Mental State Examination: A Case Study of Substance-Induced Disorders

This case study presents a mental state examination of an 18-year-old patient named Harry, who is experiencing extreme substance abuse leading to delusions, hallucinations, and aggressive thoughts, including homicidal ideation towards his brother. Harry believes he has invisibility superpowers and receives information from an agency. The examination reveals a lack of concentration, sleeping issues, and potential substance-induced mood, psychotic, sleep, and sexual dysfunction disorders. Interventions focus on patient education about drug abuse, counselling, cognitive therapy, and medication to manage aggression and improve sleep. The nursing report details the patient's background, assessment findings, and recommendations for treatment, including tranquilizers, sedatives, counselling, and mindfulness-based therapy to improve his mental health and overall well-being. Desklib provides access to similar case studies and study resources for students.

Running head: MENTAL STATE EXAMINATION
MENTAL STATE EXAMINATION
Name of the Student
Name of the University
Author note

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MENTAL STATE EXAMINATION
General appearance The general appearance of the patient was normal, and he looked
properly dressed. However, the patient did not had any interest in his
appearance as it was observed that he did not brush his hair and was least
interested hoisin making his outer appearance appealing and appropriate
for social interaction.
Behavior It was observed in the scenario that the patient failed to make or avoided
eye-contact with the health professional. He was not concerned about the
ongoing conversation and from his behavior and actions, it was clearly
visible that the patient was preoccupied with other thoughts. His speech
was fragmented with long pauses and a lack of focus. He also displayed
signs of anxiety with inappropriate and uncomfortable sitting posture in
this clinical scenario. The patient was evidently anxious to leave the
interview session.
Speech The patient was speaking in a monotonous tone and did not utilise any
proper speech patterns while talking with rapid and fragmented speech
evident. Replies to questions were typically short; only 2 or 3 sentences.
At times, the conversation seemed forced, with the patient’s utterances
seeming irrelevant the question being aksed
Mood and affect Harry accepted the fact that he felt happy whenever he was invisible to
the people around and also seemed to reject the people who were
planning to improve his health condition. However, while determining
the thoughts and actions of people as per the case study, it should be said
that to the patient’s belief in his superpower of invisibility did not affect
his mood during the interview.
Thought process The patient had several thoughts of superpowers and presented all these
details in less coherent speech and manner. In addition, as the patient was
thinking about too many aspects in his mind, he was unable to think
logically.
Thought content The thought content of the patient was involved with no suicidal ideation

2MENTAL STATE EXAMINATION
and no hallucination related effects being observed. However, the patient
had overvalued thought content as he displayed thought patterns related
to superhuman capabilities and paranoia. Furthermore, he expressed
homicidal ideation as he admitted that he could kill his brother as he
interfered with his superpower.
Perception The perception of the patient includes derealisation and illusion. The
patient accepted as fact that he has supernatural powers which other
people are not aware of. In addition, he also thought that the superpowers
helped him go invisible anytime and that he will be able to live alone and
invisible most of the time. These perceptions about the world, universe
and life indicated that the patient was living in an alternative world.
Cognition The cognition level of the patient was degrading as he lacked the
concentration and was preloaded with his superpower and delusion
related thoughts. During the interview, the patient accepted the fact that
he does not think school is an important part of his life as he is invisible.
The interviewer had to probe the patient with specific questions so that
they could provide his thoughts. However, by answering the proper date,
time and purpose of the interview, it was evident that the patient still has
some ties to reality.
Judgement When the interviewer asked the patient about his aggression and its
reason, the patient mentioned the name of his brother and said that he
wanted to kill him and was developing an action plan to harm his brother.
He did not want anybody to prevent him from being invisible and hence
he planned this actions.
Insight After going through all the responses of the patients, it should be
mentioned that the patient is likely suffering from acute substance abuse
related syndrome and is the victim of excessive drug use. The diseases he
could develop are: substance-induced mood disorder, substance-induced
psychotic disorder and substance-induced sleep disorder and substance-
induced sexual dysfunction. Therefore, proper healthcare interventions
related to mental illness should be implemented on Harry to prevent any

3MENTAL STATE EXAMINATION
serious mental health issue in the patient
Mental health harm intervention
Symptom Intervention
Excessive substance abuse and illusions  Patient education about drug abuse and its
harmful effects
 Searching for the agency responsible for patient
condition and providing them with the proper
treatment, so that the drug can be halted.
 Providing the patient with counselling session
and the healthcare providers educational
strategies to handle the patient (Burrow-Sanchez
& Hawken, 2013)
Excessive violence and abusive thinking  Using diverse methods to increase the patients
focus on peace rather than aggression.
 Providing the patient with sedatives and other
medications so that the patient stays calm and
peaceful
 Providing counselling to manage the patient’s
aggression (Galletly et al., 2016)
Poor focus and concertation with hampered sleep
pattern
 Determining the cognitive level of the patient and
applying cognitive ability therapy to them in
order to enhance their focus or connection
(Chapman, 2014).
 Providing the patient with proper care and
observation to maintain sleep (Sohraby, Attridge
& Hughes, 2014).

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Nursing report
Situation: The patient I am caring for is Harry, who is 18-years-old and a high school
student. The patient came for emergency assistance due to his extreme substance abuse. The
patient has feelings related to delusion, hallucination, and aggressive or destructive thinking due
to which he wishes to kill his own brother. Furthermore, the patient thinks he has invisibility
related superpowers and delusions in which he is given information from ‘the agency’. It was
found that the patient lacks concentration and focus abilities. He also suffers from mild sleeping
issues, which he blames on his brother. The patient thinks that his brother does not want him to
be invisible and hence, he gases the room. This is why the patient feels tremendous hatred for his
brother and shows interest in killing him. All these situations signals that that patient is unable to
concentrate on the given situation and requires proper treatment and effective interventions.
Background: The case scenario did not mention any specific medication history, but the
patient mentioned that he was involved in a substance abuse in the past week. He was
preoccupied with the thought of being invisible all the time and hence, these unrealistic thoughts
severely affected the patient condition badly.
Assessment: While determining the mental state evaluation, it was observed that the
patient is suffering from vulnerable health condition as he is having delusions destructive
thinking and sleeping disorder at the same time. The patient further lacked the proper analytical
skills that hampered the ability for him to understand the negative effects of drug or substance
abuse. He was also seen to have restlessness and anxiety and was least bothered about his
degradation of his health condition and education. Therefore, the intervention applied aimed to
control his aggression and violent nature so that his behaviors related to substance abuse and
violent nature could be minimised.

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Recommendations: The patient must be provided with medications such as tranquilisers
and sedatives so that his violent nature can be controlled. Furthermore, this will assure proper
sleeping and rest in the patent which will help in the normalization of the hormonal unbalance
created by sleeping pattern issues (Bowen et al., 2014). Furthermore, I will assign a counselor for
the case of Harry to help modifying his thought processes. Besides, counselling sessions,
administration of mindfulness-based therapy should also be applied in the care process to help in
the health and mental health improvement of the patient.

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References
Bowen, S., Witkiewitz, K., Clifasefi, S. L., Grow, J., Chawla, N., Hsu, S. H., ... & Larimer, M. E.
(2014). Relative efficacy of mindfulness-based relapse prevention, standard relapse
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Brand, M., Young, K. S., Laier, C., Wölfling, K., & Potenza, M. N. (2016). Integrating
psychological and neurobiological considerations regarding the development and
maintenance of specific Internet-use disorders: An Interaction of Person-Affect-
Cognition-Execution (I-PACE) model. Neuroscience & Biobehavioral Reviews, 71, 252-
266.
Burrow-Sanchez, J. J., & Hawken, L. S. (2013). Helping students overcome substance abuse:
Effective practices for prevention and intervention. Guilford Publications.
Chapman, A. (2014). Proposal for patient obligations for access to unapproved medical
interventions: both too much and not enough. The American Journal of Bioethics, 14(11),
25-26.
Galletly, C., Castle, D., Dark, F., Humberstone, V., Jablensky, A., Killackey, E., ... & Tran, N.
(2016). Royal Australian and New Zealand College of Psychiatrists clinical practice
guidelines for the management of schizophrenia and related disorders. Australian & New
Zealand Journal of Psychiatry, 50(5), 410-472.

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Khoury, B., Lecomte, T., Fortin, G., Masse, M., Therien, P., Bouchard, V., ... & Hofmann, S. G.
(2013). Mindfulness-based therapy: a comprehensive meta-analysis. Clinical psychology
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