NUR2200 Mental Health Across Lifespan: Mental State Examination Assessment 2 Answer
|General appearance||Peter is a 38-year old man and is looking older as per his age. Peter was wearing jeans and a shirt. He has grey hairs and has very few facial hairs and appearance and hairstyle were well maintained. His stature and height are average but he looked tired. His complexion is white and his skin is not dry. |
|Behaviour||Mr Peter is not confident while talking and continuously looks on other sides also he was not in favour of the evaluation and feels that he ready to go home. He was not making eye contact with the nurse, seems to be mumbling and not presenting clear information. He doesn't have speed in expression. |
|Speech||Peter is speaking very slowly and speaks in short phrases and stammers as he spoke. Also, he looks hesitant and though he is giving answers to all the questions but using a murmuring sound. He used soft volume but at times when he was distressed, he was looking as if he is hiding things and not giving complete information (limited content). |
|Mood and |
|Mr Leroy was looking tensed about the safety of his sister and wants to go home. Further, he had ongoing mood-swings. He was turning aggressive at one time and the next time he was calm and pleased. Also, by expression and mood, he was congruent and by effect anxious. |
|His thought process is completely different from others and he has feelings that medicines are of no use and doing no benefit to him. He does not take medicines and takes pills sometimes just to have asleep. He firmly believes that his secret voices are real and they are telling him that steeve is not the right person and belives that other males in his life paedophiles. |
|Peter beliefs that he should protect his sister. Earlier he even called police as he thought that his uncle is not safe for his mother. Also, he believes in his secret voices and feels good about such voices. He thinks that steeve is manipulating his sister and he is a paedophile. His thought content also shows that he is ok and does not have schizophrenia and is ready to go home and does not require medicines. The last moment he changes his mood that from few months he is ok with steeve and he is not that bad. |
|Perception||His perception is that he is right and other males in his life are a paedophile. He needs to protect his sister and it is the only to protect her. He keeps a knife and keeps an eye on steeve. Has disturbed image about others. |
|Rather than believing in the real truth he is forming his own opinions and pursuing them. He suffers from short-term memory loss, too. He has not maintained a confident voice and speaks no more than once phrases while talking. He lacks concentration as well. He insists that he does not need medicines to be healthy and safe that reflects his limited intelligence. |
|Insight ||Impaired insight- Despite his mental health condition (schizophrenia) he feels ok and thinks that he does not require hospitalization. Moreover, he is very cautious about other males and indulged in being strict towards them and hence keeps a knife. |
|Judgment ||Impaired Judgment- restricted his judgements to the secret voices that he hears and does not use his abilities and feels good about the voices. Further, his judgement about medicines is made on his own. |
(i). Individual psychotherapy- Individual interviews have also been found beneficial to establishing trust and rapport with the mental health patients suffering from delusions. Individual interviews are interventions to promote protection, coping effectively and increase regular interaction with people at high risk of negative thoughts or delusions (Kumar, 2020). Individual psychotherapy may help the participant understand the underlying thought that has been distorted and correct it. Literature offers increasingly strong evidence of the use of therapeutic approaches to individual psychotherapy in the treatment of persistent mental illnesses and their symptoms such as delusions (Arnold & Vakhrusheva 2016).
(ii). Pharmacological intervention (Medicines)- The key drugs used in the treatment of the delusional condition is called anti-psychotics (Abou et al., 2019). Ever since the 1950s, traditional antipsychotics, also named neuroleptics, were used to treat psychiatric illnesses. these drugs work By suppressing dopamine brain receptors. Dopamine is a neurotransmitter that is considered to be implicated in the growth of delusions (Lewekeet al., 2018). Chlorpromazine-fluphenazine (Prolixin ®), (Thorazine ®), thiothixene (Navane ®), haloperidol (Haldol ®), thioridazine (Mellaril ®), trifluoperazine (Stelazine ®), and perphenazine (Trilafon ®) are traditional antipsychotics (Abouet et al., 2019).
(i). CBT- Cognitive behavioural therapy is an effective intervention to minimize the irritation and violent nature and stress among service users. The use of open-ended interrogation, interpersonal skills, empathizing listening and talking will be the major key elements to build rapport with Peter (Thomson et al., 2017). Cognitive therapy is a well-known intervention used by nurses for the treatment of schizophrenia in mental health patients (Pontillo et al., 2016). In order to provide Peter with relaxation and ensure that he sleeps properly and has proper medication, the nurses should try to reduce the environmental stimuli (Lincoln & Peters, 2019). The section ends by affirming that interpersonal relationships constitute the most positive strategy under the rules of recognition, affiliation and reciprocity, regaining the feeling of self and comprehension psychotic experiences in a biographical context.(ii). Hallucination-integrated-treatment (HIT)- This includes several therapeutic modalities including antipsychotic medicine, cognitive-behavioural intervention, relaxation therapy, family counselling, rehabilitative intervention, portable crisis management and strategies of behaviour and empowerment (Kumar & Venkatasubramanian, 2018). In general, HIT affects the emotional state, decreases the psychological pressure, quality of life and social functioning. According to the therapy, in most situations, fair adherence and high engagement with HIT treatment are evident; 65% speech-free; most display a noticeable increase in mastery, fear, interfering with thought and social functioning; none exacerbated (Pontillo et al., 2016).
Confused thoughts and disorganized speech
|(i). Non-pharmacological interventions- Psychotherapy- psychotherapeutic approaches can be categorised into three groups: individual, collective and cognitive behavioural. Psychotherapy is a treatment process which is continually evolving. Meta-cognitive preparation, narrative interventions, and perception counselling provide new psychotherapies (Sanada et al., 2016). Non-pharmacological therapies should be used as a supplement to, not a replacement for, drugs.|
There is an elevated risk of relapse in schizophrenia patients who avoid taking their medication, that can cause health problems. It is also critical that patients are kept aware of their condition and the complications and feasibility of treatment. Any psychotherapies may help inform people about the value of their drugs being administered. Cognitive behavioural therapy ( CBT), personal therapy, and enforcement therapy are among these programmes (Tumiel et al., 2019).
(ii). Pharmacological interventions- antipsychotics significantly reduce the severity of psychiatric symptoms. In order to optimise the advantage for the patient with schizophrenia, often health care providers recommend either of these drugs, often in conjunction with one or more other psychotropic medications. Antipsychotics can be taken as an injection or as a pill (Ganguly et al., 2018).
These medications function on chemicals in the brain such as serotonin and dopamine. It is necessary to get support from the nurse and doctor once or twice a month called a long-acting injectable antipsychotic drug (LAI) as the patient thinks that those medicines are not helpful (Pandarakalam, 2016). Further, the nurses should take the responsibility to make him understand the value of conformity with drugs. It works almost as well as taking a pill every day (Pandarakalam, 2016).
Peter has been admitted to the mental health facility after the referral through his sister. He is suffering from schizophrenia but denies his mental illness. He has symptoms of schizophrenia such as hallucinations, delusions and distorted thought and speech. Further, Peter has two older brothers and one sister. His family history shows mental health issues including depression, anxiety and many health issues that were not even diagnosed. His grandfather also suffered PTSD after the war.
Peter did not complete his schooling and left school grade 11. His academics shows school refusals, low grades and disengagement and he preferred being a mechanic. He lived with his parents but due to Peter/s aggressive behaviour, they left him. He has had previous mental health referrals due to issues like voicing potential voices and showing violence towards others. He also keeps a knife with him which can result in a potential hazard.
Despite Peter’s exceptional misery, I have felt positive about my communications with him. This affirmation is because of the solid affinity and remedial relationship that has worked in Peter’s past admissions to the inpatient unit.
I would make a point to offer the most critical actualities about schizophrenia in a straightforward, and a mindful way and after that give him extra assets for data and support. Contrasted with what has happened in this clinical circumstance, the method of activity under such conditions ought to be guided by the most flow, confirm based nursing research. It is, subsequently, dampening now and again to see him keep on re-introduce and not have all the earmarks of being advanced in his recuperation.
Peter is a 38-year old man and is looking older as per his age. During evaluation and interview with the professional, Peter was wearing jeans and a shirt. He has grey hairs and has very few facial hairs and appearance and hairstyle were well maintained. He has distorted thought content and his thought process is completely different from others and he has feelings that medicines are of no use and doing no benefit to him. He does not take medicines and takes pills sometimes just to have asleep. He firmly believes that his secret voices are real and they are telling him that steeve is not the right person and belives that other males in his life paedophiles. He has impaired judgment as he restricts his judgements to the secret voices that he hears and does not use his abilities and feels good about the voices. Further, his judgement about medicines is made on his own.
Based on the evaluation Peter is not suicidal but he has violence/aggression which needs to be monitored on a regular basis as it might be harmful to other people around. Vulnerability risk is also very high and needs prompt attention. During the hospital stay, he will be kept under daily risk assessment and it will be made sure that the patient has no sharps or weapon around him to keep the surroundings safe.