week 5 response

REsponse 1

Thank you for your thorough MSE presentation. We both found the patient to be had blunted/flat affect and a depressed/dysphoric mood. I like how you added the element of anhedonia and vegetative symptoms because she did discuss her sleep and appetite changes. We both found the patient’s thought process logical and coherent with ideas flowing into one another. I added information about Thought Content because I felt that this was where the patient revealed a lot of information about her state of hopelessness and sadness; she expressed much guilt over past events, and I thought her statements of self-derision and fear of making poor future choices revealed a lot about her thought content. Her internally driven attitudes and behavior reflected intropunitive thoughts of self-derision; punishing herself for unwanted events even if she is not responsible (Wheeler, 2020). These intropunitive thoughts are associated with depression. I think her intropunitive statements also speak to her maladaptive coping mechanism; she is isolating herself, punishing herself and blaming herself for her problems (Carlat, 2021). I agree with your comments about catastrophizing where she is dramatically predicting that she will continue to make the worse decisions. It seems that she would really benefit from cognitive behavioral therapy where she will take a long look at her thoughts patterns and tease out which thoughts are unproductive and do not represent truth and form skills to reshape more positive productive thinking (Rush, 2020).

References

Carlat, D. J. (2021). The Psychiatric Interview. Fourth Edition. Lippincott, Williams & Wilkins.

Rush, J (2020). Unipolar major depression in adults: Choosing initial treatment. https://www-uptodate-com.regiscollege.idm.oclc.org/contents/unipolar-major-depression-in-adults-choosing-initial-treatment?search=cbt%20depression&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

Response 2

Thank you for sharing your mental status exam. Completing a mental status exam is an important skill for any psychiatric nurse practitioner and requires practice to master (Andres et al., 2020). A mental status exam assesses the client’s mental functioning and assesses for signs of a mental illness (Boland et al., 2021). The important components of a mental status exam include general appearance, behaviors, attitude or GABA, mood, affect, speech, thought process, thought content, insight and judgement, and cognition (Carlat, 2016). I utilized the same video to complete the assignment. I thought the client looked slightly disheveled as it looked like her hair was in her face or possibly not brushed. However, I agree with the rest of your GABA assessment. Our assessment of mood was very similar and accurate. I thought your description for affect and speech were more descriptive. I did not include flat or sluggish affect which is appropriate for this assessment. I also did not include latent speech. I also left out repetitive sentences and preservation of thoughts for thought process which I agree with as well. Our thought content and insight were similar and accurate. I originally put good judgement or ability to make reasonable decisions, however after reviewing your assessment I agree that her judgment could be impaired due to her depressed mood. Overall, I thought you did a great assessment and I learned more about a mental status examination after comparing our answers.

References

Andrés Martin, Asaf Jacobs, Robert Krause, & Doron Amsalem. (2020). The mental status exam: An online teaching exercise using video-based depictions by simulated eatients. MedEdPORTAL, 16. https://doi.org/10.15766/mep_2374-8265.10947

Boland, R., Verduin, M., & Ruiz, P. (2021). Kaplan & Sadock’s Synopsis of Psychiatry (12th ed.). Twelfth Edition. Wolters Kluwer.

Carlat D. J. (2016). The Psychiatric Interview (4th ed.). Lippincott, Williams, & Wilkins.