Mental State Examination: Components, Importance and Formulation of Need

This essay documents a summary of the patient’s mental health assessment, all the valuable components and the formulation of the need according to patient’s medical history. It covers Appearance & Behaviour, Speech, Mood, Affect, Thought, Perception, Cognition, Insight & Judgement, and Formulation of Need. The aim of an MSE and a formulation of need to assist in diagnosis, assessment, prognosis, and a treatment plan that works efficiently on patient.

Assessment 2 Written
Assessment

Table of Contents
INTRODUCTION...........................................................................................................................3
MAIN BODY...................................................................................................................................3
Appearance & Behaviour.................................................................................................................4
Behaviour...............................................................................................................................4
Speech.....................................................................................................................................5
Mood.......................................................................................................................................5
Affect......................................................................................................................................5
Thought...................................................................................................................................5
Perception...............................................................................................................................5
Cognition................................................................................................................................6
Insight & Judgement...............................................................................................................6
Formulation of Need........................................................................................................................6
Biological...............................................................................................................................6
Psychological..........................................................................................................................7
Social......................................................................................................................................7
CONCLUSION................................................................................................................................8

INTRODUCTION
Mental state examination refers to the structured way for observing along with describing
patient’s current behaviour, state of mind, perception, domains of appearance, cognition, speech,
mood, attitude, insight and judgement. Looking, listening and asking are the three components
that are crucial to conducting a successful Mental State Examination (MSE). An MSE provides
vital information for healthcare professionals in assessing and treating psychiatric patients with
their conditions (Noreis et.al., 216). Based on the interview conducted for Assessment 1, this
essay documents a summary of the patient’s mental health assessment, all the valuable
components and the formulation of the need according to patient’s medical history. The aim of
an MSE and a formulation of need to assist in diagnosis, assessment, prognosis, and a treatment
plan that works efficiently on patient (Assadi.2020).
MAIN BODY
Moreover, these assessments help to get ensure that comprehensive care is provided.
There are many aspects of a person. They need encouragement from mental health clinicians to
ask and answer open-ended questions with sensitivity, which can help to find out more about the
individual and their mental health.
An MSE is as vital as a physical assessment in general medicine. It is repeated over time
where transparent process is followed. There is need to get ensure about patient mental state
which should be conducted. MSE’s can be compared to the present MSE summary even if
different clinicians conduct it at different times. MSE should not be centred around the facts of
the person’s situation. Still, it should grasp how the person functions emotionally and cognitively
and if it is evident that they are a risk to themselves or others, it can aid in the decision making
with the team & client. It also plays an essential role in deciding whether the patient needs
surveillance and hospitalization or is fit to re-enter the community after getting ensure about the
risk of harm.
An MSE can be formal or informal. Here, this MSE is a formal one which conducted in
person and video-graphed for future reference. The patient Braine Gleeson was in the hospital
when the interview was conducted. She was ensure about safety and to express thoughts freely.
A report was successfully established by using warm tones, small talk, & validation. Braine
Gleeson, at certain moments, expressed discomfort, but Braine Gleeson was immediately

comforted, and after regular breaks, the interview was resumed. Even though this MSE is just
based on one particular visit, it helps in comparative analysis with Braine Gleeson other MSEs
and helps identify the areas to improve mental health. Being a mental health nurse, it requires
incredible strength. Mental health nurses must spontaneously act on information gathered to
promote mental well-being, protect the patients, prevent self-harm, reduce risks, and provide a
safe environment for both the patient and others.
Appearance & Behaviour
Braine Gleeson is a 58-year-old Caucasian woman. She is an averagely built person with
short blond hair and is pretty groomed, and has adequate attention to ADL’S. She wore a pair of
earrings and a golden chain on her neck. Braine dressed up in a royal blue colour top with hand
embroidery on the neck part, and black jeans, with black colour runners, appropriate to the
environment and the climate. Her behaviour was pleasant and polite, and she had an approach
settled at the time of the report. The rapport was easily established, and there was no
psychomotor agitation evident.
Behaviour
Braine was settled bit tired, and polite an approach strange and suspicious while talking
she face uneasiness in opening-up about her thoughts. Her, facial expressions made it evident
that she was uncomfortable to share her thoughts and state. She spoke significantly less and
answered only the questions which were asked to her. Earlier, she used to have medication for
paranoia schizophrenia, but she stopped the course as she felt she was fully recovered from it.
Braine used to stay with her sister and her partner and they were very supportive of her.
Lately, she started too suspicious over them regarding her audio hallucination. She felt her sister
and everyone around her, were able to read her mind and hear her thoughts. Hence she shifted
from her sister’s place to other house and now she is currently alone. Braine’s budgeting with her
pension and utilized only for the essentials. She has general and social anxiety which causes due
to AH. She agreed ongoing auditory hallucination and denied any symptoms of olfactory
hallucination. As a consequence of her condition, she has a minimal socializing with society and
avoids crowds. Throughout the interview, she maintained a good posture and responded.

Speech
Braine had an average flow of ideas and sustained a standard rate, fluency, tone and
volume throughout the interview. Her Speech and behaviour were normal. But it was evident that
she had underlying irritability or restlessness from the way she talked. Her decimal expression
shows some timidness and despondence. She maintained good body language and eye contact,
but she had some suspicion of the people around her, which is a symptom of paranoia. While
having the conversation, she pressed on her temporal region with her fingers.
Mood
Braine stated that she feel tired. This is due to lack of sleep and was fragile. Her paranoia
was the main reason of her sleep deprivation. She stated that she could not sleep as she
hallucinated that others can hear her. This is caused her panic activities. Hence she wanted to
resume her medication.
Affect
Braine was a reactive congruent where she was reactive while having the conversation,
but at the same time, she had hallucinations regarding someone hearing her. She stated that she
had obsession and compulsion regarding repetitive sounds and always was on the lookout for
harmful sounds which was heard in her head. Her above-mentioned compulsion caused severe
anxiety.
Thought
Braine displayed no signs of suicidal attempts, and there was nil flow of thought disorder.
impaired paranoid and persecutory delusions are expressed in the interview. When asked about
the same, she said that there are no thought contents of harm to herself or to damage to other’s.
She did not have any intended or currently oriented plans. However she was clear that other
people could hear her thoughts, and she agreed that thought broadcast. She did not feel safe
living by herself and had a limited engagement with society and co-patients. The same she has
social anxiety panic attacks when she goes to a crowded place (Paulus et al.,2015).
Perception
Braine expressed abnormal auditory hallucinations ongoing in her and appeared to be a
bit stressed on the interview day. She said that the voices in her head always give negative

thoughts making her distressed. There were no other difficulties like altered bodily experiences,
passivity or visual and olfactory problems.
Cognition
Braine was alert and oriented throughout the interview. She was hesitant to disclose her
problems with sleep and auditory hallucination, and she was very conscious of the surroundings
at the interview. Her concentration and memory power was not impaired as she clearly
remembers the time, place, person and season (Commenge et al.,1992). She recalled her past
memory and identified herself as Braine Gleeson, a 58-year-old female with a long history of
paranoid schizophrenia, living in Hobart service, and she returned to her sister’s house. The
clinician described her the medication’s name, and then she quickly remembered it. She was
prescribed quetiapine 300mg be taken at night and olanzapine 5mg BD as regular medication,
and some PRN medication for sleep assistance.
Insight & Judgement
Braine is impaired as per their current mental status. She appeared to have some insight
into her deteriorating mental health, ongoing delusions, and poor judgement regarding self to
ceasing medication. The reason she stopped the medication was that she was very active and
energetic and was capable of doing things like a normal person. Her judgement on the condition
was limited. She agreed to take prescribed medications.
Formulation of Need
A formulation of need can be produced from the information provided in the assessment
which is given above. This will help connect how and why the problems arose in terms of
predisposing, precipitating, and maintaining and discuss protective factors.
Biological
After the assessment, Braine Gleeson expressed that she had an interceptive sleep that
does not provide enough energy to perform daily activities on those days. If there is no
disturbance in sleep and can attended her ADLs. She eats whenever she wants otherwise she
skips her meals. However, she stated she drinks alcohol at times. Braine has been diagnosed with
T2DM (Morrison et al. 2015). She believes her T2DM that it is a side effect of her psychotic
medication. Here, Medication side effects, especially antipsychotic medication, contribute to
subjective ratings of mental health (Hayhurst et al., 2015). This can result in discontinuation or

dose reduction by patients, which may produce multiple harmful effects (Wykes et al.,2017).
Side effects vary and include severe weight gain, impotence, insomnia, chronic sedation and a
lack of concentration, all of which interfere with daily life activities (Stomski et al.,2016). Close
monitoring is essential because they are associated with physical morbidity and mortality, poor
adherence, stigma, and a negative impact on quality life (Ashoorian et al. 2014).
Psychological
Braine explained about her past psychiatric issues of ongoing AH where she stated that
her grandparents had schizophrenia. Hence, she believes it could be hereditary. Two years ago
she had the same problem, and she was under medication but after a while, when she started
feeling better, she stopped the medications. Whenever the paranoia happens, she gets anxious,
scared and insecure. Now she has come to the physician as she realized that she needs to be on
medications again.
She was introduced to diversional therapy by clinician, which includes listening to music,
watching exciting sports, small-group walking and swimming or pool exercises. She had
mentioned that she likes to swim. It is said that involving in some sort of mild physical activity
can divert her mind from focusing on the hallucinations (Barrett et al.,2018). Along with it, a
proper diet will be shared with her during her course in the hospital
Social
She is an unmarried independent woman. She believes Buddha culture and used to stay
with her sister and her partner. They are very supportive as they know her condition. Due to
paranoia it lead to made her think that her sister could also hear her. Hence she left her sister’s
house and stayed at other place. She is fighting her condition by staying away from people due to
audio hallucination.
She meet her expenses from her pension, and she doesn’t like to spend on unnecessary
things. She has social anxiety whenever she is in a place she feels other people can read her
mind. She has a fear of crowds due to the paranoia and she goes out only when it is necessary.
She doesn’t adhere to anyone most time keep isolated and has poor engaging with society.
Clinician advised to her when you are going to community you can choose the great Stupa for
your further accommodation.

CONCLUSION
Consequently, observing Braine’s mental state and conducting an integrated mental
health assessment makes it easy to see how vital a normalized process like an MSE is. The
person may portray one character one day and change to another the next day differently. It is
entirely un-predictable. Hence, it is essential to follow a person’s mental progression and
regression. A quote that transcends and gives meaning to an MSE is “life doesn’t make any sense
without interdependence. There is need to work with each other, and the sooner it can help to
learn that the better for us all.” Erik Erikson (Martinie. 2021). This quote stresses that people
who are struggling do not have to suffer in silence. Suppose mental health clinicians work on
being non-judgemental, and provide holistic, empathetic and evidence-based care. In that case,
people will be more likely to analyse and approach mental health centres for help.

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