Mental State Examination and Symptom Interventions

The document describes the Mental State Examination of a patient, including their general appearance, behavior, speech, mood and affect, thought process, thought content, perception, cognition, judgment, and insight. It also suggests interventions for symptoms like fleeting thoughts and euphoric mood.

Adult Mental Health Services
CONSUMER ASSESSMENT
Date: Time:
URN:
Family Name:
Given Name(s):
Address:
Date of Birth:
MENTAL STATE EXAMINATION
General
appearance
The general appearance of Mr. Leroy (35) seemed stressed, excited and
nervous. He came for a follow up after his parents forced him to resume his
follow up for tests and upon vising the local helath center he seemed nervous.
He was wearing a blue shirt with orange cap and green pants that indicates to
the fact that he is unable to coordinate his clothes properly. Further, this
combinantion of clothes indicated to the fact that due to urregularity of his
medications, his manic conditions are relapsing. However, he wore neat and
claen clothes and his clothes were not messy and no such accessories were
observed in his attire. One major change or physical appearance related
complication that was observed in this interveiew was his age as he appeared
much more older than his bilogical age and hence from this aspect his poor self
care and improper health and wellbeing could be identified. The patient
appeared nervous as he was not making eye contact with the helathcare
professional and was speaking a lot after each question, majority of which
were repetitive sentences. Hence, this situation indicated towards his
nervousness and distress. Further, it was seen that the patient has lost
considerable amount of weight in past few weeks and this indicated to the fact
that he is unable to eat optimum nutrition in his meals due to which his health
cinditions are deteriorating.
Throughout the interview process, the patient was slouched and was unable to

Behaviour maintain a straight sitting posture that indicated to the fcat that the patient is
least interested in the converstion and is being forced to attend the follow up
meeting. His behaviour was completely negative about the process as he was
not maintaining proper eye contact with the helathcare professional. Further,
the care professionals had to repeat each of the questions that she asked to Mr.
Leroy and while answering them he was fidgeting and tremors were observed.
Further, it was seen that the patient suffered from lack fo self confidence due
to which he was continuously lookibg downwards and he was unable to make
synchronous coordination between his head and hands. Throughout the
process, he was observed to bang his head and he was continuously sweating.
This also indicated to the fact that the patient was nervous and anxious in the
process.
Speech
In the entire interview process, the patient was seen talking to the helathcare
professional in a manner that made the entire interpretation difficult to
understand. It was also seen that the patient was taking in multiple phrases and
was unable to communicate in proper sentence structure, was using improper
phrases and syntax that made each of his sentendes clumsy and difficult to
understand. He was stammering in multiple moments and was unable to
communicare properly throughout the process. one of the primary reason of
this situation could be hs nervbousness and anxiety due to which he was
replying with such distorted and improper speech. However, while analysing
his speech, it was identified that he was unable to phrase his thoughts
effectively and hence, at the starting of each line he was unable to arrange
works and sentences properly. Hence, his speech seemed forced and improper

to the counsellor.
Mood and
Affect
The patient was in a good mood whne the interview was conducted as he
greeted the counsellor gently and responded to each of the questions after
understanding. He was able to reply without any interruption and depite his
inability to phrase the sentence structure and other aspects, he seemed to be in
a good mood. He even laughed on few of the questions that was asked to
understand his complication associated with hallucination and illicit drug
consumptions and mentioned that he is too busy to attempt all thee aspects in
his life. Hence, from these aspects, it is clearly identified that the patient was in
a good mood while answering all these questions and attemped all the aspects
upon understanding the significance of the questions. While discussing about
his affect, it should be mentioned that he was unable to maintain a normal
conversation and seemed to be excited and hyperactive in each question.
Hence, his affect was also appropriate at that time period.
Thought
process
The thought process of the patient was observed through his replies, his
personality and the way he was communicating to the counsellor. He
considered his self as very busy individual however, through the process it was
easier to understand that his mental state is deteriorating due to his inability to
maintain peroper medication cycle. He was unable to understand any of the
question and the counsellor had to reapeat each of her questions in lucid
language sothat the patient could undetsnad and reply to the questions
effectively, hence from this scenario, diversions in his thought process were
observed which required immediate care and attention.
Thought
content
This is the most ccomplicated observation that were made in case of Mr.
Leroy. He was in a denial mde upon asking about his illicit drug usage or

hallucinantion associated health condition and in reply to such questions, he
mentioned that he is unable to understand the meansing of such questions and
he is busy working due to which he cannot observe his sleeping pattern, his
diet and his medications. His thought content also included a statement as per
which, medication s should be stopped after the patient feels well. Further, his
thought content also included overconfidence and belief uponb his own
business ideas as he mentioned that some external forces help him to take
innovative ideas. However, in its previous sentence he mentioned that he do
not hear any voices or see any external forces. Hence, mild to moderate level
of halluncination was included in his thought content.
Perception
The patient did not show any sign of negative and hallucinatory perceptions in
this entire interview conducted and hence, it could be said that his thought
content did not affected his perceptions and beliefs due to which his helath
complications increased.
Cognition
Cognition level of the poatient could be identified from the his replied to few
specific questions such as his hallucination associated symptoms as it was seen
that the patient clearly mentioned that he has not seen any voices or entity in
this entire process and is unable to feel such things as he is very busy with his
works. Further, the patient aslo mentioned that he has consumed his
medications two weeks ago and is unable to take medications. However,
besides this, no such cognition analysing tests were conducted with the patient
so that they could understand the effectiveness and ability of the cognition of
the patients. Hence, through these replies it is easily understood that the
cognition level of the patient was effcetive and he was able to think of huis
complications without any complications.

Judgment &
Insight
Whileunderstanding the patient condition and his ability to judge any situation,
it should be mentioned that he was unabe to understand or implement effcetive
care and even rejected the fact tghat medication administration is an important
aspects for overcoming critical health condition. He considered himself very
busy with business thoughts, however he was terminanted from his work
months back due to which he again shifted to his parents home. He also
misjudged his helath condition and did not show up for follow up tests so that
his helath condition culd be treated. Hence he completely denied the fact that
he suffered from critical mental health complications and eventually refused
the medication and treatment provided by the local helath facilities. However,
while discussing about his insight, it should be mentioned that no such
questions were asked to the patient that could determine the insight of the
patient.
SYMPTOM INTERVENTIONS

Fleeting
thoughts
Upon evaluation of the patient interview, it can be mentioned that the patient
experienced fleeting thoughts or flight of ideas. The evidence base suggests that
fleeting ideas if left untreated might escalate and lead to serious mental health
problems such as development of an advanced stage of Schizophrenia. This
suggests that there is an increased need to adapt measures so as to foster
recovery of the identified symptom.
For the same, the first step would include arranging referral to a
psychotherapeutic counsellor who would be responsible for administering
mindfulness based therpaies such as yoga and meditation to regulate the
disturbed throughts of the client and restore calmness and focused throught
content (Pradhan & Pinninti, 2016). This would enable the client to think
clearly and communicate in a clear and coherent manner.
The second set of intervention that would be undertaken to ensure improvement
of the quality of symptom would include, instilling a safe immediate
environment such that the client is not agitated with a triggering stimulus. This
would require maintenance of a soothing home environment and lower noise
within the environment so as to promote positive recovery (Pradhan & Pinninti,
2016). The evidence base in this regard, mentions that the maintenance of a
soothing care environment promotes fostering of a peaceful and a calm
environment that accelerated the pace of recovery and also ensures
improvement of the symptoms (Bisagno et al., 2016).
Therefore, the two intervention startegies that would be undertaken to
effectively manage the disorganized throughts of the patient would comprise of

installation of a calm therapeutic environment and administration of effective
mindfulness based interventions such as yoga and meditation to reinforce
effective management of the symptoms.
Euphoric
mood
Upon analysis of the case scenario, it can be stated that the client presents
symptoms of ‘euphoria’ which is a predominant characteristic of excessive
synthesis of the hormone dopamine. The primary course of intervention that
would be undertaken in order to improve the symptom related to euphoric
mood would comprise of commencement of antipsychotic medication. The
antipsychotic medication that would be undertaken to ensure symptom
management would comprise of administration of antipsychotic medication
such as Risperidone or Aripiprazole. Research studies mention that
antipsychotic medications such as Ariprazole or Resperidone can modify the
impact of the Dopamine transmitter and help to prevent the manifestation of the
‘euphoric episode’ (Creado & Plante, 2016). The mode of action of the drugs
involves eliciting an antagonistic activity on the D2 receptors that are present
within the postsynaptic region. Also, the drugs can elicit an agonist activity
withithin the D2 receptors that are located iwthin the D2 receptors (Creado &
Plante, 2016). In addition to the same, the administered medication would serve
as a partial agonist located within the D3 receptors and as a result this would
stop or block the recpetors of Dopamine that are present within the
teberoinfundibular region,nigrostriatal pathway as well as the mesocortical
pathway. In addition to this, on account of 5HT2A antagonism woukd help to
increase the rate of dopaminergic neutrotransmission specifically within the
nigrostriatal pathway and this would help in controlling the manisfestation of

the symptoms of euphoria (Henriksen et al., 2016).
Further, administration of medictaions such as Valporate which are classified as
mood stabilisers would also help to stabilise the mood of the patient. Research
studies mention that the administration of the mood stabiliser medication drugs
such as Valporate typically elicit their action by inducing blockage of the
voltage gated Na channels (Henriksen et al., 2016). This subsequently raise the
concentration of another neutrotransmitter in blood which is known as the
ganna-aminobutyric acid or the GABA acid. The direct impact of the GABA
neurotransmitter would help to stabilise and reinforce anti-manic properties. In
addition to this, research studies also mention that the impact of the GABA
neurotransmitters help to regulate the excitability of different nerve fibres by
means of the Kv7.2 channel as well as the AKAP5 channel and as a result, it
has been studied that that the incidence of ‘euphoric mood’ is significantly
controlled among the affected inidividuals (Creado & Plante, 2016). This helps
in the maintenance of improved symptom management and prevents
subsequent psychotic episodes of mania.
Deprived
sleep or
Insomnia
The case scenario mentions that the client is unaware about his duration or
hours of sleep and one of the major causes that can aggravate his symptoms of
mania would include lack of sufficient sleep. In addition to this, it can also be
stated that the lack of sleep duration would lead to deterioration of his physical
health conditions. In order to prevent the same, an improved intervention
strategy would be imprlmented to ensure that the client is not sleep deprived
and is able to complete a minimum of 8 hours of uninterrupted sleep.

In order to ensure the same, appropriate pharmacological interventions would
be commenced. The first line of pharmacological interventions would comprise
of administering medications such as Zolpidem and Oxazepam (Ridenour et al.,
2019). The mentioned medications are sedatives that comprise of the specific
property to soothe the irritatibility of the brain and the central nervous system
which result in interrupted sleep. Research studies mention that the listen
sedative drugs typically elicit their impact on the benzodiazepine receptors and
typically alleviate the effect of the neurotransmitter GABA (Unger, 2018). This
helps in inducing an inhibitory impact on the overall central nervours systema
and thus promotes stabilization of mood and facilitates relaxation from stress
and irritation (Unger, 2018).
The second set of interventions would include administration of
psychotherapeutic interventions such as music therapy. The evidence base
mentions that the administration of music therapy makes use of soothing and
relaxing music that helps to calm the exitsing anxiety of the patient and foster
improved recovery (Feng et al., 2018). In addition to this, music therapy has
been studied to improve symptoms of insomnia and facilitate improved
tranquillity which fosters improved sleep. In addition to this, research studies
also suggests that the use of alternative therapies such as the use of a
combination of music therapy and essential oils can help to reinforce imporved
symptom management (Fradelos & Komini, 2015).

References
Bisagno, V., Gonzalez, B., & Urbano, F. J. (2016). Cognitive enhancers versus addictive
psychostimulants: The good and bad side of dopamine on prefrontal cortical
circuits. Pharmacological research, 109, 108-118.
Creado, S., & Plante, D. T. (2016). An update on the use of sedative-hypnotic medications in
psychiatric disorders. Current psychiatry reports, 18(9), 78.
Feng, F., Zhang, Y., Hou, J., Cai, J., Jiang, Q., Li, X., ... & Li, B. A. (2018). Can music improve sleep
quality in adults with primary insomnia? A systematic review and network meta-
analysis. International journal of nursing studies, 77, 189-196.
Fradelos, E., & Komini, A. (2015). The use of essential oils as a complementary treatment for
anxiety. J AJN, 4(1), 1-5.
Henriksen, T. E., Skrede, S., Fasmer, O. B., Schoeyen, H., Leskauskaite, I., Bjørke Bertheussen, J., ... &‐
Lund, A. (2016). Blue blocking glasses as additive treatment for mania: a randomized‐
placebo controlled trial.‐ Bipolar disorders, 18(3), 221-232.
Pradhan, B., & Pinninti, N. R. (2016). Yoga and Mindfulness-Based Cognitive Therapy for Psychosis (Y-
MBCT p©): A Pilot Study on Its Efficacy as Brief Therapy. In Brief Interventions for
Psychosis (pp. 55-87). Springer, Cham.
Ridenour, J. M., Hamm, J. A., & Czaja, M. (2019). A review of psychotherapeutic models and
treatments for psychosis. Psychosis, 1-13.
Unger, D. (2018). Safe prescribing of opioids and sedatives: It’s about primary prevention. British
Columbia Medical Journal, 60(10), 504-505.