Emergency Department: Mental Health Assessment Case Study Analysis

This nursing case study presents a mental health assessment of a patient in the emergency department. The assessment covers various aspects, including the patient's appearance, behavior, speech, mood, affect, thought content, thought process, perception, cognition, insight, and judgment. The patient, appearing dishevelled and agitated, exhibits symptoms such as pressured speech, hallucinations, and a low level of consciousness. The analysis follows the guidelines of Freud's mental state assessment, providing a detailed examination of the patient's condition to facilitate an accurate diagnosis and the formulation of appropriate intervention strategies. References to relevant literature support the analysis, aiming to provide a comprehensive understanding of the patient's mental state. The case study aims to aid in understanding the complexities of mental health assessments within a clinical setting, highlighting the importance of a structured approach in evaluating a patient's condition.

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Name of the Student:
Name of the University:
Author Note:

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Mental State Assessment:
According to Freud (2014), mental state assessment can be defined as a structured
procedure of observing and evaluating a patient’s state of mind. The mental state evaluation
assessment takes into consideration the criteria of appearance, behaviour, mood, affect,
speech, thought process, thought content, perception, attitude, cognition as well as insight and
judgement (Heilbrun et al., 2014). It should be noted in this context that the overall purpose
of the mental state evaluation is to obtain a comprehensive and cross-sectional description of
the patient’s mental state which in combination with biographical as well as historical
information of the psychiatric history allows therapists to forecast an accurate diagnosis and
articulate appropriate intervention strategies so as to promote recovery. In order to formulate
an accurate diagnosis of the mental health condition of Anabelle, it is extremely important to
conduct a mental state evaluation assessment.
Appearance:
The patient looked untidy and was observed to wear a pair of dirty jeans and a T-shirt.
Her hair was dyed blue and pink but was unkempt and matted. Her appearance seemed
dishevelled and unkempt and she presented to the ED barefoot. This suggested that she did
not pay attention to her appearance and grooming.
Behaviour:
The patient avoided eye contact on most occasions but at times glared at the nursing
professional with the eyes fully dilated. Her facial expression varied between being happy to
frightened and then sobbing uncontrollably. She fidgeted with her hands and seemed to be
agitated. She was observed to wring her hands and sweat profusely. She seemed to talk to
voices which were non-existent.
Speech:

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Anabelle’s rate of speech seemed to be pressured. In addition to this, her quantity of
speech seemed to be excessive and at the same time irrelevant. The tone of speech seemed to
be tremulous varying in between loud and normal pitch. In addition to this, the volume of the
speech seemed to be loud when she is observed to scream at the non-existent voices at the
ceiling. The fluency and rhythm of speech seems to be varying in between slurred and
articulate. At the beginning of the session, the patient is seen to mumble and talk to herself.
At this stage, the rhythm of the speech can be identified as slurred. The very next moment,
the patient seems to question the purpose of her being at the clinic and requests not to
mention about the interview to someone (probably the non-existent voice). Upon responding
to her query, she seems to lose her composure and scream aloud irrelevant sentences such as
‘you know don’t you? You know it’s in my veins!’ At this stage, the rhythm seems to be
articulate and the volume is loud.
Mood and Affect:
Mood: The patient appears to be low in mood and depressed. Also the patient appears to be
anxious with her eyes considerably dilated. Further, she seems to be irritated on account of
the disturbances caused to her by the voices. Therefore, overall, it can be mentioned that the
patient is low in mood, depressed, irritated and anxious on account of the messages being
conveyed to her by the voices.
Affect: Upon closely assessing the patient’s facial expression and demeanour, it can be
mentioned that the quality of affect is sad, agitated and hostile. Further, the range of affect
after studying the patient can be explained as labile. The patient appears to be emotionally
unstable and seems to experience dramatic mood swings. In addition to this, the affect was
seen to fluctuate with the range of emotions. On most of the occasions, the patient seemed to

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be terrified while on other occasions the patient seemed to be distressed and irritated.
Therefore, overall, the affect could be explained as restricted and fluctuating.
Thought Content:
The thought content appeared to be incoherent and at the same time repetitive. The
patient seemed to be obsessed with the messages conveyed by the voices. It should be noted
that no suicidal ideation was noted in the thought content of the patient.
Thought Process:
The thought process seemed to be disconnected and were noted to be incoherent. On
most occasions the thought process seemed to be abnormal and loose.
Perception:
The patient seemed to experience hallucinations without the presence of any external
stimulation. The patient kept mentioning about certain voices that irritated her but the voices
did not exist in reality.
Cognition:
The level of consciousness seemed to be low and the patient found it difficult to focus
and sustain on a particular topic of discussion.
Insight and Judgement:
The patient’s level of insight was observed to be weak and the patient seemed to lack
the awareness about her mental health issue. The patient seemed to be weak in her judgement
making skills.

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References:
Freud, S., 2014. Psychical (or mental) treatment. Read Books Ltd.P.90
Heilbrun, K., DeMatteo, D., Holliday, S.B. and LaDuke, C. eds., 2014. Forensic mental
health assessment: A casebook. Oxford University Press, USA.