (Feng et al. 2012). Therefore, the
MSE is considered imperative for an accurate diagnosis of the mental faculties of a person. It is
generally performed when cognitive abnormalities are observed while interviewing a person or if
any cortical function abnormalities arise. This examination describes thought content as the
ability to maintain a directed and coherent train of thoughts. It refers to assessment of an
individual’s thinking process (Larner 2012). There are several themes that are found to govern
individual thoughts and perceptions. Therefore, it is necessary to have an accurate description of
thought content in order to gather valuable information on the phobias, delusions,
preoccupations, ideas and obsessions that are manifested by the concerned individual. It is most
commonly found that people suffering from mental distress are often susceptible to experiencing
fearful thoughts. These thoughts often manifest in the form of agitation, delirium and suicidal
ideations that makes the individual inflict self-harm (Kaszás et al. 2012). Thus, creating
provisions for an open-ended conversation will help to explore the mind and thought process of
the person.
In addition, the MSE describes thought form as the way of expression of a person’s
beliefs and thoughts in terms of his speech. Thus, thought form refers to the logical coherence of
one’s thoughts. It involves the way of production of ideas, in conjunction with their quantity.

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Evaluating the logical flow of ideas helps to discern whether they are fragmented or disoriented
(Oosterwijk et al. 2012). Thus, thought form helps to identify presence of echolalia (repetition of
what is being said), perseveration (trouble in shifting to new ideas), and clang association (words
similar in rhyming and sound follow each other). Thus, people suffering from mental difficulties
often manifest derailment in the form of social withdrawal and apathy. Speech vagueness also
gets emphasized by manifestation of circumstantialities and the concerned individuals fail to give
specific and short answers (Akiskal 2016).
In the case scenario, the patient Annabelle is diagnosed with mental disorders in both
thought content as well as thought form. She displays abnormal behaviour that is basically
demonstrated by the constant fear and panic attacks (Carleton et al. 2013). She comes across as
extremely agitated and afraid of some unreal events or entities. The factors that result in
demonstration of such confused and fearful behaviour do not exist in the real world. She was
seen continuously wringing her hands, upon admission to the emergency department. Wringing
of hands usually display a worry or concern over some serious matter (Judd et al. 2012). Thus,
the continuous grasping and squeezing of hands explained nervousness and agitation in the
patient, probably due to fear. She was also found to change her topic of conversation, which in
turn confirmed disoriented thoughts. There was a lack of logical coherence in her speech
(Oosterwijk et al. 2012). The fact that she also suffers from suicidal ideations was confirmed by
the sore marks on her arms (Kaszás et al. 2012). Furthermore, catastrophic thinking and being
afraid of some impending danger was manifested when Annabelle displayed restlessness and
suddenly started to shout and sob, during the interview. Therefore, it can be stated that her
thought form and content were not under control.

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Answer 2
The MSE defines perceptions as the experience of a person of the outer world, through
interpretation and senses. Thus, all forms of sensory experiences that are acquired by an
individual are commonly referred to as perception. Abnormalities often arise in such perceptions
that manifest in the form of several thought disorders such as, hallucinations, pseudo-
hallucinations, delusions and illusions (Legault and Faubert 2012). Diagnosis or screening of
mental abnormalities gets facilitated by manifestation of these perceptual abnormalities. Patients
who are preoccupied with disordered thoughts are at an increased likelihood of suffering from
hallucinations. These sensory perceptions occur when external stimuli are absent (Berking and
Wupperman 2012). However, these stimuli are perceived by the patients as real. Assessment of
hallucinations is of utmost importance as it helps to evaluate the risk to self as well as to
surrounding people. Visual and auditory hallucinations are most commonly experienced by such
people (Amad et al. 2014). Patients suffering from psychotic disorders often hear voices or
commands that instruct them to perform certain tasks. Dissociative symptoms are also
manifested by such patients that make them display indifference to situations, and they begin to
consider the surrounding environment as unreal (McCarthy-Jones et al. 2012).
In this context, Annabelle was found manifesting hallucination symptoms in both visual
and auditory forms. During the interview, she was constantly found to look up at the ceiling and
suddenly began to shout. This demonstrated presence of emotional disturbances. This disoriented
behaviour suggests that she was visualizing some terrifying event in front of her eyes that made
her agitated and aggressive. These frightful visions resulted in development of anxiety symptoms
and stress, which were further manifested in the form of continued wringing of the hands
(Berking and Wupperman 2012). She was also found shouting for forgiveness during the

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interview. When she was persuaded to reveal the reason that makes her ask forgiveness, she said
that there were several children who had been hurt. This added to her distress and she began
sobbing (Amad et al. 2014). The terrified expression she demonstrated on looking up at the
ceiling confirms that she hallucinated about some individual or spirit that made her afraid.
Hallucinatory behaviour was further established when she blocked her ears and shouted, "You
won’t tell her anything will you?”.
Annabelle also demonstrated social withdrawal as a primary symptom. On questioning
her mother, it was known that social isolation developed after she dropped out from the
university. This was soon followed by locking herself up in a room and speaking in a manner
that suggested the probable coexistence of other objects or entities with her. Visual
hallucinations made her believe that the planets were falling down upon her. These made her
misinterpret the surroundings (Legault and Faubert 2012). To conclude, it can be stated that the
auditory and visual hallucinations resulted in the foreboding of some unexplainable cataclysmic
events that made her demonstrate emotional outburst and she became extremely afraid.
Answer 3
There are certain disagreements related to the description of mood and affect in the MSE.
Mood is described a sustained and pervasive emotion, which is subjectively experienced.
Following its experience, an individual reports these moods, which are observed by the
surrounding people. Thus, the patient should describe the emotional states that are experienced in
his/her own words, which will help in providing a clear explanation of the mood (Ekkekakis
2013). Thus, moods help to alter an individual’s perception about the surrounding environment.
There are different terms such as, euphoric, angry, neutral, anxious, and apathetic, which

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demonstrate a wide range of observable moods (Farb, Anderson and Segal 2012). While the
condition where an individual fails to experience pleasure sensation refers to anhedonia, people
displaying an incapability of describing the mood’s subjective state demonstrate alexithymia
(Cook et al. 2013). Absolute euphoria or a trance-like state (ecstasy), persistent loss of interest in
daily activities (depression), stability, calm and composed behaviour, and sustained euphoria
(elevation) are the other kinds of mood behaviour that can be demonstrated by an individual
(Bijttebier et al. 2012). Therefore, moods help in detection of the emotions that sustain over a
long period of time.
Moreover, the MSE encompasses the concept of affect, which is the observed expression
of a particular emotion that has recently been manifested. Thus, the nonverbal behavior of an
individual, such as, happiness, sorrow or anxiety, conveys the apparent emotions that are labeled
as affect. Hence, it can be defined as the emotional state or feeling that is inferred by an assessor,
on the basis of the statements, behaviour and appearance of an individual. It helps in evaluating
the appropriateness of a particular behaviour, with respect to the context (McLeod, Uemura and
Rohrman 2012). It also facilitates determination of congruency of the behaviour with the though
form and content of the said person. Most commonly observed affect include, anxious,
depressed, euphoric and euthymic (Bora et al. 2013). While, euphoric affect is most commonly
confirmed by the presence of an elevated mood, depression and apathy signify the presence of
dysphoric affect. A reasonably positive and non-depressed mood is regarded as euthymic affect.
A fluctuation or sudden change was observed in Annabelle’s mood during the interview.
Although she was smiling to herself at the beginning, which demonstrated a happy mood, she
was found extremely distressed as the interview progressed, which was confirmed by her panic
attacks and emotional outburst. Her admission to the emergency department was a fearful

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incident that made her display nervousness by continuously wringing her hands and pacing up
and down the hospital corridor. This is confirmed by the fact that research evidences have
established positive correlation between trauma, anxiety and the behavioural manifestation of
pacing (Clauss and Blackford 2012). An individual resorts to this behaviour to cope with
stressful conditions. She was found to get extremely frightened and alerted by all kinds of sounds
around her, which in turn contributed to her violent behaviour and made her aggressive. Her
sudden mood shift to grief signifies lack of congruence. Thus, it can be well understood that the
thoughts and feelings that Annabelle experienced during the interview were in no way consistent
with her actions (Bora et al. 2013). Furthermore, she also demonstrated a flat effect or near
absence of expressed emotions when her feelings got suddenly heightened and were reduced the
next moment (McLeod, Uemura and Rohrman 2012). To conclude, the sudden emotional
outburst can be associated to emotional incontinence or pseudo-bulbar affect (PBA), which was
characterized by her sudden emotional display of uncontrollable laughing and crying
(Colamonico, Formella and Bradley 2012). Heightened fear and rage were further established by
the presence of sweating arms and dilated pupils. Symptoms of restlessness were also supported
by the fact that she failed to sit quietly throughout the interview.
Answer 4
Appearance helps in providing valuable clues related to the cognitive state, mood, and
presence of persistent thought disorders, self-awareness, motor activity, and physical health.
Descriptions of appearance in MSE includes unusual physical characteristics like tattoos or
shaved head, obesity or thinness, hygiene and grooming, eye contact, apparent age, facial
expression, and unusual clothing or make-up (Gillen 2015). Thus, it helps to determine how well
groomed or dishevelled a person is. Colourful or bizarre clothing confirms that the individual is

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unkempt or dirty and probably suffers from mania. It also suggests possible existence of
schizophrenia or severe depressive disorder. Poor care of self or ill-health is demonstrated by an
apparent age that looks more than the actual chronological age.
Additionally, behaviour refers to description of the mental image of an individual. This
reveals information about the muscle strength, mood, energy levels and general medical
conditions of the person. Behaviour is generally expressed by a person’s gestures and
mannerisms and is most commonly described by abnormalities in arousal and activity levels
(Kessler et al. 2014). An observation of the patient’s eye contact and gait also helps to establish
the behaviour. Display of catatonia (psychomotor immobility that is manifested by stupor) and
tics (repeated non-rhythmic muscular movements) are manifestations of abnormal behaviour
(Keyes et al. 2012). Abnormalities in movements such as, choreoathetoid, choreiform and
athetoid movements are also essential aspects of an individual’s behaviour. Delusions or
hallucinations are demonstrated when an individual shows repeated side glancing (Akiskal
2016). Autism or depression is also confirmed by the absence of adequate eye contact in the
individual.
Several abnormalities were manifested in Annabelle’s behaviour during the interview
process. Upon admission to the hospital she was found in a pair of dirty jeans and walked
barefoot. There were many piercings in her eyebrows, nose and the lips. Her hair was dyed pink
and blue. This added to her dishevelled and dirty look (Gillen 2015). Annabelle was found
restless and failed to sit quietly for a while. A disorganized gait was also observed. Her recent
loss of weight suggested that her diet lacked adequate nutrients and she suffered from
malnutrition. This can be correlated with presence of depressive symptoms (Halfon, Larson and
Slusser 2013). Reports from her mother about keeping a dirty room also confirms presence of

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poor hygiene. Abnormal functioning of the higher mental faculties was portrayed by her hostile
and aggressive behaviour. Thus, there was a total lack of contact with reality (Hasan et al. 2013).
To conclude, it can be stated that the psychotic disorders that Annabelle was suffering from
created hindrances in her emotional behaviour.

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References
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Amad, A., Cachia, A., Gorwood, P., Pins, D., Delmaire, C., Rolland, B., Mondino, M., Thomas,
P. and Jardri, R., 2014. The multimodal connectivity of the hippocampal complex in auditory
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Berking, M. and Wupperman, P., 2012. Emotion regulation and mental health: recent findings,
current challenges, and future directions. Current opinion in psychiatry, 25(2), pp.128-134.
Bijttebier, P., Raes, F., Vasey, M.W. and Feldman, G.C., 2012. Responses to positive affect
predict mood symptoms in children under conditions of stress: A prospective study. Journal of
Abnormal Child Psychology, 40(3), pp.381-389.
Bora, E., Harrison, B.J., Yücel, M. and Pantelis, C., 2013. Cognitive impairment in euthymic
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Carleton, R.N., Fetzner, M.G., Hackl, J.L. and McEvoy, P., 2013. Intolerance of uncertainty as a
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Clauss, J.A. and Blackford, J.U., 2012. Behavioral inhibition and risk for developing social
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Psychiatry, 51(10), pp.1066-1075.

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Colamonico, J., Formella, A. and Bradley, W., 2012. Pseudobulbar affect: burden of illness in
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