Mental Status Examination

This reflection contemplates upon a case study for the understanding and diagnosis of clinical depression according to the Clinical Reasoning Cycle. The case study focuses on a 38-year-old woman named Alison who is experiencing financial difficulties and is at risk for suicide. The assessment reveals that Alison is suffering from 'Depression with anxious distress' and suggests Cognitive Behavioural Therapy as a recovery-oriented approach.

Running head: MENTAL STATUS EXAMINATION
MENTAL STATUS EXAMINATION
Name of the Student
Name of the University
Author’s Note:

1MENTAL STATUS EXAMINATION
The purpose of this reflection is to contemplate upon a case study for the
understanding and diagnosis of clinical depression according to the Clinical Reasoning Cycle
(Hur & Roh, 2013). In this scenario, this case study is about ‘Alison’ who is a 38 year old
woman with two kids. Alison has been from her about four years ago and since she has been
raising the kids alone. Presently, Alison is working in a supermarket, however, recent
takeover of the supermarket she is working on and wage cuts has put her in a bit financially
difficult situation. Due to this condition, presently, she is not able to manage her condition
quite properly and she is lagging behind in her bills. In this regard, there are some stressors
which are being in play in this situation. Her financial condition is chief among them.
Additionally, this root cause (financially unstable) engenders few other stressors which
started to impact her life. In her own word, she cannot provide to her what they asking and
this made her into thinking that she is a ‘useless’ mother. All these factors have been working
as stressors in her situation. However, there are also some protective factors in case of Alison.
One of them is her sister. Her sister has noticed her recent condition, she recommended her to
visit to the general practitioner for check- up.
Aetiology of the mental health can be linked to many different factors and to
determine the reason for a particular mental health condition, many different area need to be
assessed in this scenario. As clinician or nurse, it is paramount to know these factors and the
reason behind the incorporation of these factors in the assessment. However, in this scenario,
Alison needs a biophysical approach for her assessment. One of the major features of this
biophysical approach (Kumar et al., 2014) is mental status examination or MSE (Woods&
Denton, 2014). In this scenario, mental status examination was conducted by the general
practitioner. From the summary of this assessment’s findings it can be stated that the general
appearance of Alison was very timid and nervous. She was rarely making eye contact with
her general practitioner. From her behaviour it can be stated that she was lacking confidence

2MENTAL STATUS EXAMINATION
in herself and her abilities. Cognitively she was bit down, however, her thought process was
clear and she can clearly portray what she was thinking. Her thought process was logical and
rational and she has the judging capacity to think what is harmful and what is not, what is
good for her children and what is not. During the interview process, she was speaking in
intermittent manner and become tearful with the slightest of cues and stays like that for the
rest of the interview. Her thought process and recent experience was bereft of any delusional
subjects which is generally common among the mental health patient. However, distortions in
cognitive ability can be evident her contemplation of suicide or ending her own life. The
mood of her during the interview was very gloomy and she was sobbing continuously. When
Alison was asked whether she is contemplating on harming herself, she mentioned that she
has but it is generally occurs at night when she is alone. Nonetheless, she has not taken any
preparation for this. From this Alison’s static risk factors can be determined as loneliness,
financial burden whereas mood swing and change of mental state can be presented among the
dynamic risk factors.
From the data presented above and after analysing the data particularly from the
mental status examination, it can be stated that the Alison has been suffering from
‘Depression with anxious distress’ according to the DSM- 5 guidelines
(Dsm.psychiatryonline.org, 2019) as she has shown the symptoms of being tense, difficulty in
concentration due to extreme worry, and feeling of loss of control in her daily life activities.
As a result, she is in currently risk for risk of suicide, longer duration of the illness as well as
non- responsiveness towards treatment.
Alison’s present financial condition is in tatters and in together with her present
condition might have detrimental effect on her children aged 11 and 9 years. Her children
might be emotionally distress, might have separation anxiety and they will not get the sense
of security from their mother. In addition to that their educational and physical growth might

3MENTAL STATUS EXAMINATION
get hamper due to the financial incapability. In addition to that, her relationship with Dave,
her boyfriend, also is in serious trouble due to her condition.
The next process for this assessment will be to creation of a treatment for the Alison
and to implement a recovery oriented approach (Schrank et al., 2014), Alison will be
provided with a ‘Cognitive behavioural Therapy’ (Cuijpers et al., 2013). This is one of the
most common therapies in case of mental disorder and this therapy helps people with
depression to better cope with their situation.
The situation of Alison is quite complicated as she is suffering from depression,
financial and personal problem. In addition she has two young kids as well. Therefore, as a
nurse, I need to consider her mental condition, financial stability, and well- being of her
children as well. Foster home care service can be arranged for the children (Conn et al., 2014)
and therapy will be applied to Alison as mentioned above. In addition, Alison can be entitled
to the National Disability Insurance Scheme or NDIS (Ndis.gov.au, 2019), so that her
financial condition can be improved.
For the evaluation of the clinical outcomes, a later date will be set up with the patient
in mutual consent. In addition to this, SAM or Systematic Activation Method (Clignet et al.,
2017) can be implemented for the evaluation as well.
By assessing this case study of Alison, I have learnt few new things which I was not
aware earlier. From this assessment, I have learnt different stages of depression according to
the DSM – criteria and I believe this will help me immensely in dealing with depression
patient in future.
Therefore, from the above discussion, it can be said that the different steps of Clinical
Reasoning Cycle (Hur & Roh, 2013) were utilized in this reflection to understand and assess
the patient situation and for the determination of her current condition with respect mental

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illness. By utilising the Clinical Reasoning Cycle, it can be established that the patient,
Alison, is suffering from ‘Depression with anxious distress’ according to the DSM- 5
guidelines and ‘Cognitive behavioural Therapy’ was suggested as a recovery oriented
approach.

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Reference:
Clignet, F., van Meijel, B., van Straten, A., & Cuijpers, P. (2017). A qualitative evaluation of
an inpatient nursing intervention for depressed elderly: The systematic activation
method. Perspectives in psychiatric care, 53(4), 280-288,
https://doi.org/10.1111/ppc.12177.
Conn, A. M., Calais, C., Szilagyi, M., Baldwin, C., &Jee, S. H. (2014). Youth in out-of-home
care: Relation of engagement in structured group activities with social and mental
health measures. Children and Youth Services Review, 36, 201-205,
https://doi.org/10.1016/j.childyouth.2013.11.014.
Cuijpers, P., Berking, M., Andersson, G., Quigley, L., Kleiboer, A., & Dobson, K. S. (2013).
A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in
comparison with other treatments. The Canadian Journal of Psychiatry, 58(7), 376-
385, https://doi.org/10.1177/070674371305800702.
Dsm.psychiatryonline.org. (2019). Retrieved from https://dsm.psychiatryonline.org/pb-
assets/dsm/update/DSM5Update_October2018.pdf
Hur, H. K., &Roh, Y. S. (2013). Effects of a simulation based clinical reasoning practice
program on clinical competence in nursing students. Korean Journal of Adult
Nursing, 25(5), 574-584, https://doi.org/10.7475/kjan.2013.25.5.574.
Kumar, A., Yang, S., Ajilore, O., Wu, M., Charlton, R., & Lamar, M. (2014). Subcortical
biophysical abnormalities in patients with mood disorders. Molecular
psychiatry, 19(6), 710, https://doi.org/10.1038/mp.2013.84.
Ndis.gov.au. (2019). National Disability Insurance Scheme (NDIS). Retrieved from
https://www.ndis.gov.au/

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Schrank, B., Brownell, T., Tylee, A., & Slade, M. (2014). Positive psychology: An approach
to supporting recovery in mental illness. East Asian Archives of Psychiatry, 24(3), 95,
Retrieved from:
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Woods, S. B., & Denton, W. H. (2014). The biobehavioral family model as a framework for
examining the connections between family relationships, mental, and physical health
for adult primary care patients. Families, Systems, & Health, 32(2), 235,
http://dx.doi.org/10.1037/fsh0000034.