Question 1

Thought form provides a record of how a patient thinks which is frequently described as logical and goal-oriented. If as Mental Status Exam (MSE) is carried out, a patient can be said to have a disorder in their thought form if the demonstrate blocking, flight of ideas, loose associations or tangentiality and circumstantiality (Baer & Blais, 2010). During the MSE a nurse seeks to find out how from a patient’s conversation, their thought order is produced and how they associate and connect one subject to the next. 

Under the MSE, thought content refers to what a patient thinks as opposed to looking at the process involved (Fortinash & Holoday-Worret, 2012). Under the thought content, the occurrence of delusions and psychotic symptoms is also assessed alongside other ideations that the client may have such as suicidal and homicidal plans. 

The two concepts can be used on to interpret the thought disturbance for Annabelle. For example, Annabelle’s thought content indicates that she has persecutory delusions which make her believe that she will be harmed. For example, the patients are hesitant to enter her cubicle like someone who is entering a trap and is also quick to point out that the nurse does not inform the rest of their talk. Annabel also requests to be forgiven and indicates she did not mean to hurt anyone. Annabel also demonstrates auditory hallucinations as evidenced by the fact that she talks when alone and even shouts as if she addressing someone.  The concept of form can be applied as Annabel is seen to have a flight of ideas as she speaks about one thing and quickly shifts her mind to address another issue. The concept of thought blocking is evident given that she talks during the examination and the stops suddenly and starts to stare at the ceiling. 

Question 2

Perception, as it relates to MSE, is the ability of a patient being aware of their senses and also being in a position to form a mental impression from the different sensual centers (Roberts, 2013). For example, when assessing the perception of a patient, the nurse makes a determination if the patient can see, hear and touch while at the same time interpret the messages gotten from these senses. 

Based on the definition of perception under MSE, we may interpret that Annabel has some disturbances in her senses. For example, Annabel has some disturbance in her auditory perception. The patient has auditory hallucinations as evidenced by the fact that she refers to voices that are talking to her. The auditory hallucinations are also evidenced by the fact she hears voices which provide her with some form of commands that she tends to communicate to the people around her such as when she asks the nurse if they can “hear what they are saying” during the examination. 

Annabel’s senses are also altered as demonstrated by the comments she makes about seeing children hurt. The patients have visual hallucinations as evidenced by the fact that she can perceive children who are hurt to the point that she even slumps to the floor and sobs in distress. Her gaze on the ceiling is also a presentation of the alteration in her visual senses. 

Another sense that is altered in Annabelle is that of tactile which results in the form of hallucination is where the patient senses as if some sensations are crawling on their skin. The tactile hallucination is evidenced in Annabelle’s case as she stares at her arms and continues to pick the sores covering her arms. The patient also continues to refer to what is under her skin and also adds that “they are everywhere” and would result at the end of everyone. 

Question 3

Affect is defined as an emotion is immediately expressed by an individual, and it is observable by other parties. Thus an emotion only qualifies as to be described as an affect when it is observed through the demeanor of the person or the tone of their voice (Hunt & Eisenberg, 2010). Some of the typical examples of affect include euphoria, sadness or even anger. A patient may demonstrate a range of affect which can be termed as broad, restricted, blunt or even flat. 

The mood is defined as an emotion that is pervasive and sustained which if it occurs in the extreme form tends to cloud an individual’s perception of life (Schultz & Videbeck, 2013). When evaluating the patients, the nurses seek to establish if they demonstrate a congruent mood.  

Annabelle’s mood, as well as the range and intensity of her affect, are evident can be interpreted from her interactions with the nurse. The mood of the patient can be said to be dysregulated as she exhibits extreme mood states. The patient exhibits some signs of substance-induced depression given that she locks herself in her room for days and avoids interactions with other people. The patient also demonstrates anxiety as evidenced by her fear that someone would know about her actions and aim to hurt her to the extent that she even apologizes without having made any mistake. 

Similarly, Annabel’s affect can be described as being labile. The patient’s affect is unstable as seen in the situation where she is screaming then starts to stare at the ceiling and then begins to sob with distress. The labile affect can also be shown in the range and intensity of her emotions since she smile once the nurse enters the room and then next minute she starts to stare at the ceiling and seems to be terrified. 

Question 4

Annabel behavior has an instance of akathisia which constitutes increased levels of restlessness and a compulsion to remain in motion (American Psychiatric Association, 2013). The patient is said to be very tense and keeps pacing up and down the ED corridor. The behavior of the patient also demonstrates some level of hyperactivity as she responds instantly to any form of sound or movement within the ED. The patient behavior is also characterized by chorea which is semi-directed and irregular movement of one hand (Tasman, Kay, & Ursano, 2013). The report indicates that Annabel kept wringing her hand when pacing around the corridors of the ED which also continued when she was taken to her cubicle. In some instances, the patient also failed to maintain eye contact with the staff and chose to stare at the ceiling. The failure to maintain eye contact with the staff could be an illustration of being depressed. 

The description of appearance as characterized in the MSE can be used to characterize the appearance of Annabel. The clothing that the client presents within the ED are dirty and does not even have shoes which are indicative of a disheveled appearance. The patient’s appearance is also devoid of proper grooming as she described as having dyed her hair blue but is unkempt and matted. The facial expression of the patient constitutes some instances of being tense and suspicious as demonstrated by her gaze is said to shift from being afraid to hostile. The patient can also be said to have peculiar make-up such as dying her hair blue which is not considered as a normal color. The patient is also said to have lost a lot of weight which indicates that her body appears to be emaciated. 

References

American Psychiatric Association, 2013. Diagnostic and statistical manual of mental disorders (DSM-5), Arlington: American Psychiatric Association.  

Baer, L., & Blais, M, 2010. Handbook of clinical rating scales and assessment in psychiatry and mental health, New York: Humana Press. 

Fortinash, K., & Holoday-Worret, P., 2012. Psychiatric mental health nursing, St. Louis: Elsevier Mosby.

Hunt, J., & Eisenberg, D., 2010. Mental health problems and help-seeking behavior among college students. Journal of Adolescent Health, 46(1), pp.3-10. 

Roberts, L., 2013. International handbook for psychiatry: A concise guide for medical residents and medical practitioners, Singapore: World Scientific Publishing Company.

Schultz, J., & Videbeck, S., 2013. Lippincott’s manual of psychiatric nursing care plans, Philadelphia: Lippincott Williams.

Tasman, A., Kay, J., & Ursano, R., 2013. The psychiatric interview: Evaluation and diagnosis, West Sussex: John Wiley & Sons.