HLT301, University Name: Mental Health Assessment of Psychosis

This assignment presents a detailed mental health assessment of a patient exhibiting symptoms of psychosis, likely schizophrenia, based on a provided case study video. It defines mental health assessment, its purpose, and its significance in nursing and midwifery practices. The assessment analyzes the patient's appearance, behavior, speech patterns, mood, and affect, identifying key signs and symptoms of psychosis such as hallucinations, delusions, and suicidal ideation. The assignment also explores potential diagnostic tests, including blood and urine tests, imaging tests, and neurophysiological tests, and discusses the findings of Dr. Taylor's assessment. Furthermore, it evaluates the patient's insight into his condition, assesses the risks he presents to himself and others, and proposes a comprehensive treatment plan that includes pharmacological and psychological interventions, such as antipsychotic medications, family intervention, and social interaction therapy. The treatment plan considers the most suitable setting for care and provides rationales for the proposed approach.

Running head: MENTAL HEALTH ASSESSMENT OF PSYCHOSIS
Mental health assessment of psychosis
Name of the Student:
Name of the University:
Author Note:

1MENTAL HEALTH ASSESSMENT OF PSYCHOSIS
Q1) Define mental health assessment. Why is it used? Why is it a useful tool for nursing
or midwifery practices?
A1) Mental health assessment is a form of check-up to evaluate the mental state of a
person through a set of questions and physical examination to diagnose clinical psychological
conditions such as psychosis, depression, anxiety and eating disorders (Townsend and
Morgan 2017).
The purpose of this assessment is to check if the psychiatric capacity of the patient is
deteriorating and screen for any mental disorder such as depression or anxiety if present. It
might also help in diagnosing neuropathology such as Alzheimer’s disease or on suspecting
substance abuse. It assesses the behavioural risk that might threaten the victim or others. It is
recommended if the individual is facing difficulties in school or workplace (Freeman et al.
2017).
Mental health assessment acts as a baseline to record the mental health of a patient.
This assessment is essential in nursing or midwifery practices to help them understand the
person’s distress and gives an insight into the sufferer’s appearance, speech, cognition,
thoughts and perception. This is important to develop a patient-oriented treatment plan
(Fortinash and Worret 2014).
Q2) Describe Andy’s appearance and behaviour during the initial assessment.
A2) Andy’s clothing showed no peculiarity as such. However, he but some unshaven
beard. Otherwise, his overall hygiene seemed reasonable. Throughout the assessment, he
appeared disturbed and restrained from eye contact with the doctor. He looked distressed and
suspicious of the people around him. He suspected his roommates were conspiring against
him and were working for MI5 along with their professor. His speech was muddled and

2MENTAL HEALTH ASSESSMENT OF PSYCHOSIS
often, confusing to comprehend. He depicted reduced motor activity and a lowered level of
arousal. His behaviour displayed distressing impulses and was full of negative thoughts. He
was also cooperative with the doctor in sharing his distress but did not believe that he was
mentally ill.
Q3) Differentiate between mood and affect. Describe affect in regard to Andy.
A3) Affect refers to an experience or a particular state of emotion resulting in spontaneous
or immediate responses and expressions of the patient. It is essentially a direct response with
stimuli. On the other hand, the mood describes a condition or state of sustained emotional
endurance persisting for a prolonged period (Simon, Clark and Fiske 2014).
Andy depicted a dismal and an anxious affect which ranged for almost the entire time. He
looked miserable and depressed from inside. His body language did not depict significant
agitation or arousal and seemed labile. However, he expressed his tension and concern
throughout the assessment. Also, most of his answers addressed the questions asked.
Q4) Discuss Andy’s speech.
A4) Andy’s speech was mumbled and at some points, lacked clarity. His responses were
difficult to understand in some cases. He spoke minimally and only answered to the questions
asked. He did not look directly at the doctor while speaking and seemed distracted with
frequent looks around the room. Also, the rate of his speech was slow with considerate
latency. His tempo was soft but worrisome. Frequently, he depicted a slurred fluency.
However, he was continually trying to explain his point to the doctor and made significant
efforts to establish his thoughts. In between his answers, frequent pauses were also observed.
Q5) What signs or symptoms associated with psychosis did you identify with Andy?

3MENTAL HEALTH ASSESSMENT OF PSYCHOSIS
A5) Andy experienced an impaired relationship with reality. He believed his roommates to
be associated with the terrorist group, MI5 and that their professor was also involved in it. He
encountered third-person auditory hallucinations which were evident from his mention of a
constant conversation in the background. He also reflected signs of social withdrawal by
mentioning his unwillingness to leave home, specifically his room. His thoughts were
delusional in believing a chip to be inserted into his head by his roommates. His cognitive
ability was deteriorating, and his activities were somewhat slow. He also expressed suicidal
motives and stated thoughts of overconsuming pills to end his life. Also, he mentions a
history of substance abuse. Other relevant signs include disturbed attention and constant
headache (Moritz et al. 2017). To add up, he also displayed an eating disorder as he suspected
his food to be poisoned. These symptoms are indicative of psychosis.
Q6) Which tests might Dr. Taylor request at the end of the session? How are these tests
significant to the symptoms of psychosis?
A6) Dr Taylor might request laboratory tests such as the urine and blood tests to identify
the cause of the disease. It might be helpful as Andy mentions his history of doses of drugs.
Thyroid test and electrolyte level evaluation might also be asked. These tests detect
nutritional, neural, endocrine or autoimmune dysfunction, which is frequently associated with
psychosis. Magnetic resonance imaging (MRI), computed tomography (CT) scan and
electroencephalogram are some tests which might be requested for brain imaging. Imaging of
the brain is required as Andy mentions a severe, constant headache (Padmanabhan et al.
2015). Other relevant tests that might be requested by Dr Taylor include neurophysiological
tests and functional neuroimaging of Andy’s brain and responses. Along with tests to
examine physical signs, a detailed, comprehensive mental assessment test can conclude the
patient positive for psychosis.

4MENTAL HEALTH ASSESSMENT OF PSYCHOSIS
Q7) Describe what Dr Taylor assessed from Andy’s thoughts and document her
findings in progress notes.
A7) Dr Taylor identifies the conversation of Andy’s housemates and running commentary
in the background as mentioned by Andy as third-person hallucinations. These hallucinations
are auditory as stated by Andy. No visual or smell-related hallucinations are observed. She
also notices delusions in his thoughts as he believes to have a chip inserted into his mind by
his housemates. Moreover, she also performs risk assessment, and a differential diagnosis
recommends drug-induced psychosis. Other significant findings include an eating disorder in
his refusal to eat food and social exclusion. Suicidal thoughts and drug history and be
conclusive of a psychotic illness, preferably schizophrenia.
Q8) How would you assess Andy’s insight into his current emotional and cognitive
state? What are the probable positive or negative impacts associated with this level of
insight? Comment on his overall judgement as well.
A8) Andy is aware of the unusualities around him but considers himself fit and blames his
housemates for his condition. He attributes these disturbances to the chip inserted into his
mind by his housemates. His emotional state is worrisome and full of anxiety. Lack of his
acceptance of mental illness might harm his treatment. The positive impact is that he
recognises the unusual experiences around him and is willing to cooperate to get rid of it.
However, he attended the psychiatrist only for the sake of his mother and is unable to
recognise that he has a mental disease which might be a potential risk for himself and others.
Q9) Considering the overall assessment of Andy, what risks does he present? Are any
risks excluded? Provide evidence for each response. Consider his physical health along
with other possible risks.

5MENTAL HEALTH ASSESSMENT OF PSYCHOSIS
A9) Dr Taylor performs an overall assessment of Andy and identifies some potential risks
to himself and others. Andy expressed his suicidal thoughts as an escape from the
background conversations and overflow of thoughts which he is unable to control. He also
considered the option of overconsuming pills to end his life. This indicates a severe risk to his
life. He has also restrained from eating as he thinks it is being poisoned. This depicts a severe
concern he poses to his health and life. Psychotic sicknesses are accompanied with health
effects such as increased cardiovascular conditions, sexual dysfunction, reduced motor
activities and an increased chance of diabetes mellitus. Majority of the psychotic patients
have an increased chance of developing either of these diseases at an early stage of their life.
Moreover, he has kept a knife and a baseball bat in his room for personal defence. He intends
not to harm anyone with it and has kept it for an extreme scenario for self-help but it might
become risky at any time considering the decreasing cognitive ability of Andy. He is also
suspicious of his housemates and a lecturer. This makes him a risk for the ones around him.
Other risk factors include social withdrawal and mental decline. His refusal to interact in
society might result in his total exclusion for the community and lower his rate of recovery
and treatment. He shows increasing deterioration of mental capacity and does not
acknowledge himself as ill but puts the blame on his housemates for his current condition.
Q10) Suggest the treatment plan most suitable for Andy’s recovery from the psychotic
illness he has been diagnosed with. Consider the setting in which care might be provided
and give rationales for your plan.
A10) A suitable plan for Andy to recover from the psychotic illness, most likely
schizophrenia would include the following aspects:
 Pharmacological treatment: Pharmacotherapy is an essential approach to treatment
and rapidly control the symptoms. The primary treatment includes intake of

6MENTAL HEALTH ASSESSMENT OF PSYCHOSIS
antipsychotic drugs which controls the symptoms to a significant extent. However,
these drugs, called first-generation antipsychotics (FGAs) are accompanied with side-
effects such as an increase in weight, sexual dysfunction, lethargy and heavy
sedation. Thus, second-generation antipsychotics (SGAs) must be used with limited
doses of FGAs to minimise the adversity of FGAs. SGAs are also known to increase
the risk of type 2 diabetes, along with some metabolic dysfunctions (Stafford et al.
2015).
 Psychological treatment: Though medication remains an essential component of
treatment, psychological intervention and care are equally crucial for adequate
progress and provides long-term recovery with a minimum scope of relapse. Family
intervention in the care of the patient is crucial to prevent relapse of the disease.
Thus, it is also essential to educate the family members of the patient so that care and
support can be provided to the victim accordingly. Mental support from close ones,
such as his mother along with psychotherapy, can help Andy recover effectively with
reduced chance of relapse. Interactive sessions with a therapist, like Dr Taylor, will
help in a step-wise recovery for Andy and also improve his cognitive and social
disability. Social interaction is vital to keep Andy in touch with reality and reduce his
auditory hallucinations. This therapy has a more widespread influence than drugs and
aims to provide cognitive and social recovery, reduced anxiety and distress,
development from trauma and limited substance misuse (Lutgens, Gariepy and Malla
2017).
Hospitals and rehabilitation settings have been promoting mental recovery therapies for a
long time. These institutions can help in reducing the risk of suicide, harm to others and drug
abuse. However, it might not be the optimum treatment plan for Andy as it will make him

7MENTAL HEALTH ASSESSMENT OF PSYCHOSIS
socially disabled. He seems close to his mother and staying close to her, would reduce his
suspicions of others and limit drug abuse along with providing mental support.

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References
Fortinash, K.M. and Worret, P.A.H., 2014. Psychiatric mental health nursing-E-book.
Elsevier Health Sciences.
Freeman, D., Reeve, S., Robinson, A., Ehlers, A., Clark, D., Spanlang, B. and Slater, M.,
2017. Virtual reality in the assessment, understanding, and treatment of mental health
disorders. Psychological medicine, 47(14), pp.2393-2400.
Lutgens, D., Gariepy, G. and Malla, A., 2017. Psychological and psychosocial interventions
for negative symptoms in psychosis: systematic review and meta-analysis. The British
Journal of Psychiatry, 210(5), pp.324-332.
Moritz, S., Pfuhl, G., Lüdtke, T., Menon, M., Balzan, R.P. and Andreou, C., 2017. A two-
stage cognitive theory of the positive symptoms of psychosis. Highlighting the role of
lowered decision thresholds. Journal of behavior therapy and experimental psychiatry, 56,
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Padmanabhan, J.L., Tandon, N., Haller, C.S., Mathew, I.T., Eack, S.M., Clementz, B.A.,
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