week 5 Mental status screening discussion
Week 5 Discussion 1: Conducting a Mental Status Exam
Value: 100 points
Due: In an effort to facilitate scholarly discourse, create your initial post by Day 4, and reply to at least two of your classmates, on two separate days, by Day 7.
Grading Category: Discussions
Note: In this type of discussion, you will not see the responses of your classmates until after you have posted your own response to the question below.
Initial Post
Please view and select one of the patients depicted in the following videos. Both patients have different diagnoses and presentations—the diagnosis is apparent from the titles and not the focus of the assignment.
The purpose of this assignment is to evaluate the patient and write up a mental status exam on what you observe in the video that you choose.
Your initial post should identify which video you have chosen and should include a detailed mental status exam write-up of that patient. The intent of this exercise is to help you to develop your skills in the assessment of a patient’s mental status and documentation of the mental status exam.
Please watch the following video clips and write up a mental status of the patients:
The Video
MINI Screening for Mood, Anxiety or Psychotic Disorder Video Transcript
Matt: Hello, Chris. My name’s Matt. Thanks for coming in to see us today. I understand from your JJ worker that he’s wanted you to come back into to the drug and alcohol service.
Chris: Yeah, pretty much.
Matt: Can you tell me a little bit about how things have been gone for you?
Chris: They’re all right I guess.
Matt: Tell me a little bit about this CBO. What’s that for?
Chris: Probably got it worked out in your file there, haven’t you? Why don’t you tell me?
Matt: Actually, it doesn’t tell us very much. It just says you got busted for an alcohol related break-in, break and enter. What’s your version?
Chris: All right. Me and the boys went down to the footy park one night, and just having a few brews and bit of a night footy session. Before you know it, that all got me a bit riled up. Before you know it, I’m pinching a bit of grub from inside of the footy club. Sort of had to break in and stuff. Yeah.
The thing about that is, is that … and this is the same thing that really gets at my goat is that is was actually like the other guys’ idea in the first place and they put me up to it. Then I’m the one who ends up having to go to court, and fulfill this order, and come to meetings like this and stuff. Yeah.
Matt: It sounds like you felt it was pretty unfair. Did they get charged as well?
Chris: No. No. (inaudible 02:13)
Matt: Okay. Has your use of alcohol got you into other trouble with the law or is the other night the first offense?
Chris: That was the only real offense.
Matt: Okay.
Chris: Yep.
Matt: Just the focus on the alcohol first, how many days a week would you be drinking?
Chris: I’ll probably had a bit most days I reckon, a couple of really heavy nights and then just whenever I can.
Matt: Okay. The heavy nights, how much would you drink on a heavy night?
Chris: I get pretty, pretty wasted. I don’t know. Me and the boys try to swallow probably two or three bottles of spirits or something like that.
Matt: Do you pass out, like drink to the point of passing out?
Chris: Sometimes, but I try to keep my head above water most nights. Sometimes that happens.
Matt: Okay. Then you drink the other days. How much would you drink on the other days? A six pack?
Chris: Yeah, if that. If I can, yeah. Maybe not.
Matt: Whatever you can get.
Chris: Yeah, whatever. Yeah.
Matt: Okay. Do you do any other drugs? Do you smoke any pot?
Chris: Yeah. Doesn’t everyone? I’m sure you tried a bit of that in your heyday.
Matt: It’s a fairly commonly used one of the drugs.
Chris: Yeah. I do that a bit, but not much. Not really. I’m not really one though to.
Matt: Okay. Would you do that as often as you drink alcohol?
Chris: No, man.
Matt: Just once or twice a week?
Chris: Yeah, whatever. Sometimes.
Matt: Okay. Do you do any other drugs like-
Chris: Hey, come on. You’re making me sound like a bloody drug addict now, mate. Jeez. I drink a bit, or I might have a little bit too much sometimes, but as far as the other stuff goes, just lay off, would you? I’m not here to talk about drugs. I don’t really do drugs.
Matt: Yeah. I’m sorry if I’ve offended you, Chris. I don’t mean to make out that you’re a drug addict or anything like that. I’m just-
Chris: Yeah, well you’re not doing a really good job at it, are you?
Matt: Okay. They’re just routine questions we ask everyone. Do you want to sit back down and we can carry on talking about it?
Chris: I’m cool here.
Matt: Okay. Just to get back on to the alcohol, the things that you kind of like about it, you like hanging out with the mate, having a few drinks. You get a bit wasted. Is there anything else that’s good about it?
Chris: I can relax. To chill out, have fun, the usual things.
Matt: Yeah. Are you always drinking with your mates? It’s always sort of a social kind of thing?
Chris: Yeah, but also just when I’m by myself, when I’m at home and stuff. Just it helps me to relax and stuff.
Matt: Okay. Is there anything not so good about the alcohol? Obviously it’s run you in with the law a couple of times.
Chris: Look. I guess as far as I’m concerned, it’s all pretty sweet, but things have been getting a bit intense recently. Like with my J worker and stuff, he’s been on my case and that, and mom as well. Like the other day, I had a bit of a heavy night and I just sort of wanted to sleep it through and chuck a sickie that day and just call in sick and stuff, but I didn’t really get the opportunity to do that because like mom’s really dogging me in to me worker. She’s like on the phone with him and stuff, and like she shouldn’t be doing that. You know what I’m saying? Like she’s supposed to be on my side here, and she’s got no ground to stand on anyway. I mean she’s the one who’s bloody stealing me Ritalin pills from when I was a little kid, wasn’t she? She’s just putting her foot in it, and so that means that like the JJ worker’s on me case and everything, and he’s telling me I’m going to get breach if I don’t get my shit together. Then mom’s telling me she’s going to kick me out if I don’t I pull it together. If this happens one more time, she’s just going to kick me out, and it’s not like I can go and live with me psycho dad, is it?
Matt: Why don’t you just sit down and chill for a bit, Chris? You want a glass of water or something? I’ll pour it for you, mate.
Chris: Thanks.
Matt: Just take a couple of minutes. You seemed to get pretty wound up there. You mentioned your psycho dad. Has he got a mental illness?
Chris: I guess that’s what you call it, yeah.
Matt: What happened with him? Is he getting treatment?
Chris: Yeah. Yeah, he’s … I don’t know. I don’t really see him that much anymore.
Matt: He’s not living at home?
Chris: No.
Matt: Okay. Certainly you seemed to get really riled up there, and it sounds like you’re under a fair bit of pressure at the moment, Chris.
Chris: Yep.
Matt: You got pretty upset there when I was sort of talking about drugs. Is that the problem in the home?
Chris: Not as far as I’m concerned.
Matt: All right. I guess one of the things that we do as a matter of routine with all their intake assessments, we like to check in with people to see how their emotional and mental health is. We’ve got have a screening questionnaire that we ask. It’s basically just a yes/no sort of tool. But it’s when people are under a lot of stress as what you’ve just been describing, that’s probably not a bad idea to just touch base with that.
Chris: You’re making me sound like a bloody mental case, mate.
Matt: Yeah, no. It’s not to make it sound like that, but it-
Chris: I just don’t think we really need to go into that sort of thing.
Matt: Okay. I guess it’s not uncommon. I’m not sure whether you’re aware of this with media stuff that’s out there about the prevalence of mental health issues, but it’s not as bad as what people … People get frightened by the word I guess. Basically this is about checking in with people early on to prevent things from happening or just touch base with them. That be okay?
Chris: Yeah.
Matt: It doesn’t take too long. It’s just a yes/no sort of thing. It’s just a routine part of the questions that we ask.
Chris: Yeah.
Matt: Okay. The first question is mostly around sort of new type stuff. Have you been consistently depressed or down most of the day, nearly every day for the past two weeks?
Chris: No.
Matt: No? Okay. In the past two weeks, have you been less interested in most things or less able to enjoy the things you used to enjoy most of the time?
Chris: Yeah. I guess with all the stuff that’s been going on at home and trying to fulfill this order and the commitments and stuff, it’s been stressing me out a bit. Yeah.
Matt: It sounds like you’ve certainly got a lot on your plate. You seem pretty tense at the moment. Have you felt sad, or low, or depressed most of the time over the last two years?
Chris: No.
Matt: In the past month, did you think that you would be better off dead or wish you were dead?
Chris: No. I try to keep myself alive for the time being. Give myself a few more years.
Matt: That’s a good thing. Have you ever had a period of time when you were feeling up, hyper, or so full of energy or full of yourself that you got into trouble or that other people thought you weren’t your usual self? That’s sort of like times not when you’ve been say so drunk for using drugs, but just at other times.
Chris: Yeah, yeah. I guess sometimes it just all gets a bit much. With everyone sort of like really getting up against me all the time, it’s sort of making that a bit worse. Yeah.
Matt: You get real sort of wound up. Would that last few days or is it sort of-
Chris: Yeah. It’s sort of brewing a bit.
Matt: Yeah? Okay. Have you ever been so irritable, grouchy, or annoyed for several days that you had arguments, verbal or physical fights, or shouted at people outside your family? Or others notice that you’ve been more irritable or overreacted compared to other people, even though you might’ve thought you were right to act that way?
Chris: Just do one bit at a time?
Matt: Yeah. Basically, what you sort of been so irritable, grouchy, or annoyed for several days that you had arguments, verbal or physical fights, or shouted at people outside of your family?
Chris: Yeah. I guess just like in relation to all the stuff that’s going on. It’s just been getting at me.
Matt: Yeah, so maybe a bit more irritable about that sort of stuff?
Chris: Yeah, yeah. Pretty much. Just having a few more blues with mom and stuff than I usually would. Yeah, a couple of other little incidents I guess here and there, yep.
Matt: Just people outside of your family, yeah?
Chris: Yeah, yeah.
Matt: Okay. People sort of notice that you’ve been more irritable compared to other people? Do they sort of make those sort of comments?
Chris: Yeah. Well, with all the stuff that’s going on, like yeah.
Matt: Okay. The next section of questions are sort of around anxiety and those sort of things. You’ve heard that sort of term before, anxiety?
Chris: Yeah, I guess so.
Matt: All right. The first question is in two paths. Have you had one or more occasions when you felt intensely anxious, frightened, or uncomfortable, or uneasy, even when most people wouldn’t normally feel that way?
Chris: Yeah. Yeah. I get a bit sort of worked up inside sometimes when … I don’t know. Like I get the feeling that there are a few things going on with my mom’s friends and stuff. Like mom’s been threatening to keep me out and they’re really encouraging that. Yeah. Does that kind of answer the question?
Matt: Not really. That’s more like more about sort of feeling really anxious or frightened.
Chris: Oh, well that’s kind of been making me feel really anxious.
Matt: Oh, okay. You’ve been worrying about it.
Chris: Yeah, just that they may sort of really … Yeah, they’re just on me. Yeah.
Matt: Okay.
Chris: There’ve been a couple of times like that I guess.
Matt: Okay. Do those sort of really intense feelings get to the worst within ten minutes? It’s like a really sudden onset kind of thing and really peaked-
Chris: No.
Matt: In a quick time?
Chris: No, because it’s more something that sort of kind of brewed in me, and then just sometimes it sort of pops out.
Matt: Okay, so like a constant pressure kind of thing.
Chris: Yeah, it’s just kind of like a bit more like that I guess. Yeah.
Matt: Okay. Do you feel anxious or uneasy in places or situations where you might have the panic like symptoms that we were just talking about? You sort of feel that anxious or uneasy in situations where help might not be available or escape difficult. For example, like say sitting, standing in a crowd, being in a bus or train or car, that sort of feeling where you can’t escape and you get that really intense, anxious feeling?
Chris: Most of the time I’m pretty good with that sort of stuff. I mean I tend to sort of stay out of situations where there’s lots of people. Like I don’t really like going to go out to pubs and stuff. I just sort of … Yeah, most of the time I’m all right.
Matt: Is that because you feel like anxious in those situations or you just don’t like-
Chris: Yeah. Yeah. I just don’t really like sort of being with too many other people. Just sort of like hanging with me mates and just by myself when I’m not with them sort of thing.
Matt: Okay. Have you worried excessively or been anxious about several things over the last six months?
Chris: Yeah, yeah, yeah, yeah. Quite a lot.
Matt: It sounds like from what you’ve described before there’s a lot going on for you. Are these worries present most days?
Chris: Yeah. Right now they are, yep.
Matt: In the past month, were you were afraid or embarrassed when others were watching you or when you were the focus of attention? Sort of being afraid of being humiliated. An example might be like speaking in public or eating in public.
Chris: There’s a couple of guys at the park where they’re making me fulfill the order. Sometimes they just sort of put me in a position to make me look kind of stupid and get me to do all the dirty work and stuff like that. Sort of laughing at me and poking fun. Yeah, I don’t really like sort of being there too much with them.
Matt: Yep. You’re worried that they’re going to humiliate you in some way or something?
Chris: Yeah. Also, they’ve sort of got it in for me. They really, really don’t … They’re just making it so it’s hard for me.
Matt: Okay.
Chris: Yeah, right now they are. Yep. I’m getting all the shit jobs and stuff like that.
Matt: Okay. In the past month, have you been bothered by thoughts, impulses, or images that you couldn’t get rid of that was sort of unwanted, distasteful sort of thoughts, just intrusive and that you didn’t like and that just kept coming into your head? An example might be like worrying about being dirty, or contaminated, or having germs, things like that.
Chris: I’m not really worried about little things like that? What was just the first bit of the question?
Matt: Just in the past month, have you been bothered by thoughts, or impulses, or images that you couldn’t get rid of, that just sort of come into your mind?
Chris: Yeah. Like what I was saying about mom’s friends and stuff, like I just get the feeling that they’ve really got it in for me. I don’t know. That’s just kind of been on my mind a lot, and I don’t really know what to do about it, and it seems to be getting worse. Mom’s not really listen to me when I talk to her about it.
Matt: Okay.
Chris: I’m not like seeing stuff or anything like that. I mean I’m just … yeah.
Matt: Just these thoughts of worrying and all that.
Chris: Yeah.
Matt: Yeah. No worries. In the past month, did you do something repeatedly without being able to resist doing it? An example of that might be like washing your hands quite excessively, or cleaning the house, or counting or checking things over and over again.
Chris: No.
Matt: No. Have you ever experienced, or witnessed, or had to deal with an extremely traumatic event that included either actual or threatened death or serious injury to you or someone else? Examples can be things like serious accidents, sexual or physical assault, fire, the sudden death of someone close to you.
Chris: Bloody drilling.
Matt: Yeah, they’re doing a bit of maintenance out there.
Chris: Lighten that up. It’s bugging me. Can you just say … just go ahead, one bit at a time maybe?
Matt: Sure. Have you ever experienced, or witnessed, or had to deal with an extremely traumatic event that included some actual or threatened death or serious injury? That could be either to you or someone else. Examples can be things like serious accidents, sexual or physical assault, fire, the sudden death of someone close to you.
Chris: Yeah. Yep.
Matt: Okay. Which example would it …
Chris: Yeah. I guess when I was about ten or something, there’s a bit of stuff with my mom and dad went down.
Matt: What happened with them?
Chris: It just things got messy. Like around the time when the shit hit the fan with dad and everything, it got a little bit intense.
Matt: Like a domestic violence or-
Chris: Yeah, yeah, yeah. Sort of hanging around for a bit of that.
Matt: Okay. That would have totally had … Do you find yourself re-experiencing those events over the last month? Things like having dreams or sort of intense recollections of that event, or flashbacks?
Chris: No. Not really like flashbacks or anything that serious, but I guess I think about it from time to time and I just really hope it doesn’t … I don’t have to go through any sort of that stuff again.
Matt: Yeah, so it’s been over the last month?
Chris: Yeah, yeah. I’m still thinking about it.
Matt: Okay. All right. We’re nearly finished. Interview only got one last series of questions to ask. Have you ever believed that people were spying on you or that someone was plotting against you or trying to hurt you?
Chris: I don’t think people are spying on me, but like the boys that sort of riled me up to steal the grub from the footy club and stuff like that, like people are just really taking advantage of me. Then there’s the guys at Albert Park who were just a bit chummy with the supervisor and are sort of making it so I’m the one who gets left with all the shitty jobs, and I’m having to do them alone all the time. I think they’re sort of really sort of ganging up on me there.
Like as I was saying before, mom and her friends and stuff really wanting me to move. Yeah. No one’s really like listening to me about this stuff.
Matt: Okay. So you sort of feel like they’re plotting against you in some way-
Chris: Yeah, sort of.
Matt: To get you out of the house.
Chris: They’ve got it in for me. They want me to rack off.
Matt: Okay. Has that been a thought you’d had for a while or is it more recent?
Chris: Sort of being saying it more recently I guess. Every time I come around, it seems to be.
Matt: Okay.
Chris: I can just sort of tell by the way they’re talking and stuff.
Matt: Yep. Have you ever believed that someone was reading your mind or could hear your thoughts, or that you could read or hear anyone else’s?
Chris: No, nope.
Matt: Have you ever believed that someone or some force outside of yourself put thoughts in your mind that weren’t your own or made you act in a way that was not your usual self? Sort of like almost being possessed in some way.
Chris: No. No, not really.
Matt: Okay. Have you ever believed that you were being sent special messages through the TV, radio, or newspaper?
Chris: No.
Matt: No. Have your relatives or friends ever considered any of your beliefs strange or unusual?
Chris: I guess my mom’s been on my case a little bit recently and just telling me that like I’m sort of making things a lot worse than they really are. She doesn’t really believe. She reckons the guys at the park are actually just trying to help me and stuff. She’s just not listening to me.
Matt: You’re sort of feeling like they’re all against you, and she’s not agreeing with your side of it?
Chris: Yeah, yeah.
Matt: Have you ever heard things that other people couldn’t hear such as voices or sounds that other people couldn’t hear?
Chris: No, not really. I don’t know. It’s hard to say. Yeah. I don’t know. It’s just hard to say.
Matt: Did you experience something that you’re just not sure?
Chris: Yeah. I’m just not really sure. Other people are probably getting the same thing. They’re probably hearing it too, but I don’t know. Just sometimes I’m not really sure exactly what’s going on.
Matt: Yeah, there’s something worrying you.
Chris: Yeah.
Matt: Okay. The last question, have you ever had visions when you were awake or have ever seen things other people couldn’t say?
Chris: No., no.
Matt: Okay, thanks for doing that. That was all of the questions that I had to ask. I know that some of those questions seem a little bit odd and unusual, but it is important that we do run those screens on everyone we see. It’s not that you’re unique or different or anything like that.
From just going through the questions with you, I’m a little bit concerned I suppose about the pressure you’re under at the moment. It sounds like you’re under a lot of stress. I guess there are a couple of areas there that you do seem concerned about, that seem to be really playing on your mind a bit. You feel like people are out to get you. I mean they’re doing some pretty mean stuff. I’m just wondering whether you would be okay to maybe do a joint visit with a mental health worker, just to talk about some of that stuff in a little bit more detail.
Chris: Is that something we have to do? I mean I don’t really think we’d need to go into it any more than just this thing that you’ve been doing. Did like my answers and stuff, sort of does that make you think that maybe I should?
Matt: I think it’s worth, just as I said before, about just touching base and checking it out, because you do seem like you’re under a lot of stress and you are obviously easily irritated and get wound up pretty quick.
Chris: Yep.
Matt: I guess I’m a little bit worried that it’s putting your CBO a bit in jeopardy.
Chris: Yeah.
Matt: Well enough that the JJ worker and that sort of stuff-
Chris: Yeah. All right, yep.
Matt: It might be worth just doing that.
Chris: Okay. That sounds all right then.
Matt: All right. Well, I’ll make the phone call and we’ll just check out a time when they can come and catch up with you.
Chris: All right.
Matt: We’ll just organize it to be one of the times when you’ve got to come and see me anyway.
Chris: All right. That sounds all right.
Matt: Okay. Thanks, Chris.
