Integrating Practice 3: Clinical Reasoning Cycle and MSE Analysis

This report details the application of the clinical reasoning cycle to a case study of a 38-year-old single mother, Alison, exhibiting symptoms of clinical depression. The report follows the eight stages of the cycle, starting with an assessment of Alison's situation, including financial instability and relationship difficulties. It then describes the collection of cues through a mental state examination, noting her soft tone, avoidance of eye contact, and cognitive function. The information is processed using DSM-5 criteria to diagnose melancholic depression, and issues are identified, including financial strain and its impact on her parenting and relationships. The report establishes goals for medication and psychotherapy, proposes interventions such as antidepressants and cognitive behavioral therapy, and emphasizes the evaluation of outcomes to ensure treatment plan adherence. The conclusion highlights the importance of a structured approach to patient assessment and intervention in mental health care.

Running head: CLINICAL REASONING CYCLE
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Clinical Reasoning Cycle
Student’s Name
University

CLINICAL REASONING CYCLE
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Clinical Reasoning Cycle
Introduction
Gummesson, Sundén, & Fex (2018) suggest that the clinical reasoning cycle is the
process of understanding the situation of the patient and developing interventions that reflect the
needs that the patient presents. In this case, the professional goes through eight stages that lead to
the development of clinical knowledge about the patient and developing an action to address the
problem.
Patient’s situation
The first step of the clinical reasoning cycle is the review of the patient situation to
understand the issues that need to be considered. This paper reviews the case of Alison, a single
mother aged 38 with two children who seems to be suffering from clinical depression. From the
current situation where she is financially unstable and struggling to meet her daily needs which
makes it difficult for her to cope well. From the analysis, there are significant stressors like low
mood, loss of appetite, difficulty sleeping and even poor relationship with her kids which all
point to signs of depression (Siu, 2016). However, there are protective factors of very limited
history of the psychiatric history from the fact that she has had such a situation in the past but
managed to overcome.
Collect cues and information
In the collecting information phase, the focus is to probe the patient through mental state
examination with a focus on the issues that Alison was presenting in the clinical environment.
From the examination her behavior was seen in speaking in a soft torn that showed someone who
was low, she avoided eye contacted and she showed signs of retardation through hand wringing.

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Her cognition was good with a moderate level of consciousness, attention, concentration and
good memory of the different accounts that she had gone through (Driessen & Hollon, 2010).
Her thought process is normally based on the way she was explaining herself and the information
that she was presenting was flowing and connected. Her thought content showed no signs of
illusionary or preoccupation content but seems to show no signs of hope. Her effect can be
described as dysphoric since she shows signs of depression and irritation due to the challenges
that she is facing. Lastly, her mood state can be characterized as affecting her eating, sleeping,
social and sexual life which shows that she is disturbed and depressed from the low mood.
Process the information
The next step is processing information using the DSM-5 to determine the risk that she is
facing. From this tool, I can firmly conclude that Alison is depressed because of the specific
features that she displays. Tolentino & Schmidt (2018) suggest tat one of the requirements for
concluding that the patient is depressed is having five or more symptoms in the same period
within two weeks and at least one of the symptoms of depressed mood or loss of pressure. For
Alison I have noted that she is having a depressed mood most of her days, she is having
diminishing interest and pleasure in things like social relationships where she is no longer
meeting the demands of her relationship with Dave her boyfriend. Simms, Prisciandaro, Kruege
& Goldberg (2012) adds that characteristics of depression are seen in significant weight loss due
to poor eating and loss of appetite, feeling of worthlessness where she is full of guilt for not
being there for her two kids lately and her diminished ability to concentrate recently. These
features indicate that she is suffering from melancholic depression that is characterized by low
mood, lack of response to pleasure situations, changes in appetite, the feeling of guilt and
agitation.

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Identification of issues
From the analysis, I have noted that Alison is being affected by her current financial
situation which has affected her normal functioning. This has affected her two kids and made it
difficult to fulfill her parenting needs. This has also made it difficult for her relationship with
Dave since her social functioning has been affected and made it difficult for her to relate well
with other people.
Establishment of goals
To diagnose medications that will help Alison cool down her symptoms of depression.
Development of a psychotherapy program to treat the depression.
Take action
The first thing to do is to assist the patient to overcome the effects of depression like loss
of appetite, change of mood and problems sleeping. Ionescu, Rosenbaum, & Alpert (2015)
suggests that this entails the use of antidepressants like selective serotonin reuptake inhibitors,
typical antidepressants, tricyclic depressants and monoamine oxidate inhibitors which will assist
her to sleep well, regain her appetite and overcome the symptoms of depression to ensure that
they do not escalate further.
The next thing to do is the application of cognitive behavioral therapies that will assist
Alison to overcome the challenge that she is facing. Hofmann (2011) argues that cognitive
behavior therapies are used to improve the mental state of the patient by changing unhelpful
distortions that the patient experiences through developing coping strategies to solving the
current problem. From the case of Alison the best cognitive method that works well for her is the
alternative action formulation method that works through the use of a worksheet that allows the
patient to list the problems being faced, listing the vulnerabilities and triggers so that they can be

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understood well (Barth, et al., 2013). Thus once the mental health professional has assisted
Alison to define and understand the problem that she is facing, then she will develop coping
strategies together with the mental health worker that focus on ways that she can use to deal with
the problem. Since the nature of depression that she is facing stems from the financial difficulties
that she has, then it means that the issues in her life can be managed by assisting to learn how to
deal with different issues by listing alternative actions that work for the problem.
Evaluation of outcomes
To ensure that the patient is following the requirements of the treatment plan there is a
need to evaluate the progress made. This means that the professional needs to review the
progress of the patient after some time to identify the progress made.
Conclusion
Therefore, the clinical reasoning cycle can be applied in analyzing the patient situation
and developing an action plan for addressing the challenges that the patient is facing. This means
that the role of the mental health professional is to assess the patient and gather enough clinical
information that can be used to identify the issues being faced by the patient and developing a
proper action plan to meet her needs.

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References
Barth, J., Munder, T., Gerger, H., Nüesch, E., Trelle, S., Znoj, H., . . . Cuijpers, P. (. (2013).
Comparative Efficacy of Seven Psychotherapeutic Interventions for Patients with
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Driessen, E., & Hollon, S. (2010). Cognitive behavioral therapy for mood disorders: efficacy,
moderators and mediators. The Psychiatric Clinics of North America, 33(3), 537-555.
Gummesson, C., Sundén, A., & Fex, A. (2018). Clinical reasoning as a conceptual framework
for interprofessional learning: a literature review and a case study. Physical Therapy
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Hofmann, S. (2011). An Introduction to Modern CBT. Psychological Solutions to Mental Health
Problems. Chichester: Willey Blackwell.
Ionescu, D., Rosenbaum, J., & Alpert, J. (2015). Pharmacological approaches to the challenge of
treatment-resistant depression. Dialogues in clinical neuroscience, 17(2), 111-126.
Simms, L., Prisciandaro, J., Kruege, R., & Goldberg, D. (2012). The structure of depression,
anxiety and somatic symptoms in primary care. Psychol Med, 42, 15-28.
Siu, A. (2016). Screening for Depression in Children and Adolescents: U.S. Preventive Services
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Tolentino, J. C., & Schmidt, S. L. (2018). DSM-5 Criteria and Depression Severity: Implications
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