Mental State Examination (MSE) | Case Study

genial State Examination (MSE) Case StudyEllie Fitz-GeraldGiving examples from the contingency study, how would you describe Amandas conduct and appearance as set come out of the closet in a MSE?A mental state examination (MSE) is use to assess an individuals mental capacity and reasoning at the time of an interview. It couples a number of cognitive domains in an attempt to characterise a individuals mental state (PCDCBP, 2011). The first domain of a MSE is a visual assessment of the longanimous, non-judgementally describing an accurate appearance of the patient including as galore(postnominal) details as possible. These aspects include but be not confine to age, gender, build, posture, grooming, hygiene, heath levels, signs of drug use, hair style and colour and ethnicity. Behaviour is roughly other non-judgemental assessment of the patients behaviour in general, but as well a description of shopping mall dejection and eye contact, body movement and any gestures that be made. This is often coupled with an go outation of the patients reaction to their current situation examples whitethorn include descriptions such as being cooperative, hateful, withdrawn or suspicious (PCDCBP, 2011).Appearance Amanda is a three-year-old woman with dyed blue and pink hair, which is mattered and unkempt. She has a number of piercings in her nose, eyebrow and lip. Her arms argon c overed in sores and her pupils atomic number 18 dilated. On paramedic stretch, they expound that Amanda was sitting upright appearing dazed and importunate. In the cell on arrival to ED, she appeared very tense. Later in the cubicle, Amanda is smiling and then quickly appears terrified. Amandas mother has reported that she Amanda comes al-Qaida dishevelled and dirty. She has lost a lot of weightBehaviour Amandas behaviour over the course of the case study could be described as erratic, often shifting betwixt states of anxiety, happiness and terror. On arrival of the paramedics, Amanda was described as anxious and short of breath. In the cubicle at the ED, Amanda was pacing up and down the corridor and wringing her hands occasionally, responding quickly to any stimulus by staring intensely at the ceiling or at rung members. A description of her eye sight twisty her manner and gaze alternating between being intrigued to afraid to hostile, coupled with difficulty remaining still. Amanda was hesitant to be touched, and argumentd to be constantly picking at sores. Later, Amanda was later happy and quickly moody to terror and despair. Amanda is described by her mother in these examples Amanda hasnt been herself since fall out of university, She has lost contact gradually with nearly all of her familiarity and become increasingly isolated, Over the last three months her behaviour has become increasingly odd and erratic, goes out, sometimes for days at a time, talking loudly to herself in her roomover the past week she has been shoutingbut thither was no a dept in her room with her., Last night she burst out of her bedroom and screaming incomprehensibly at her father then stopped suddenly and went rearwards into her room. plant cognition and then briefly discuss how we might interpret how both Amandas vox populi content and thought mastermind are disturbed?According to Miller and Wallis (2009), cognitive or executive control, or cognition, refers to the ability to coordinate thought and action and direct it toward obtaining goals. Cognition is primary(prenominal) in planning and sequencing complex events of behaviour, as well as prioritizing goals (Miller and Wallis, 2009). vox populi content and serviceing is a somewhat subjective insight into cognitive capacity. For example, thought process can be a description of a patients thinking and a characterisation of how a patients ideas are communicated. The speed of thought is how quickly a patient changes ideas, known as flight of ideas (Snyderman and Rovner, 2009). An example t rooped by Amanda is in the ED cubicle where she had asked the clinician You wont tell her anything will you?, quickly progressing through with(predicate) a series of thoughts from you know dont you? to Theyre everywhere to The whole artificial satellite is falling and then Shut up shut up.Additionally, thought form is another domain which could be described as goal-directed or conversely, disorganised. These terms carry descriptors, describing whether a patients thoughts are logical, tangential (quickly diverging, as shown through Amandas haphazard thought progression), circumstantial (unsupported thinking) or loosely associated (Snyderman and Rovner, 2009). Amanda displays a number of disorganized thought categories, stating Everyone of us is falling the whole planet is falling is a description of both unsupported thinking, and potentially an trick Amanda is experiencing. Another interpretation of dis ordinanceed thought is that of intrusive thoughts or neurotic ideas. As sev erity of mental health illness increases, patients may exhibit delusional thinking (a false belief not held by peers that persists disdain evidence to the contrary), hallucinations (false perception of sensory stimuli) or illusions (a misperception of real life) (Martin, 1990). Amanda illustrates both hallucinations and illusions. Amanda counts to march hallucinations through multiple spoken phrases Theyre everywhere. Everywhereunder my skin, Shut up, shut up, Cant you hear what theyre saying? All the children have been hurt. Taken together, Amandas thought content and process appears compromised.Briefly explain the differences between hearing and listening. learn two skills of listening and discuss how you would use these skills to effectively communicate with Amanda. What are some of the barriers you might face in the process? audition is the process of physiological receiving and processing sounds, without being fully attentive or actively concentrating on what is being ver balize. This is passive listening. In contrast, listening is an active process, give attention to what is being said, constructing meaning from, and in addition, often responding appropriately to what has been said using astute observation (Purdy and Borisoff, 1997). Listening is necessary for the health sea captain as it involves more than simply sending and receiving words, and can validate the patients emotions and promote an reason between patient and health captain. Hearing on the other hand does not continue or incite interaction. Listening can be enhanced by actively applying legion(predicate) measures. Two of these are providing non-verbal cues and picking up on the non-verbal cues of the patient. Providing non-verbal cues to Amanda would encourage a non-judgemental and mutual concord environment, often involving the implementation of an acronym SOLER (Sit squarely, Open posture, Lean forward, Eye-contact, Relaxed) (Egan 2002). In addition to this, nodding the head a nd quiet murmurs as encouragement too aids active listening, this may assist in making Amanda odour better understood, and potentially play a social function in minify her defensiveness to a medical situation. Secondly, picking up on non-verbal cues from the patient is comminuted in making them feel understood. A health professional should endeavour to pay frightful attention to what the patient is expressing and how they are displaying these emotions. This may testify through facial expression, body posture, movements or excessive/poor eye contact and illustrate a patients emotion or frame of mind (Egan, 2002). In Amandas situation, recognizing that she is in distress by verbally acknowledging it may led to some kind of mutual understanding and rapport building between Amanda and the health professional. Some barriers to this include Amandas current inability to fitly perceive her environment correctly. Amanda does not seem as aware of her surroundings and stares often at the ceiling. She may be inattentive to the non-verbal postural cues by the health professional aimed to interject her at ease. Her responses may be skewed and irrational, and the potential hallucinations that she may be experiencing are external to any verbal communication that can dismiss her distress.Define therapeutic communication. Using case study examples, explain the difficulties involved in communication when managing a complex scene that includes an anxious patient who presents in the emergency department with a distressed and demanding copulation.Therapeutic communication occurs between a health professional and a patient, which considers a patients experienced emotion and explores the meaning and potentially faulty cognition in an attempt to resolve them. It is often formal, purposeful and structured, with a long term goal to name a desired change (Plutchik, 2000). Managing patient anxiety in a scenario with a demanding comparative has its challenges. When paramedics have arrived to the scene of Amanda, her mother is sort of distressed, further Amanda is highly anxious, The mother is constantly obstructing and getting in their way do interruptions. The assertiveness of Amandas mum may obfuscate the ability of the paramedics to attain a therapeutic relationship with Amanda in order to de-escalate the situation. Furthermore, this may worsen the anxiety experienced by Amanda. Moreover, attention may be given to the mother in order to place her at ease. iodin manner to reduce this difficulty is to try to separate the parties. In the ED, this changing may result in similar difficulties, and the presence of a demanding sexual intercourse in this context could potentially result in Amanda having difficulty communication additional information due to her anxiety. Although in the case study Amandas mum is not particularly difficult, in the scenario where a distressed and demanding relative was present in the ED and hindering patient treatment th e scoop up course of action would be to kindly ask them to take a seat in the waiting area. If the distressed relative is being quite difficult to handle other tactics include asking relative to go and get an item such as a present for the patient, which would require that they leave the area. If the relative continues to cause disruption to the patient care they must be informed that if they cannot allow the healthcare team to fare their care for the patient they will be removed from the area/hospital.What are the key components of an effective handover between health professionals from different disciplines? Discuss the essential considerations of patient handover in regards to objective information and confidentially.A clinical handover is the counterchange of professional responsibility, accountability, clinical information and patient to another set of health professionals on a permanent or temporary basis. In order for an effective handover to occur, numerous consideratio ns must take place. First, the handover should have clear leadership. Second, there should be support for the handover process to come from all levels of the medical team. Third, adequate information regarding the patient and the current situation and future direction should be provided if applicable. Fourth, tasks must be prioritised, further care plans put in place and unstable patients are reviewed in a rapid manner (AMA, 2006). A qualitative study on paramedic and emergency department handovers showed that paramedics deprivation for a consistency in the terminology used, a shared understanding of the team members in each of the roles of health professionals, and a standardized come up to handovers, such as a predetermined format which is flexible and recognises professional judgement and experience (Owen et al. 2009). A problem arises when considering the objectiveness of information that is acquired from mingled sources. In order to address this, health professionals should speak non-judgementally, and take note of what was observed, as opposed to spoken by the patient, or reported by a significant other in terms of incidents. These processes maintain some level of objectiveness. Confidentiality is a necessary and critically important obligation and law-binding role of all health professionals. One manner to protect confidentiality would be to teach handover in an area whereby members of the public cannot overhear.Reference ListAMA (2006) caoutchouc handover Safe patients Guidance on clinical handover for clinicians and managers. Australian Medical Association. Kingston, ACT, Australia.Egan, G. (2002) The skilled confederate a problem-management and opportunity-development approach to helping. 7th edition. Pacific Grove, California Brooks/Cole.Miller, EK, and Wallis, JD (2009) decision maker Function and Higher-Order Cognition Definition and Neural Substrates. In Squire LR (ed.) encyclopedia of Neuroscience, volume 4, pp. 99-104. Oxford Academic P ress.Martin, DC (1990) Clinical Methods The History, Physical, and Laboratory Examinations. 3rd edition., Butterworth PublishersOwen, C, Hemmings, L, Brown, T (2009) Lost in translation Maximizing handover effectiveness between paramedics and receiving staff in the emergency department, Emergency Medicine Australasia, 21 pp. 102-107.PCDCBP (2011) Understanding the Mental State Examination (MSE) a basic training guide. Palmerston Association Inc. Subiaco, WA.Plutchik, R (2000) Emotions in the practice of psychotherapy Clinical implications of affect theories. American mental Association. Washington, DC, US. pp. 149-168.Purdy, M and Borisoff, D (1997) Listening in everyday life A personal and professional approach. Second Edition. University Press of America Inc. LLanham, Maryland.Snyderman, D and Rovner, BW (2009) Mental Status Examination In Primary Care A Review. Am Dam Physician, 15(80) pp. 809-814.1