CNA256 Mental Health Assessment: Annabelle's Case Study Analysis

This report analyzes a mental health case study of a 22-year-old woman named Annabelle, who presented at an emergency department with significant mental health imbalances. The assignment begins with a discussion of the crucial considerations before initiating a Mental State Examination (...Read More

Running head: CNA256 MENTAL HEALTH
CNA256 Mental Health
Name of the Student
Name of the University
Author Note

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Introduction
Mental State Examination (MSE) is an indispensible part of the mental health
assessment. This examination is undertaken in order again a detailed understanding about the
psychological aspects of the patients at a particular point of time in order to gain direct care.
The following assignment is based on the case study of Annabelle who is 22 years old and
has reported to the emergency department of the hospital with significant imbalance in
overall mental health condition. The assignment will initiate with a detailed analysis of the
issues that are required to be keep under consideration before the initiation of the MSE. The
second part of the assignment will discuss the main aspects of the MSE in relation to the
current scenario of Annabelle. At the end, the assignment will discuss the psychological
aspect of Annabelle in relation to her present mental health condition.
Main Issues in Relation to Recovery
In order to undertake the MSE of the Annabelle, the first consideration that must be
given prime importance will include development of a friendly and trustworthy relationship
with her. From the case study, it can be easily extracted that that Annabelle is petrified for
some unknown reasons even under the presence of her mother. When she first sees me,
disturbances reflected in her overall postures like she is wringing her hands and is sweating
with dilated pupils. When Annabelle was approached personally, in order to conduct a
confidential yet private interview, she said, "you won't tell her anything will you?". This lines
signifies that Annabelle is tensed or scared of someone, be it her mother, her any other family
members or other peers. According to Gaebel et al. (2014), trust is defined as an optimistic
acceptance under a vulnerable situation where the truster believes that the trustee will care for
the truster’s interest. Thus the development of trust is extremely important between the
service users and the service givers of the mental health. Gaebel et al. (2014) further stated

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that development of trust helps to increase the overall effective interaction between the
service users and the service givers and there using the overall patient’s satisfaction in the
mental health service. One of the important aspects of the development of trust is active
listening of the concerns of the clients with a positive body language and maintenance of the
direct eye contact. This will help service users like Annabelle to feel that the other person is
concerned about her condition and is equally worried and feeling for her. The approach of
active listening as explained by the interpersonal communication skills will help Annabelle to
open up and thereby helping to conduct the MSE. Moreover, MSE examination deals with a
detailed analysis of the speech, mood, thoughts cognition, insight and judgement and thus a
development of an inherent relationship will help to promote a detailed yet thorough
assessment of the MSE of Annabelle. The development of therapeutic relationship with
Annabelle will also help to ensure that the she feels that her personal information will be kept
confidential and this will help to her discuss her concerns in detail (Gaebel et al. 2014).
She is also constantly telling that “they are everywhere”. I will make her belief that
there are no one and she is safe while she is with me and I will not allow anyone to enter and
will keep her safe. According to Harner and Riley (2013), in the majority of the cases in
complex mental health condition, the lack of safety and trust is the major trigger of fear and
this might results from lack of reassurance coming from parents and some past fear from
traumatic experience during the childhood. Giving a sense of hope and faith provides self-
assurance and helps to overcome the sense of self-doubt and thereby helping the mental
health service users to overcome their fear and to indulge in active conversation with the
mental health professional.
Another issue to consider before the initiation of the MSE of Annabelle is proper
assessment of her physical state. As per the case study, external appearance of Annabelle, she
looks disoriented like her jeans her dirty, she is barefooted, and her hair is un-kept and

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matted. Moreover, her arms are covered with scores. This signs along with the overall mental
health condition of the Annabelle signified that her overall physical health conditions is also
not healthy, so I will also perform the preliminary physical state examination along with
helping her with basic hygiene needs. This might help her to feel comfortable and thereby
helping her to indulge in effective communication (Unützer et al. 2013).
Main Aspect of the MSE
In the domain of the appearance and the behaviour, it can be said that physical
appearance of Annabelle was not pleasing. The manner in which she is greeting me was also
not normal. Her looks were disoriented, with ugly clothes, coloured hair and too main
piercing on the nose, eye-brows and lips. Her physical appearance does not coincide with the
appearance of a nursing student and thus it can be gauzed that her drastic transformation in
the physical appearance has occurred after she was dropped out from her graduate course in
nursing. Her activity level was high as she was responding at any sounds or movements in the
ED and she looked hostile yet afraid. She was also exhibiting hallucinatory behaviour as she
was talking with some imaginary person telling, "Shut up, shut up and shut up". While
meeting me she was also tensed at one time while laughing at another time. According to
Shiozawa et al. (2013), presence of hallucinatory behaviour both verbal and auditory signifies
the presence of mental health complications like schizophrenia. Halluciantions mght also
have certain pharmacological background. As per the study conducted by Sivanesan, Gitlin
and Candiotti (2016), over-dose of intoxicating drugs and other substance abuse might lead to
both visuals and auditory hallucinations. Moreover the hand of Annabelle shows signs of
sores and this might be the injury spot of intra-venous drug injection. In the domain of speech
assessment it can be said that the state of Annabelle is speech is spontaneous, talkative to
mute. At times she is shouting, at times she is scared and then suddenly breaking down into

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tears over the floor. Her current emotional state is also highlight unstable. She was found
saying that, “Can’t you hear what they’re saying?! All the children have been hurt…”. It
might be that during her tenure as a nursing student, she might have come across certain
adverse cases in paediatric centre, which have affected her mental state. McCarthy-Jones and
Longden (2015) are of the opinion that having a traumatic past experience both mental as
well as physical might lead to the development of the post-traumatic stress disorder.
However, the conditions of Annabelle are much more severe in compare to the symptoms of
the post-traumatic stress disorder. Her thought process is ill-logical with flight of ideas,
altered body expressions, hallucinations and delusional. She was telling, “Forgive me!
Forgive me! I never meant to hurt anybody… please forgive me?” then suddenly she started
screaming in fear and this surprised her pleading emotional state and transformed it into
scared stated, at the end, she was trying leading to total emotional breakdown. There were
also signs of hallucinations as her was hearing noises like other people are talking to her or
she was talking to other people. Shiozawa et al. (2013) are of the opinion that people who
have mixture of different kind of feelings along with a high sense of hallucinations, might be
suffering from the schizophrenia. Her level of cognition was also questionable as she was in
delirium and has lack of awareness of self and was continuously referring to her experience
however, she was unable to express the underlying reason behind it. Her insight of judgment
is also very poor. Thus the overall mental state of Annabelle, as evident from the case study
is very confusing and further personal level of conversation is required to be undertaken in
order to make a detailed analysis.
Psychological Aspect and Issues Relating to Mental Health
From the above mental state of Annabelle, as evident from the case study, it can be
said that the psychological aspect of the Annabelle might have developed from her past

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traumatic experiences. The past traumatic experience might be due to her drop-out from
graduate school or inappropriate practice during the course. The relation to her academic
degree is extremely evident to her current psychological state because as per her mother, the
mental health complication of Annabelle started after she was dropped out of her university.
Thus, her psychological state of mind is guide by some traumatic experience in the past. This
might be heightened by substance abuse as highlighted by the scar marks over her hands.
According to the study conducted by Niemi-Pynttäri et al. (2013), there is an inherent co-
relation between the substance abuse psychotic disorders and the schizophrenia spectrum
disorders and this increases the severity of the disease. There are several interventions that
can be taken under consideration in order to treat the people like Annabelle who are suffering
from the complex psychological conditions. However, such interventions must be in line with
their psycho-social needs, their underlying past history and their physical state. The
interventions must target the personal stigma. In order to elucidate the personal stigma a
detail interaction with Annabelle, is extremely important (Gerlinger et al. 2013). According
to Gerlinger et al. (2013), cognitive behavioural therapy (CBT) is extremely helpful for the
people who are suffering from schizophrenia. The CBT is found to decrease the psychiatric
conditions like the fluctuating behaviour, mood swings, and uncontrolled emotions along
with disturbed mental state. Moreover, CBT in relation to schizophrenia is also highlight
acceptable and can be used as an immediate alternative for the pharmacological interventions
and has no significant side-effects. Apart from the application of the CBT, mindfulness based
cognitive behavioural therapy can be proved to be effective in case of Annabelle, as her
current psychological state also reflects reference of certain past traumatic experience and
such was evident her few excerpts was well. According to Gotink et al. (2015), mindfulness
based cognitive therapy is extremely helpful for fighting against the post-traumatic stress
disorders. Moreover it is also effective in reducing the depression and anxiety disorder which

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is recurrent. Shonin, Van Gordon and Griffiths (2014) further stated that mindfulness based
therapies is also effective in the treatment of psychosis. Chien and Lee (2013) argued about
the effectiveness of the mindfulness-based therapy in effective treatment of schizophrenia.
The mindfulness-based therapy in case of schizophrenia is mainly based on pseudo-
education. It helps to increase the illness insights, improve the severity of the symptoms, and
overall thought process and the mental health functioning and thereby helping to recover past.
In relation to Annabelle, it can further be stated that she is petrified from certain unknown
things which is still not clear from the current case study, moreover, her sense of thought
process is currently going through certain guilt feelings a guild feeling in relation to children
injury. All these aspects are required to be considered in detail before framing the person-
centred therapy plan for Annabelle.
Conclusion
Thus from the above discussion, it can be concluded that the Annabelle is at present
passing through certain complex mental condition which is characterised by hallucinations,
high level of anxiety, emotional imbalance, lack of co-relation in the speech, distressed look
and lack of hygienic in the overall physical appearance. She is also suffering from lack of
trust and is passing through certain impending fear. So in order to engage in a detail
conversation with Annabelle to get a thorough overview of her mental state, it is require to
first develop therapeutic relationship with her. Development of therapeutic relation can be
done via utilization of effective inter-personal communication skills. The use of proper verbal
and non-verbal communication skills like active listening, maintenance of proper eye contact
will help to earn the trust of Annabelle and this will help her to open up and discuss all her
concerns and issues. The development of the trusty yet healthy relationship with Annabelle is

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also important in order perform her MSE. Cognitive behavioural therapy and mindfulness
based behavioural therapy will be helpful for Annabelle.
References
Chien, W.T. and Lee, I.Y., 2013. The mindfulness-based psychoeducation program for
Chinese patients with schizophrenia. Psychiatric Services, 64(4), pp.376-379.
Gaebel, W., Muijen, M., Baumann, A.E., Bhugra, D., Wasserman, D., Van der Gaag, R.J.,
Heun, R. and Zielasek, J., 2014. EPA guidance on building trust in mental health
services. European Psychiatry, 29(2), pp.83-100.
Gerlinger, G., Hauser, M., De Hert, M., Lacluyse, K., Wampers, M. and Correll, C.U., 2013.
Personal stigma in schizophrenia spectrum disorders: a systematic review of prevalence rates,
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Gotink, R.A., Chu, P., Busschbach, J.J., Benson, H., Fricchione, G.L. and Hunink, M.M.,
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Niemi-Pynttäri, J.A., Sund, R., Putkonen, H., Vorma, H., Wahlbeck, K. and Pirkola, S.P.,
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