Mental State Examination and Interventions for Leroy Smith

This assignment presents a comprehensive Mental State Examination (MSE) of Leroy Smith, a 35-year-old male, based on a provided case study. The assessment covers various aspects, including general appearance, behavior, speech, mood, affect, thought processes, thought content, perception, cognition, judgment, and insight. The assignment details the findings from the MSE, including observations of his grooming, eye contact, speech patterns, and emotional state. It also explores his thought patterns and content, identifying potential issues like tangential thinking and obsessive thoughts. Furthermore, the assignment provides a detailed nursing report summarizing Leroy's history, current presentation, and potential diagnoses, including sleep disorder, bipolar disorder, and substance use. The report also recommends specific interventions for addressing his symptoms, such as CBT, interpersonal psychotherapy, contingency management, motivational interviewing, psychoeducation, and family-focused therapy. The assignment concludes with a discussion of differential diagnoses and relevant references supporting the interventions.

Adult Mental Health Services
CONSUMER ASSESSMENT
Date: Time:
URN: 8675309
Family Name: Leroy James Smith
Given Name(s):
Address: 11 Salisbury Lane, Ipswich, QLD,
4306
Date of Birth: 25th December 1983
MENTAL STATE EXAMINATION
General
appearance
Leroy dress not so appropriately but is groomed.
Behaviour He seemed to be alert but rarely maintain eye contact while talking as evident
by his actions during interview. He also depicted signs of abnormal movements
of head such as continous shaking while responding.
Speech Fluent but more than normal volume and rate as evident by the way of his
response. No defect with verbalizations
Mood and
Affect
Leroy is subjectively shows “emotional instability”, anxious behavior as
evident by his claim of his parents as crazy. Objectively he is a little blunted
with a labile affect. The range of affect seems restricted to limited range as
evidenced by his spontaneous break when asked about medications on mood
swing or substance use.
Thought process
Continuity of thoughts, tangential thought with subject digression, sometimes
inclusion of thoughts which are not related and relevant for the subject such as
abusing individuals and claiming his parents require a treatment.
Thought content
No delusion as evident by his reponse to the interviewer on questions related to
hearing voices on TV or radio, obsessive thoughts over great ideas of business
plans in the mind, incoherent, feeling of drepression on watching TV, no
suicidal thoughts
Perception Quite Normal
Cognition
Quite goal oriented and clearly attentive as evident by Leroy’s statements on
his great ideas of business plans. No sign of reduced concentration or
symptoms of dementia.
Judgment &
Insight
Leroy is unable to acknowledge that he is unwell and is not ready to take any
mediactions or treatment for his mood swings or change in behaviour.
SYMPTOM INTERVENTIONS
Neurovegetative:
1. CBT
Level 1 evidence is considered for CBT. CBT also referred to as Cognitive
behavioral therapy combined with behavior based treatments are recognized to
depict enhanced level of effectiveness to treat patients like Leroy who suffer

sleep, appetite from sleep disorder. Various types of small studies as well as case studies have
suggested that CBT could be used to treat frail individuals as well as patients
with moderate cognitive impairment (Grover, Gautam, Jain, Gautam & Vahia,
2017).
2. Interpersonal Psychotherapy
Interperonal therapies such as sleep hygiene as well as education are recognizd
to be effective if used in combination. It involves examination of sleep habits,
various sleep behaviors as well as other factors such as environmenta related
factors. Studies have reported that the intervention involves educating the
patients regarding basic habits/practices interfering with sleep while
implementing approaches to avoid it (Mulsant, Blumberger, Ismail, Rabheru &
Rapoport, 2014)
Substance
Abuse
1. Contingency management (i.e.,CM)
It is also known as voucher-based therapy, a type of evidence-based
intervention on the basis of principles to modify behavior. The major aim is to
encourage positive behavior through positive reinforcement while the patient is
progressing forward with different types of treatment goals and maintaining
punitive measures in case of undesirable behavior of patient. A study evidence
the use of vouchers, different type of privileges, and in some cases a moderate
level of price money to increase the behavior and to treat substance use
disorders (Chaborski, Bitterlich, Alteheld, Parsi & Metzner, 2015). Another study
stated that CM helps in improving adherence for any substance substitution
programs.
2. Motivational interviewing (i.e.,MI)
MI has its use in exploring and resolving the patients ambivalence regarding
substance use while initiating positive changes in behavior as well as
psychology. It involves to express empathy by the process of reflective
listening, to devlop discrepancy among the goals, values as well as recent
behaviour, to avoid augmenting with confronting them, etc. As evident in a
meta-analysis based on 22 studies recognized that studies reviewed the
evidence of MI being an efficient treatment modality to reduce substance
within the short-term (Jhanjee, 2014).
Mood: Mania
1. Psychoeducation
It forms Level 1 evidence which will helps in providing Leroy the information
regarding his mental health along with symptom recognition while facilitating
creation of coping strategies. As suggested in a review, it includes upto 3
sessions to teach Leroy on self-management tools, including workbooks on
self-help, videos to address diagnosis, and treatment of mania with relapse
prevention plans (Miklowitz, 2016).
2. Family-Focused Therapy
It forms the Level II evidence characterized through the modules which
conists of psychoeducation, and training to provide communication and

problem solving skills. Evidence from studies have addressed that
Leroy and his family reactions towards his mental state, prognosis as
well as its treatment will help in developing coping strategies
specifically in family context for reducing the event of high-expressed-
emotion and mood disorders (Goodwin et al., 2016).
Nursing Report
Leroy is a 35-year-old caucasian male who has been treated for a maniac episode 6 months
ago in a localized mental health clinic. He is unemployed and is separated from his partner
and have moved back to his parent’s house. Since then he is being reluctant about the
psychiatrist's follow up as an appointment. Leroy has experienced mild episodes of manic
resulting in numerous arguments with parents. His general appearance is not being well
dressed with a little groomed. As a result of his manic episode, he has also depicted signs and
symptoms of early depression with labile and anxiousness. The findings state that he is
suffering from bipolar disorder hence, resulting in sleep and food disorder as evident in the
case study from over the past few months, Leroy has rarely slept for more than 4 hours a
night while he spends his time talking on the telephone at night to various people in America
about his business ideas and eating poorly which often leads to mood swings. His behavior is
seemed to be alert but rarely maintains eye contact while talking as evident by his actions
during the interview. He also depicted signs of abnormal movements of head such as
continuous shaking while responding while his speech is fluent but more than normal volume
and rate as evidenced by the way of his response. No defect has been recognized with
verbalizations. Leroy’s sudden “mood swings” are evident to go from happy and excited to
abusive and threatening quickly. He is subjectively emotional unstable with anxious behavior
and is a little blunted with a labile affect. The range of affect seems restricted to a limited
range as evidenced by his spontaneous break when asked about medications on mood swings
or substance use. His thoughts are continuous and tangential with a subject digression. He
was recognized to be non-delusion related to hearing voices on TV or radio, obsessive
thoughts over great ideas of business plans in the mind, incoherent, feeling of depression on
watching TV, with no suicidal thoughts. Leroy is mildly goal-oriented and is attentive with
no sign of reduced concentration or symptoms of dementia and importantly he is unable to
acknowledge that he is unwell and is not ready to take any medications or treatment for his
mood swings or change in behavior. After MSE, Leroy exhibited a somewhat sullen

appearance with facial expression. Clearly, he has a depressed affect. His present status of
manaic episodes along with his current history of depression with his recent poor appetite,
disturbance in sleep, indicating that Leroy is on the verge of developing a serious bipolar
disorder in terms of his present mental condition.
From the information attained from the MSE and Risk screening tool, the following
differential diagnosis could be recognized:
1) Sleep disorder
He meets up to 5 criteria in DMS-IV on MSE.
2) Bipolar disorder
Leroy's personality traits might be improvised by stress levels and depression.
3) Substance use
Leroy’s unwillingness to perform everyday activities, as well as concerns of business plans,
have predisposed him.
References
Chaborski, K., Bitterlich, N., Alteheld, B., Parsi, E., & Metzner, C. (2015).
Placebo-controlled dietary intervention of stress-induced neurovegetative
disorders with a specific amino acid composition: a pilot-study. Nutrition
Journal, 14(1). doi: 10.1186/s12937-015-0030-3
Goodwin, G., Haddad, P., Ferrier, I., Aronson, J., Barnes, T., & Cipriani, A. et al.
(2016). Evidence-based guidelines for treating bipolar disorder: Revised third
edition recommendations from the British Association for
Psychopharmacology. Journal Of Psychopharmacology, 30(6), 495-553. doi:
10.1177/0269881116636545
Grover, S., Gautam, S., Jain, A., Gautam, M., & Vahia, V. (2017). Clinical
Practice Guidelines for the management of Depression. Indian Journal Of
Psychiatry, 59(5), 34. doi: 10.4103/0019-5545.196973

Jhanjee, S. (2014). Evidence based psychosocial interventions in substance
use. Indian Journal Of Psychological Medicine, 36(2), 112. doi:
10.4103/0253-7176.130960
Miklowitz, D. (2016). Evidence-Based Family Interventions for Adolescents and
Young Adults With Bipolar Disorder. The Journal Of Clinical
Psychiatry, 77(Suppl E1), e05-e05. doi: 10.4088/jcp.15017su1c.05
Mulsant, B., Blumberger, D., Ismail, Z., Rabheru, K., & Rapoport, M. (2014). A
Systematic Approach to Pharmacotherapy for Geriatric Major
Depression. Clinics In Geriatric Medicine, 30(3), 517-534. doi:
10.1016/j.cger.2014.05.002