University Psychosis Case Study: HLT301, Mental Health Assessment

This case study presents an assessment of a patient, Andy, exhibiting symptoms of psychosis. The assignment begins with defining the mental state examination (MSE) and its utility in nursing. It then describes Andy's appearance, behavior, mood, and speech during the initial assessment, highlighting signs of psychosis such as auditory hallucinations and delusions. The case study explores the differences between mood and affect, discussing Andy's gloomy affect. It outlines potential tests, including blood and urine analyses and brain imaging, that might be requested to determine the cause of Andy's illness. The findings are documented, noting delusional thoughts and auditory hallucinations. The assessment evaluates Andy's insight and judgment, identifying risks to himself and others. Finally, the assignment proposes a suitable treatment plan, combining pharmacological interventions with antipsychotic drugs and psychological therapies, alongside the importance of social inclusion and family support for recovery. The case study emphasizes the need for a comprehensive approach to manage the symptoms and improve the patient's quality of life.

Running head: PSYCHOSIS: A CASE STUDY
Assessment of psychosis
Name of the Student:
Name of the University:
Author Note:

1PSYCHOSIS: A CASE STUDY
Q1) Define mental state examination. When is it to be used? Why is it a useful tool in
nursing and midwifery practices?
The mental state examination (MSE) is a medical evaluation system which
investigates the patient’s rational function and behavioural traits in a structured manner to
detect clinical mental disorders such as psychosis, anxiety, depression and others (Townsend
and Morgan 2017).
Mental state examination reports the patient’s medical history, instances of substance
abuse and psychological findings such as depression or anxiety for better diagnosis and
accurate treatment plan (Fernando and Carter 2016).
This test is useful to obtain information of the patient’s mental capacity to enable
nursing experts to develop a patient-centred treatment plan according to the insights
perceived based on the patient’s speech, cognitive state, appearance and thought-process
(Townsend and Morgan 2017).
Q2) Describe Andy’s appearance and behaviour during the initial assessment?
His attire displayed no significant abnormality and looked appropriate. His personal
hygiene looked considerable with some unshaved beard on his face. Andy’s behaviour
seemed distraught and with frequent fidgets and glances around the room. He made minimal
eye contact with Dr Taylor during the conversation throughout the assessment. He was
disturbed with his present condition and suspected his housemates for this scenario. No
significant aggression in any form was observed in his behaviour and seemed quite calm. His
motor movements were low with suppressed arousal. Besides, his attitude towards the
psychiatrist was collaborative to resolve his disturbance. He was unaware of his mental

2PSYCHOSIS: A CASE STUDY
illness and considered himself fit. Andy’s speech lacked clarity in most of his answers and
was challenging to understand.
Q3) What is the difference between mood and affect? Discuss affect in regard to Andy.
Mood refers is a reflection of an individual’s perception of their present emotional
status and may persist for an extended duration. On the other hand, affect is the phenomenal
experience of emotion and can be observed by the psychiatrist (Luong et al. 2016).
Frequently, the mood of a person may not be congruent with their affect. Andy reflected a
gloomy affect full of anxiety which persisted throughout the session. Also, he looked
dejected and utterly miserable.
Q4) Discuss Andy’s speech.
Andy’s speech lacked clarity and was low in tempo. The rate of his speech was slow
and the fluency was slurred. The content of the speech depicted significant disturbance of
meaning. He spoke very less, only answering the questions addressed to him. However, he
made considerable efforts to explain his viewpoints to Dr Taylor.
Q5) Describe the signs and symptoms associated with psychosis which can be identified
in the interview?
Andy experienced auditory hallucinations as per his statement of continuous
background conversations. His thoughts express delusions and he is losing touch with reality.
Andy imagines a chip planted inside his mind by his housemates who were working for MI5.
He also considered committing suicide to eliminate background noises. These symptoms
imply a psychotic disorder in Andy (Kjelby et al. 2015).
Q6) What tests might Dr Taylor request at the end of the interview with Andy and how
are these tests important in context with psychosis?

3PSYCHOSIS: A CASE STUDY
As Andy mentions his history of substance abuse, Dr Taylor might request for his
blood and urine analyses to detect the cause of his illness (Jones 2016). As psychosis is
frequently associated with endocrinal, neural, nutritional and autoimmune impairment, a
thyroid and electrolyte concentration test might also be required. Dr Taylor, might also
request a brain imaging to determine the cause of his severe headache. These tests include
electroencephalogram, computed tomography (CT) scans and magnetic resonance imaging
(MRI) (Falkenberg et al. 2017). Clinical laboratory tests determine his physical status and
need to be accompanied by a comprehensive mental state examination to infer Andy positive
for psychosis.
Q7) How would Dr Taylor describe and document her findings of Andy’s thoughts into
progressive notes?
Dr Taylor reports his thoughts as delusional in imagining a chip inside his head by his
housemates. Also, the background conversations heard by Andy might be noted as auditory
third-person hallucinations. His refusal to eat food and seclusion from society implies serious
issues. Andy also represents a history of taking drugs and thoughts of suicide, which indicates
a mental impairment, precisely psychosis (Kjelby et al. 2015).
Q8) How would you assess Andy’s insight into his current emotional and cognitive
state? What possible positive or negative outcomes can be associated with this level of
insight? Comment on his overall judgment as well.
Andy is conscious of the disturbances around him but suspects the chip inserted by his
housemates for the unusualities and ponders himself healthy. He is well oriented to time,
place and person. Awareness of these disturbances and seeking professional help to get rid of
it demonstrates a positive impact. However, his lack of knowledge about his mental disorder
may hinder his process of recovery and pose a threat to himself and others.

4PSYCHOSIS: A CASE STUDY
Q9) What risks does Andy possess based on his appearance? Are there risks that you
have excluded? Provide evidence for each response.Give consideration to his physical
health along with other possible risks.
As Andy does not acknowledge his mental disorder, he poses a high risk to himself as
well as others around him. He is distressed with the hallucinations which he describes as
relentless background conversations and considers suicide as a solution to get rid of it by
overdosing pills (Kjelby et al. 2015). Moreover, he avoids food as he believes it to be
poisoned by his housemates. Alongside, psychotic diseases also affect the physical health of
the patient and might lead to cardiovascular disorders, impaired motor activity, sexual
dysfunctioning and a high risk of developing diabetes (Shiers, Bradshaw and Campion 2015).
Andy suspects his housemates to be conspiring against him due to which he has preserved a
baseball bat and a knife for self-defence. He does not intend to use them on his housemates
but is willing to use it if required. Besides, the psychological capacity of Andy is
deteriorating increasingly, and he is isolating himself socially. These explanations prove that
Andy is prone to harm himself as well as others which makes him a potential risk element.
Q10) Andy is diagnosed with a psychotic disorder. Suggest a suitable treatment plan
and care options for him.
Andy’s needs an immediate treatment plan to prevent his condition from worsening.
A treatment plan consisting of both pharmacological and psychological aspects will be the
most appropriate for Andy’s recovery. Medication is the primary step to control the adverse
symptoms of psychosis and provides faster results. Antipsychotic drugs such as first-
generation antipsychotics (FGAs) are administered to psychotic patients (Nielsen et al. 2015).
As these drugs present several side-effects, FGAs might be combined with doses of second-
generation antipsychotics (SGAs) to minimise the ill-effects such as weight gain, sedation

5PSYCHOSIS: A CASE STUDY
and sexual impairment (Chiliza et al. 2015). A significant drawback of SGA administration is
its risk of developing diabetes. The medication works closely with psychological therapy.
Psychological intervention is an essential element for the long-term recovery of Andy with a
minimum risk of a relapse. Engaging Andy in interactive sessions with a suitable
psychologist enable structured recovery and keeps him socially involved. Talkative sessions
might also improve Andy’s speech and make him more understandable (Holding, Gregg and
Haddock 2016). Social inclusion is necessary for Andy to reduce his delusions and to lead a
healthy life. Psychological therapy aims to improve the cognitive and emotional status of the
patient. It is also vital to control Andy’s consumption of drugs for a healthy mental state.
Support from family or close friends also plays a significant role in the treatment of a
psychotic illness. Andy appears close to his mother and feels safe with her, which might be
useful for his recovery. Educating Andy’s family is crucial to provide him with adequate care
and support. Teaching self-management skills to Andy by psychotherapy will help him cope
with the adverse effects of psychosis. Institutional settings such as hospitals and rehabilitation
centres are often suggested to many patients. These settings prevent suicides and substance
abuse. However, Andy will benefit more by staying close to his family, particularly mother as
it will also keep him involved in the society.

6PSYCHOSIS: A CASE STUDY
References
Chiliza, B., Asmal, L., Oosthuizen, P., Van Niekerk, E., Erasmus, R., Kidd, M., Malhotra, A.
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episode schizophrenia treated for 12 months with a first-generation antipsychotic. European
Psychiatry, 30(2), pp.277-283.
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K.D., Murray, R.M., Marques, T.R., David, A.S. and Jarosz, J., 2017. Clinical utility of
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