Appearance, Speech, Thought Content And Form Of A Patient With Schizophrenia

Risk factors

Discuss about the Mental Status Examination:  Modelled From NSW HEALTH Documents.

Appearance

Mr Tan, is 30 years old male Asian look with skinny

Casual bright clothes inappropriate with the weather, wearing two layers of cloths.

Unshaven and clothing appeared bright.

Appeared younger then the stated age

Long black hair and un groomed hair

Folding arms and scratching left side of chick repeatedly while having a conversation, slightly anxious at the start of the interview.

Poor eye contact with the interviewer few times during the interview.

Co-operative with the nurse but partially engaged in conversation because Dimitrie asked the assessor to repeat the question few times to repeat the question and which proven that he was pre- occupied. 

Slightly agitated and restless by demonstrating fidgety hands and scratching chicks repeatedly at the beginning of the interview.

During his course of interaction with the nurse he looked pre-occupied and had his hands folded close to his body.

Willing to shake hand but firmly

Psychomotor retardation, Reduced body language.

Dimitrieemotional state appeared euthymic during his conversation with the nurse.

There was a blunt look on his face and seemed indifferent of showing active participation in the interview.

Restricted in speech as well as emotional expression because he didn’t show much interest even while he was explaining about the things which interest him much.

Dimitrie showed Inner irritability because he has unable to finish his novel writing which he had started while in high school. He was agitated with this topic and started mumbling.

Showed little bit flat, subdued affect however he provides appropriate responsiveness throughout the interview.

Dimitrie stated that he felt uncomfortable with the hearing voices and them seems scary for him.

Dimitrie seems to apathetic because when the nurse asked him about his interest he had a long pause and was not able give clear answer about his interest however he has only one thing to do that is writing.

Dimitrie also claimed that the voices interfere him in his writing novel which makes him frustrated.

Speech

Slow & ordinary speech; no obvious speech impediments; taciturn; repetitive.

Flow of speech: hesitant, long pauses mid-sentence, forgetful, emotional.

Soft volume, appropriately animated when in discussion of particular topics such as friends and his mum.

Mumbled once when nurse asked if he is a writer.

Tone of speech: monotonous; scant.

Long intermittent breaks were applied by him during his speech (poverty of speech)

Goal/S

Thought Form

Evidence of thought blocking, taking a longer time to respond to questions, poverty of thoughts.

Nil Thought delusions because Damitrie believes that no one can put voices in his head.

Thought Content

Denies thought of suicide but does not rule it out in the future

He denies thoughts of wanting to harm others but does not rule out in future because he stated to nurse that if someone attack him or if he is in danger then he will defend himself.

 He is experiencing auditory hallucinations, as he speaks of hearing voices criticizing him. The evidence of Dimitriesaying “shut up“to the voices in the video also proven that the voices was interrupting him.

Nil delusions:Damitrie stated to nurse that no one can put voices in his head.

Auditory hallucinations: Damitrie stating he hears voices and in particular that he can hear voicescriticizing him and saying stupid things. Voice also interrupting him while having conversation with the nurse. Voices was telling him that “his maths sucks” when he was trying to count the numbers.

Alert and oriented.at time of interview. Dimitrie was able to recall the date and month and year and the place. Generally, Dimitra was able to follow the interview process.

The evidence of unfinished writing creative novel also proven that Dimitrie is lacking intelligence.

Lack of concentration as Damitrie was only able to count twice when the nurse asked him to count downwards from 100 with subtracting 7. He was not able to tell any other friends name when the nurse mentioned about his friends, Either he did not want to answer or cannot recall. Further assessment required such as MMS / RUDAS.

However, Damitrie stated in the conversation that hebelieves that he has illness, but he was brought in hospital by his friend Cheryl which proves that he has some absent degree of awareness of his treatment. He also stated that he will continue writing his novel once he stopped hearing voices. He knew that skipping medication can make him worst, so he agrees to continue with medication.Later in the conversation, hedidn’t show interest in staying hospital, he was not sure how bad is his condition is and agreeto stay in hospital if required. Thus,Damitriehas some insight present of his illness.

Risk factors   Identify 4 (  5 marks)

1.Risk of harm to others or

2.either self-harm or AuditoryCommand Hallucination

3.Social isolation/ lack of role – unemployment and financial difficulties

Interventions

4.Current medication withdrawal

After conducting the interview, it is seen that the main care priority of the patient would be to treat his auditory hallucinations that are affecting his quality life. The main risk factor that has been identified for this disorder in the case of the patient is social isolation as he states that he has very few friends and most of his fiends live far away. Even he is seen to go to movies lonely that shows his social isolation. The second risk factor is that the patient has forgotten to take his anti-psychotic medication that had resulted in the recurrence of his psychotic conditions that in this case may be confirmed as schizophrenia. His repeated hearing of voices in his mind can be taken one of the most important cues that signify him being affected by schizophrenia(Firth et al., 2015).

If symptoms of schizophrenia like auditory hallucinations are not treated effectively by the healthcare professionals in the patients it may lead to different types of harmful and threatening situations (Kantrowitz et al., 2018). These are depression, anxiety, phobias and extended social exclusion. Abusing of substances may also follow like the use of alcohol, drugs and prescription of medications. Researchers also associate self-injury, suicide and death with outcomes of hallucinations and therefore, this should be treated as a care priority in the patient (Vancampfort et al., 2016).

Goal/S

Three important goals should be set for the patient. These three goals would be to help the patients overcome the misperceptions and thrive back in reality. The professionals should also fix up a goal for eliminating or decreasing alternation to auditory perception of the patient. The third goal would be to develop reality base for the patient before he is discharge from the healthcare centre.

INTERVENTIONS –  1 The nursing professionals should not directly deny the fact that the patient is hearing a voice but at the same time explain to them that the professionals are not hearing the voice. 2 The nurses should also be alert for the signs of increasing anxiety, fear as well as agitation. The client can be involved in some reality based simple interactions or can be encouraged for reducing anxiety for distracting the client from hallucinatory material 3 the nurses should first develop a therapeutic relationship, say with the client, and tell them to try their best to instruct the voices to go away (Deste et al., 2015).

RATIONALES  1. This would help the patient to develop a” doubt” on the validity of his or her own voices that will eventually help him to develop a connection with reality (Brook et al., 2015). 2 that he does not tend to harm himself or face any accident due to the commands of the voices heard by him. It would also help the patient to connect with reality. 3 Clients are seen to be successful in learning to push the voices aside when given repeated instruction within a framework of trusted relationship and therefore

The evaluation will mainly comprise of the monitoring the effectiveness of drug, compliance to health instructions, levels of patient’s functioning and patient is mental status. Besides, environmental stimuli should be controlled like low maintenance of low noise, minimal activity and many others.. Besides, medication should be given properly on time (McFarlane, 2016).

The four main positive aspect was that the nurse was able to exhibit proper body language with proper eye contact. She was also speaking in a calm tone of voice that had positive influences on the patient. The second positive point was that the nurse did not hurry in the interview giving enough time to respond for the patient. This increases respect of the patient who thereby feels comfortable. The third was that she was negative in feedback giving and sharing with the patient. The fourth one was that she introduced herself well and asked for the patient’s consent that helped to maintain his dignity. The negative aspects was that she asked many close ended questions which made it seen a one-way communication procedure. She also did not assure the patient of his confidentiality at the end that was ethically not correct.

References:

Brooke-Sumner, C., Petersen, I., Asher, L., Mall, S., Egbe, C. O., & Lund, C. (2015). Systematic review of feasibility and acceptability of psychosocial interventions for schizophrenia in low and middle income countries. BMC psychiatry, 15(1), 19.

Deste, G., Barlati, S., Cacciani, P., DePeri, L., Poli, R., Sacchetti, E., & Vita, A. (2015). Persistence of effectiveness of cognitive remediation interventions in schizophrenia: a 1-year follow-up study. Schizophrenia research, 161(2), 403-406.

Firth, J., Cotter, J., Elliott, R., French, P., & Yung, A. R. (2015). A systematic review and meta-analysis of exercise interventions in schizophrenia patients. Psychological medicine, 45(7), 1343-1361.

Kantrowitz, J. T., Swerdlow, N. R., Dunn, W., & Vinogradov, S. (2018). Auditory system target engagement during plasticity-based interventions in schizophrenia: a focus on modulation of N-methyl-d-aspartate-type glutamate receptor function. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging.

McFarlane, W. R. (2016). Family interventions for schizophrenia and the psychoses nursing: A review. Family process, 55(3), 460-482.

Vancampfort, D., Rosenbaum, S., Schuch, F. B., Ward, P. B., Probst, M., & Stubbs, B. (2016). Prevalence and predictors of treatment dropout from physical activity interventions in schizophrenia: a meta-analysis. General hospital psychiatry, 39, 15-23.