Clinical Reflection on Mental Status Examination

This article provides a clinical reflection on a mental status examination, discussing the use of the Clinical Reasoning Cycle (CRC) framework and the evaluation of patient symptoms. It also explores the goals, actions, and outcomes of the examination.

Running Head: MENTAL STATUS EXAMINATION
CLINICAL REFELECTION ON MENTAL STATUS EXAMINATION

MENTAL STATUS EXAMINATION
Introduction
Mental Status Exam (MSE) describes the mental state and behaviors of an individual (Josefsson,
Lindwall & Archer, 2014). It is the psychological equivalent of a physical examination. In the
current scope of a reflective essay, an analysis of a video watched on YouTube was conducted
(University of Nottingham, 2012). The video showed an examination being conducted by a GP
of a patient, who faces depressive disorder. Using clinical reflective skills, the Clinical
Reasoning Cycle (CRC) is used as a framework to understand details regarding the case.
Clinical Reflection
Clinical Reasoning Cycle (CRC) is a comprehensive framework for nursing students. It
allows opportunities to question and reflect on assumptions and prejudices. I feel this framework
is critical to integrate into any case analysis to prevent negative impact in clinical reasoning and
moreover impact patient outcomes. Applying the CRC on the current case analysis, the following
steps are followed;
Patient situation: The patient showed symptoms associated with tearfulness, low mood,
reduced motivation, reduced energy, inability to sleep well, early morning awakening, weight
loss, loss of appetite, reduced enjoyment, poor concentration and less interest in self-care. The
patient was a 38-year-old woman, divorced with two children. She worked at the supermarket.
Collection of cues/information: The patient had a past history of low mood and suicidal
risks. Currently, the patient suffers from low mood, inability to sleep, frustration, tearfulness
whenever she recalls an experience and loss of appetite. New information regarding the patient
revealed an inability to participate in regular life activity. The patient did not enjoy time with her
children. She was not able to interact easily with her husband also. Recalling knowledge reflects
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MENTAL STATUS EXAMINATION
that her symptoms are reoccurring in nature. Her appearance was not normal, her speech was
sometimes blurred and appeared teary. Her mood was throughout the interview, low. Her thought
process reflected nothing levels of solemnness and her emotional status was revealed from her
facial expression (Thota et al, 2012). Though her attitude towards the examiner appeared
cooperative in nature.
Process information: Interpreting the cues and information collected, a clear
understanding of her symptoms can be arrived at. She appeared abnormal as she repeatedly faced
the ceiling while answering questions.
Discriminating between relevant and irrelevant information provided, inconsistencies
were narrowed to arrive at the recognized gaps. She could have hypertension, high blood
pressure, which could be signs from impending shocks. Inferring from the opinions, subjective
and objective cues, the alternative consequences considered (Ayuso-Mateos et al, 2010).
Deductions made from the logical flow of opinion is that she might attempt suicide in case her
current symptoms are left untreated. Her situation had recurred in the past and currently, such
symptoms can be considered to be aggravated in nature. Predicting an outcome is that she might
consider suicide if her condition worsens.
Identify problems/issues: Synthesizing facts and inferences to arrive at a definitive
diagnostic related to the patient problem, reveals that the patient faces severe depressive
symptoms. She faces characteristics of severe depressive disorders. She is sad which is severe
enough and persistent. It interferes with her regular functionalities, which is revealed by her
decreased interests in her children and decreased pleasure in activities. She appeared to be
miserable with tearful eyes, down-turned corners of her mouth and furrowed brows. She had
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MENTAL STATUS EXAMINATION
slumped posture, with poor eye contact with the GP and lacked facial expression. Her speech
changes were absent and she lacked body movements. Evaluation of her condition revealed
severe impairment of nutrition with the necessity of interventions.
Establish goals: One of the major goals to be set for the patient, is to improve her mood.
She will need to overcome her frustration and lack of interests in life. Her levels of motivations
need to be developed such that she is able to take the active part back in her life ( Rao & Chen,
2009). Her nutrition levels have to improve with regular dietary intakes and with adequate
supplements. She will need to get various tests conducted to determine her overall physical
health as well. The desired goal for the client will be aimed to be attained within a time frame of
6 months.
Take Action: Amongst the different courses of action available are support therapy,
psychotherapy, and drug therapy. The patient will need to be provided a support therapy with
psychotherapy. Initial support from the GP through education and monitoring of progress can
ensure effective improvisation. Psychotherapy especially cognitive behavioral therapy along with
interpersonal therapy can be effective with this patient as she faces major depressive disorder.
Evaluate outcomes: Post the patient was provided a combination of support therapy and
psychotherapy, she showed tremendous improvement. The effectiveness of the outcome can be
analyzed by noticing that the patient stopped in-taking drugs to improvise her mood.
Reflect on the process and new learning: Learning from the practical analyzing activity
has been tremendous. It enabled the application of skills and knowledge learned during the
course. It also allowed matching learnings with CRC framework. The application of the
framework required tremendous competencies by depicting MSE skills. Next time I would
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MENTAL STATUS EXAMINATION
undertake a note of each and every point that the patient states. I would also try to provide
counseling and assistance to the patient and assure regarding support every time, even over the
phone. I should have provided her with more guidance at the time MSE was conducted. If I had
practical knowledge, then I would have been able to implement the CRC framework in a better
manner. Now my understanding of CRC framework and MSE is more detailed in nature. In my
professional experience, I will make sure to use this framework every time, to reduce negativities
in my diagnosis.
Conclusion
To conclude, it can be said that the CRC framework is an effective methodology that
allows the appropriate evaluation of patients. Nurses can ascertain proper medications and
patient outcomes, only if proper diagnosis of conditions through assessment is undertaken. The
various parameters of MSE evaluation through the CRC framework will work as an adequate
mechanism for dealing with a patient.
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MENTAL STATUS EXAMINATION
References
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Retrieved from https://youtu.=be/4YhpWZCdiZc
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