Mental Health Nursing: Dimitri's Case Study, MSE, & Care Plan Analysis

This report presents a comprehensive analysis of Dimitri's mental health case study, focusing on the application of Mental State Evaluation (MSE) to assess his psychological and emotional state. It details Dimitri's appearance, behavior, mood, affect, speech, thought form, perception, cognition, insight, and judgment, leading to a diagnosis of schizophrenia. The report identifies key risk factors such as auditory hallucinations and lack of social connection. A nursing care plan is developed, prioritizing the management of auditory perceptions through interventions like education, mindfulness therapies, and narrative therapy. The report also critiques the interview process, highlighting strengths like maintaining eye contact and a soft tone, alongside weaknesses such as using long sentences and a lack of friendly gestures. The goal is to foster mental peace and enable Dimitri to perform daily activities without being interrupted by the voices. The report concludes by emphasizing the importance of appropriate nursing interventions to prevent the worsening of symptoms associated with schizophrenia.

Running head: MENTAL HEALTH NURSING
MENTAL HEALTH NURSING
Name of the Student:
Name of the University:
Author Note:

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Introduction:
As per the World Health Organization (2019) mental health is a crucial aspect of an
individual’s health status as it helps the individual to realize his/her own abilities and
increases their abilities to cope with the lifestyle, environmental and emotional stress.
However, as per the Australian Medical Association (2019), 7.3 million people between the
ages of 16 to 85 suffer from mental health conditions such as stress, anxiety, depression.
Further, it also mentioned that the primary health complication in Australia is anxiety
disorder, depression and substance abuse due to which majority of the Australian population
suffer from primary and secondary healthcare complications (Crome et al., 2015). The
primary aim of this paper is to analyze the case study of Dimitri and then evaluate it on the
basis of Mental State Evaluation assessment and then would through the assessment of his
associated risk factors and complications, develop a care plan. Finally a critical evaluation of
the interviews process conducted, the strengths and loopholes of the process would be
discussed so that assessment of the quality of interview could be obtained.
Mental State Evaluation (MSE) of Dimitri:
MSE is a process through which mental healthcare professionals could conduct a
detailed assessment of the psychological and emotional aspect of the patient and then
depending on the results, defines the behavior, and mental state of the patient involved (Yang
et al., 2015). In this case of Dimitri, MSE was conducted so that a descriptive analysis of his
behavior could be obtained. The following sections would provide detail of the MSE of
Dimitri:

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Appearance
While observing Dimitri while conducting interview, he seemed slim built Asian and
his age was estimated to be in early 20’s. He seemed very hygienic as he was observed to be
properly dressed and wearing a black glasses. However, his hair was rough and unkempt and
the way he was sitting on the chair indicated towards poor body posture.
Behaviour
Dimitri was continuously fidgeting on his chair and the body posture he maintained in
the entire interview session indicated towards his lack of concentration. He was unable to
speak a complete sentence at a time and was slow in his every response.
Mood
Dimitri was scared and conscious throughout the interview and was constantly felt
irritated due to the voices he used to listen.
Affect
Patient was constantly distracted due to some external voices and was avoiding some
questions indicating towards blunt and flat responses.
Speech
As mentioned earlier, Dimitri was unable to speak a complete sentence at a time and
used very minimal speech throughout the interview process. His voice tone and flow of
sentences indicated towards his concentration issues> further his hesitation to answer some of
the question was also observed in his MSE process.
Thought form
From his improper responses, lack of concentration and inability to form a complete
sentence while taking interview indicated toward inability to form a positive and constructive
thought process.

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Perception
Dimitri has auditory hallucinations, and as per him, he was distracted because of these
voices while taking the interview.
Cognition
Dimitri was able to make himself oriented as he knew the place, date and time of the
interview, however while conducting the process, he was unable to concentrate on the
communication that indicated towards minimal impairment of long term and short term
cognitive abilities.
Insight
Dimitri was able to understand his mental health condition associated issues was
asking the mental healthcare professionals to provide him with a medication namely
‘Olanzapine’.
Judgment
Patient’s judgment abilities were normal and he was aware of the situation that
without proper medication, his mental health would not be improved.
Disorder impression
After completion of this MSE process, it could be evaluated that his primary concern
was the auditory hallucinations due to which he was unable to perform his activities because
the voices used to criticize him un every step. Further, due to this, he was unable to focus on
social inclusion and found to be socially depressed. Olanzapine was his medication for
mental state and finally depending on the DSM-V screening tool, he was diagnosed with
Schizophrenia.

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Identified risk factors
After complete assessment of Dimitri’s mental health and associated concerns, total
four risk factors could be identified, depending on which the care plan should be developed
so that the uncontrolled stage of mental health could be avoided.
 The first risk factor is associated to his auditory hallucinations due to which
he was unable to focus on any action or communication. Therefore, this could
harm the patient by increasing his violence or agitation level as he is unable to
find a way out of this concern and could lead to anxiety disorder (Bor et al.,
2014).
 Lack of social connection could be the second risk factor as he was unable to
share his mental health concerns to his family and hence, it could lead to
severe depression.
 Dimitri in unable to focus and unable to utilize his constrictive thought
process because the auditory hallucinations used to criticize him and his
actions that increased his agitation and violence. It could lead to sleeping
disorder and obesity in the patient’s health condition. Therefore, it should also
be focused for the development of care plan for Dimitri (Crome et al., 2015).

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Nursing Care Plan:
Aligood (2013) stated that while caring for a patient, it is important to essentially
focus on the patient needs on a priority basis. Once the patient is diagnosed for the disease
condition, the patient needs are identified and accordingly a nursing plan is developed to care
for the patient. A nursing care plan helps in listing patient needs on the basis of priority and
accordingly devise interventions to address those needs.
Prioritizing problem:
The problem priority for the patient would be chosen as the auditory perceptions or
the ‘voices’ that disturbed the mental peace of the patient. As mentioned by Arnold and
Boggs (2015), the auditory perceptions in the form of extrinsic voices as well as visual
hallucinations are common symptoms experienced by schizophrenic patients. In addition to
this, common symptoms of schizophrenia cover experiencing problem with sensory
perceptions and neurological as abnormal neurological changes.
Justification for selecting the problem:
Through the complete interview process, the patient seemed to lack focus and seemed
distracted by the voices. The patients was finding it difficult to concentrate on the questions
asked by the mental health nurse and on certain occasions was seemed to be preoccupied.
Also, during multiple instances, the patient was seen to ask the voices to ‘shut up!’ When the
nurse inquired about what were the voices telling him, he told her that the voiced always
criticized his abilities. Therefore, it can be said that the auditory perceptions seemed to
disturb the patient and also hamper his ability to perform activities that he liked such as
writing and working on his novel to finish it.

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Nursing Goal:
The primary goal for the patient would be to foster mental peace and induce
intervention that would ensure that the voices cease to exist. In addition to this, the nursing
goal would aim at promoting patient recovery and ensure that the patient is capable for
performing activities that interest him without being interrupted from the voices.
Nursing Intervention and Rationale:
The nursing intervention with supporting rationale that would help in promoting
patient recovery is mentioned in the table below:
Nursing intervention strategies Rationale
Educate the patient about the mental health
disorder and administer counselling sessions
to make him understand that the voices he
hears are unrealistic and do not exist in
reality
Research studies suggest that while dealing
with patients with a mental health disorder,
such as schizophrenia, the experience of the
disorder might be overwhelming to the
patient. It is important for care professionals
to educate the patient about the disorder so
that they are aware of the problem and its
implication that they are going through.
Further, the administration of counselling
helps in analysing the problem faced by the
patient and making the patient aware that
the voices do not exist in reality (Mearns et
al., 2013).
Administer mindfulness based therapies
such as meditation and yoga to promote
Research studies suggest that while
administration of mindfulness based

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mental peace therapies such as meditation and yoga can
help in promoting mental peace and
reinforcing calmness in the patient (Tang et
al., 2015).
Administer narrative therapy to the patient
in order to identify the cause of the disorder
and develop an insight into any major life
events that could have caused the disorder
Studies suggest that narrative therapy builds
upon identifying the values and skills of the
patient and accordingly empowers the
patient with abilities to confront any
problems that they experience (Denborough,
2014). The use of narrative therapy would
help in challenging the dominating belief of
the patient about the ‘voices’ that disturb his
mental peace and make him feel low.
Critique:
The fundamental aspect of mental health nursing is based upon effective
communication (Arnold & Boggs, 2015). The interview of the patient Dimitri with the mental
health nurse contained certain aspects of effective communication and certain aspects of
ineffective communication. Throughout the video the mental health nurse can be seen to
maintain eye contact with the patient. This can be identified as an example of effective
communication. Also, the nurse maintained a soft tone and was patient with Dimitri during
the interview process, which is another important aspect of effective communication. The
mental health nurse informed about the procedure that would be taking place next. He was
informed that the doctor would examine him and check his medications. This can be
identified as another instance of effective communication. The mental health nurse was

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empathetic to the patient and was observed to use phrases such as, ‘that must be difficult for
you in a different place with people speaking a different language’ when the patient told her
that he was unable to take his medication because he went to Japan and ran out of his
medication and was unable to consult any physician.
On the other hand, a few negative instances were also observed in the interview. The
nurse used long sentences to ask questions and it seemed that the patient found it difficult to
follow. Also, the nurse did not smile or use friendly gestures to pacify the patient when he
seemed to be disturbed by the voices.
Conclusion:
Therefore, it can be said that Schizophrenia is a complex mental health disorder that
reduces the ability of social interaction and is accompanied with auditory or visual
hallucinations that disturbs the mental peace of the patient. However, with the use of
appropriate nursing intervention that symptoms can be prevented from worsening further.

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References:
Alligood, M. R. (2013). Nursing Theory-E-Book: Utilization & Application. Elsevier Health
Sciences.
Arnold, E. C., & Boggs, K. U. (2015). Interpersonal relationships: Professional
communication skills for nurses. Elsevier Health Sciences.
Australian Medical Association. (2019). Mental Health - 2018. Retrieved from
https://ama.com.au/position-statement/mental-health-2018
Bor, W., Dean, A. J., Najman, J., & Hayatbakhsh, R. (2014). Are child and adolescent mental
health problems increasing in the 21st century? A systematic review. Australian &
New Zealand journal of psychiatry, 48(7), 606-616.
Crome, E., Grove, R., Baillie, A. J., Sunderland, M., Teesson, M., & Slade, T. (2015). DSM-
IV and DSM-5 social anxiety disorder in the Australian community. Australian &
New Zealand Journal of Psychiatry, 49(3), 227-235.
Denborough, D. (2014). Retelling the stories of our lives: Everyday narrative therapy to
draw inspiration and transform experience. WW Norton & Company.
Mearns, D., Thorne, B., & McLeod, J. (2013). Person-centred counselling in action. Sage.
Tang, Y. Y., Hölzel, B. K., & Posner, M. I. (2015). The neuroscience of mindfulness
meditation. Nature Reviews Neuroscience, 16(4), 213.
World Health Organization. (2019). Mental Health. Retrieved from
https://www.who.int/mental_health/en/
Yang, A. C., Hong, C. J., Liou, Y. J., Huang, K. L., Huang, C. C., Liu, M. E., ... & Tsai, S. J.
(2015). Decreased resting‐state brain activity complexity in schizophrenia

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characterized by both increased regularity and randomness. Human brain mapping,
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