Detailed Mental State Examination Findings of Mrs. B

This blog discusses the detailed mental state examination findings of Mrs. B, including her general appearance, behaviour, emotional state, speech and language, and other assessment information. It also provides insights into diagnostic formulation and the main goals of the care plan during her stay in the hospital. Collaboration with Mrs. B and her family for care planning is also discussed.

Assessment 3- Case study blog 2

Contents
Detailed Mental State Examination Findings of Mrs. B..................................................................3
General appearance and Behaviour..............................................................................................3
Level of conscious awareness......................................................................................................3
Cooperativeness and support.......................................................................................................3
Speech and language....................................................................................................................4
Emotional State............................................................................................................................4
Thought possession and stream....................................................................................................4
Other assessment information..........................................................................................................4
Diagnostic formulation....................................................................................................................5
Main goals of the care plan during Mrs. B’s stay in hospital..........................................................6
Collaboration with Mrs. B and her family for care planning..........................................................6
References........................................................................................................................................7

Detailed Mental State Examination Findings of Mrs. B
General appearance and Behaviour
Mr. B presented appropriately and her dressing style was suitable for weather. She usually chose dark
colour dresses to wear which can be associated with the gloomy mood. She had a slouching
posture which made her heads and shoulders stoop. She made minimum eye contact and looked
down frequently. These can be thought of as signs of depressive mood. Her body movements
were slow and twisting motion of her hands at the commencement of the interview suggested a
possibility of motor agitation.
Level of conscious awareness
She seemed conscious regarding the location and process of interview but in the middle of the
interviews she lost focus and seemed disoriented at several instances. Her level of alertness also
lowered during the interview. Her GCS was 15.
Cooperativeness and support
It was difficult for the attending professional to develop a rapport with her as she acted suspicious of the
procedure and the professional. She was irritable and also subconsciously had aggressive
feelings for the professional. Interviewing her was a difficult task as her thoughts were
incoherent with no links and interpenetration of personal themes.

Speech and language
She had slow flow of speech as she was uncertain and took long pauses while answering. Her tone was
emotional, tense and monotonous. However, her pitch was loud.
Emotional State
She had blunt facial expression, rhythm and tone of voice and her social gestures and her emotional state
was angry and frustrated.
Thought possession and stream
The steam of thought of Mrs. B had numerous pauses at several moments while answering. She
demonstrated a lack of links to the professionals’ questions. Obsessional thoughts can be viewed
as she had irrational and intrusive thoughts which can be classified under the signs of depression.
Throughout the interview she exhibited perceptual impairments as visual hallucinations which
may suggest confusion.
Other assessment information
For assessment of cognitive impairments and dementia, it is essential that deficit must be diagnosed in
two or more cognitive functions which includes learning disability, difficulty in recalling,
reasoning or task completion, visuospatial incompetency, speech difficulty, reading and writing,
behaviour, and personality issues. The Mini-Cog and Mini Mental State Examination
assessments, for example, are simple and quick investigation tools for assessment of dementia
patients and evaluate a person’s management performance, memory, visuospatial proficiency,
attention, language and orientation (Milian, et al., 2012). In addition, neuropsychiatric symptoms

should be assessed to completely understand Mrs. B’s experiences, conducts and previous
history. The findings of different assessment tools can be compared with the information
collected from family and other carers is important to recognise the traits of the neuropsychiatric
troubles and make the precise diagnosis. Neuropsychiatric Inventory assessment is another
authentic, authorised and well-recognised assessment tool which includes an organised interview
examining twelve symptoms of Mrs. B from her carers/family perspective (Lai, 2014). Integrated
extraction of data from findings of the different assessment tools and Mrs. B’s detailed mental
status examination will provide all the required diagnostic information to the practitioners so that
they can ascertain the underlying causes of cognitive disorder.
Diagnostic formulation
After carefully examining the case study video and presentation, it is reviwed that she is suffering from
Urinary tract infection along with acute confusion, hypothyroidism with an onset of psychotic
behavioural and psychological symptoms of dementia (BPSD). BPSD is indicated by her various
episodes of wandering, hallucinations, irritable behaviour, aggressive and disinterested attitude
(Cerejeira, Lagarto, & Mukaetova-Ladinska, 2012). In addition, several researches have proved
that dementia patients frequently face BPSD at some stage of their disorder (Tible, Riese,
Savaskan, & Gunten, 2017). BPSD is viewed as advancement of the illness but various other
reasons may also result in its development like pain, fear, fatigue, boredom, communication
issues, etc. Mrs. B may be suffering from other symptoms due to misinterpretation,
misunderstanding or her unmet requirements. Certain behavioural symptoms such as agitation
and aggression towards the carer are commonly triggered during events of personal care such as
bathing, toileting, etc.

Main goals of the care plan during Mrs. B’s stay in hospital
The primary goal with prioritisation is to treat and control the two acute medical conditions from which
she is suffering, that is UTI and hypothyroidism during hospitalisation. Another essential goals is
reassessment of her psychological troubles and recommend suitable medications. For controlling
her hypothyroidism, 2-6 weeks’ time period may be required. Further, the potency of
Levothyroxine medication may also needed to be increased. After that the TSH, T3 and T4 levels
will be investigated again and in case of not reaching the normal range, the potency will be
increased further and titrated up until normal levels are gained (Jonklaas, et al., 2014). The
findings of increased CRP, ESR and WBC are signs of UTI. It is essential that the recurrence of
UTI is prevented in Mrs. B’s case. Therefore, sensitivity tests of the bacteria will be done prior to
prescribing antibiotic. It is only when particular antibiotics are administered in suitable dosages
to Mrs. B, that she will be able to defeat the infection completely. EEG indicated nonspecific
generalized slowing and the brain scan of Mrs. B found mild age-related atrophic alterations in
the brain, therefore, after the acute conditions are managed appropriately, a MMS will be
conducted to check for early signs of dementia and if it is below 25, administration of
cholinesterase inhibitors will be considered. Adherence to medication regime must be monitored.
Collaboration with Mrs. B and her family for care planning
Frequent case meetings will be conducted with Mrs. B’s son, her attending professionals and other staff
involved in her care to formulate a detailed care plan for Mrs. B, investigate its progress and
review it (Javed & Herrman, 2017). Two fundamental strategies involved in the care plan that
will be discussed in the meetings are non-pharmacological interventions and pharmacological

treatment. Since the family and carers are significantly involved in the treatment and
maintenance of patient’s health as they can influence patient’s health outcomes, they will be
educated regarding psychosocial approaches such as emotion-orientated care. In addition through
talks and role play they will be taught and encouraged to implement activities such as validation
and reminiscence by recalling memories in a non-disputing manner and exhibiting empathetic
attitude towards Mrs. B. it will assist in restoring her self-esteem and sense of identity. The non-
pharmacological methods can help in lowering the doses of medication, reducing hospital stay
and supplementing the treatment in a positive way.
References
Cerejeira, J., Lagarto, L., & Mukaetova-Ladinska. (2012). Behavioral and Psychological
Symptoms of Dementia. Front Neurol., 3(73).
Javed, A., & Herrman, H. (2017). Involving patients, carers and families: an international
perspective on emerging priorities. BJPsych Int., 14(1), 1-4.
Jonklaas, J., Bianco, A. C., Bauer, A. J., Burman, K. D., Cappola, A. R., & Celi, F. S. (2014).
Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid
Association Task Force on Thyroid Hormone Replacement. Thyroid, 24(12), 1670-1751.
Lai, C. K. (2014). The merits and problems of Neuropsychiatric Inventory as an assessment tool
in people with dementia and other neurological disorders. Clin Interv Aging, 1051-1061.

Milian, Leiherr, Straten, Müller, Leyhe, & Eschweiler. (2012). Clinic., The Mini-Cog versus the
Mini-Mental State Examination and the Clock Drawing Test in daily clinical practice:
screening value in a German Memory. Int Psychogeriatr., 24(5), 766-74.
Tible, O. P., Riese, F., Savaskan, E., & Gunten, A. v. (2017). Best practice in the management of
behavioural and psychological symptoms of dementia. Ther Adv Neurol Disord., 10(8),
297-309.