Mental Status Examination

[ Bipolar Affective Disorder ]

 TEERTHANKER MAHAVEER COLLEGE OF NURSING
Teerthanker Mahaveer University, Moradabad

MENTAL STATUS EXAMINATION

On
“DEPRESSION-(BPAD)”

Submitted to Submitted by

Miss. Luxmi Ms. Amit Das

PG Tutor II [Link] Nursing
Dept of Psychiatric Nursing Dept of Psychiatric Nursing
TMCON, TMU TMCON, TMU

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  Identification Data Of The Patient

NAME : Mr Nadeem

AGE : 22 years

SEX : Male

WARD : Male General Ward

EDUCATION : 10th std.

OCCUPATION : Unemployed

MARITAL STATUS : Unmarried

RELIGION : Muslim

LANGUAGE : Hindi, English, Kannad

SOCIO- ECONOMIC : Middle Class Family

D.O.A. : 17.08.18

DIAGNOSIS : Provisnal Diagnosis: Depression

Final Diagnosis: Bipolar Affective Disorder

CHIEF COMPLAINTS:
 Decreased interaction from one month
 Decreased appetite from past two weeks
 Sadness also from past two week
 Decreased sleep from one week
 Hearing voices from one week
 Fearfulness past three days
 Suspiciousness past three days
 Decreased self-care two days
 Self-harming behaviour past yesterday
 Increased talks yesterday
 Big talks yesterday

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I. History of Present Illness:

Duration: 3 weeks
Mode of onset: acute
Course: continuous
Intensity: increasing
Predisposing factors: not specify.

II. Treatment History:

1. Inj Diazepam 10mg 1-0-1

2. Inj luminal / Phenobarbital10mg 0-0-1
3. Inj Haloperidol 10mg 0-0-1
4. Tab escitalopram 20mg 0-0-1
5. Tab THP 20mg 1-1-0

Past psychiatric and Medical history: In the 1995, he was noticed laughing inappropriately.
He was working in a private company with his 3 friends, one day complaint to his mother of
having physical relationship with his senior when enquired nothing was found. One day he
became nude in the top floor of his house seeing a Female person from another building, then
he showed some aggressive behaviour but was managed with some sedatives.

 Over talkativeness from yesterday, muttering to self is noticed prior to his marriage,
sexual thoughts & talks & then he received a cycle of ECT & is controlled after that.

III. Family History:

Type of family member: Nuclear family.
No of family member: 4 members in his family.
Any psychiatric history in family: There is no history of any medical illness like
cardiac disease, respiratory disease etc or psychiatric illness or suicidal history.

IV. Personal history:

a. Perinatal history:

There is no attendant present with the Patient Mr Nadeem so perinatal data will
not be collected from the patient.

b. Childhood history:

In childhood, Primary caregiver was his mother. There was no presence of any
behaviour and emotional problem. And also there was no significant illness during
childhood like jaundice, accident, respiratory problem etc. I can’t able to collect
history about feeding, age of weaning, developmental milestone because there is
no attendant.

c. Educational History:

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 Age of the beginning of formal education: 6 years
Academic performance: Performance was good.
Extracurricular achievement, if any: He was interested in participating in games
and watching movies and listening songs
Relationship with peers and teachers: Relationship with teachers and peer was
good.
School phobia: Not present.
Reason for termination of studies: There was a history of termination of studies
after 10th std.

d. Play History:

Games play: He used to play cricket, gully danda, Ice Pice a lot with his
playmates
Relationship with playmates: Relationship with playmates is very good along with
play groups and seniors.

e. Emotional problems during adolescence:

Running away from home/ delinquency/ smoking/ drug taking/ any other
(specify):
There is no significant emotional problem during adolescence, according to
patient and informant.

f. Occupational History:

There are no particular occupational history. But now a days He attend bakery
classes in psychiatric rehabilitation services.
g. Sexual and Martial History:

He is unmarried and there is no sexual and marital history.

h. Premorbid Personality:

 Interpersonal relationship: Extrovert

 Family and social relationships: he maintained good relationship with society with
relatives and family members.
 Use of leisure time: Passing time with family and friends, watching T.V, listening
songs and sleeping.
 Predominant mood: mostly cheerful
 Attitude to self and others: he is responsible enough to work as well as being with
other activities.
 Attitude to work and responsibility: He is responsible for his work and do his work
sincerely and obediently.
 Religious beliefs and moral attitudes: He believes in god. He attends in all kind of
Ibadat or ritual function that is held in his colony or near by areas.
 Fantasy life: absent.
 Habit:

Eating: Regular

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 Vegan: Non-Vegan
Bowel/Bladder pattern: Regular.
Sleep: Irregular.

i. Substance abuse History:

 Use of drugs, tobacco, alcohol: There are no history of using alcohol, drugs or tobacco etc.

MENTAL STATUS EXAMINATION

1ST DAY INERVIEW:

I. APPEARANCE
1. GROOMING AND DRESS
Inference: Patient was well groomed and wearing appropriate dress which was
according to the place and season. Hairs are combed properly.

2. HYGIENE
Inference: Hygienic condition of the patient was fair. Patient takes bath every day,
brushes his teeth but did not change his clothes daily. His clothes are cleaned. Nails
are cut properly.
3. PHYSIQUE/BODY BUILT
Inference: Patient is having average built with mesomorph characterstics

4. POSTURE
Inference: Patient is having open posture. He is sitting upright on the bed.

5. FACIAL EXPRESSIONS
Inference: Facial expressions of the patient are normal, they are appropriate,
according to the talks of the patient.

6. LEVEL OF EYE CONTACT

Inference: Patient maintains eye to eye contact throughout the conversation.

7. RAPPORT
N: Namaste Nadeem!

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 P: Namaste!
N: Mein [Link]. (N) ki student hoon. Aaj mein aapse kuj sawaal karungi, jp apke
ilaj aue meri padhai mein meri sahyeta karenge. Kya aap mere se baat
karengi?
P: haan ! boliye.
N: aap kya kar rahe hai
P:Mai abhi magazine pad raha tha.
N:Aaaj ka kya vichar hai apka
P:Abhi toh waise kuch nahi aap suniye?
N: Teacher aane wale hai mere abhi toh padane thodi hi der me.
Inference: A good rapport is maintained with the patient. He took part in the
conversation well and responded to all the questions asked to him by actual
site observation

II. MOTOR ACTIVITY

Inference: Patient is having restlessness level of activity because he was ticking-twiching
his eyes a lot. Unusual gestures or mannerisms are not present.

III. SPEECH
Inference: Patient speaks in Hindi language. Rate of speech is low and He speaks in
softly. His content of speech is appropriate according to the conversation.

IV. EMOTIONS
1. MOOD
N: Kaise ho Nadeem aaj aap?
P: Bas Theek hoon, pehle se behtar mehsoos kar rha hoon.
N:dawai kha li than a kal?
P:hmmm!kha li thi…(with nodding head)
N:aaj maan kaisa hai.
P: aaj toh kafi aacha laga raha hai. Bus ghar jana hai thik hoke jaldi se jaldi.
Inference: Patient is feeling normal and better than before.

2. AFFECT

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 Inference: Patient’s tone of voice is normal and emotional response is constricted
with the speech content.
CONCLUSION (1ST DAY): At my first day interview, I talk about his identification,
illnesses, chief complains, personal history, and observed patient’s general appearance, way
of talking, behaviour and mood and affect. And I fix time for next day conversation.

2ND DAY INTERVIEW

CONVERSATION:

STUDENT NURSE: Good morning Mr. Nadeem

PATIENT’S REPLY: Good morning Brother.

STUDENT NURSE: How are you?

PATIENT’S REPLY: Fine Brother.

STUDENT NURSE: Did you took bath?

PATIENT’S REPLY: yea Brother.

STUDENT NURSE: What is the time of your online bakery class?

PATIENT’S REPLY: 10 o’clock.

V. THOUGHT
1. FORMATION LEVEL
N: Aap kis vajah se yahan par admit huyi?
P: Mere ander bahgwan rehte hai woh mujhe roz bulate [Link]
Inference: Patient’s thought process is illogical and delusion present in the
formation level of patient.

2. CONTENT LEVEL
N: Kya aapko kabhi lagta hai ki log aapke bare mein baat kar rhe hain?
P: Haan bahut se log mere bare mein baatein karte hai.

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 N: Kya aapko kisi cheej se darr lagta hai?
P: Haan, Hetan se darr lagta hai..

Inference: Delusions and phobias are present in patient. Content level of

thought is impaired.

3. PROGRESSION LEVEL
N: Kya koi khayal aapke mann mein baar baar aata hai?
P: Haan, mujhe bhgwan dikhayi dete hain.

Inference: Patient is not able to progress in his thoughts as preoccupied with

thoughts in which he himself has god. He keeps on thinking about his bhagwan.
Progression level of thought is impaired.

VI. PERCEPTION
N: Woh, silati class mein kursi pe kon betha hai?
P: Woh,teacher gi hai.
N: Kya aapko koi ajeeb ajeeb awazein sunayi deti hai Jo kisi aur nhi sunayi deti?
P: Haan, bhgwan bulate hain.
N: Kya aapko koi aysi cheej dikhayi deti hai jo kisi aur nhi dikhayi deti?
P: Haan, bhgwan dikhayi dete hai.

Inference: Patient is not having auditory and visual hallucinations and illusions.
Perception of patient is not intact as He identifies the person near to him.

CONCLUSION(2ND DAY): In my 2nd day conversation, I discussed regarding

his thought, perception, idea, feelings, concept regarding surrounding etc. And I
fix time for my next day conversation. I established rapport and He is very
obedient, behaviour also good, answered elaborately.

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 3rd DAY INTERVIEW:
CONVERSATION:

STUDENT NURSE: Good morning Mr. Nadeem

PATIENT’S REPLY: Good morning Brother.

STUDENT NURSE: How are you?

PATIENT’S REPLY: Fine Brother.

STUDENT NURSE: Have you finish your breakfast?

PATIENT’S REPLY: Yea Brother.

VII. SENSORIUM AND COGNITIVE ABILITY

1. LEVEL OF ALERTNESS/ CONSCIOUSNESS

Inference: Patient is alert and conscious. He is actively listening to all the questions
asked to his but not giving appropriate answers.

2. ORIENTATION
N: Yahan. Hospital mein kaun hai aapke sath?
P: koi nahi.
N: Aap ka ghar kahan par hai?
P: Bangalore mein
N: Aaj kaun si tarik hai?
P: 22.12.2015

Inference: Patient is fully oriented with the person, place and time.

3. MEMORY
(a) Immediate memory after 15 minutes
N: Jo mein 5 no. bolungi dhiyaan se sunana aur phir mujhe batana- 3,6,8,5,10?
P: 3,6,8,5,10

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 Inference: Immediate memory of the patient is intact.

(b) Recent memory

N: Aap hospital mein kabh ayi thi?
P: Pata nhi.
N: Kal raat ko kya khaya tha?
P: Pata nhi

Inference: Recent memory is impaired.

(c) Remote memory

N: Aapki janam tarik kya hai?
P: 15.12.1989

Inference: Patient’s remote memory is intact.

4. CONCENTRATION AND ATTENTION

N: Ek swaal hai, isse solve karo?65+6=?
P: 71
N: Ulti ginti kro 10 se 1 tak?
P: 10,9,8,7,6,5,4,3,2,1.
Inference: Patient’s concentration and attention is good.

5. INFORMATION AND INTELLIGENCE

N: India ka prime minister kaun hai?
P: Narendra modi
N: India ki capital kya hai?
P: Delhi.

Inference: Patient is intelligent and is having good general information.

6. ABSTRACT THINKING

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 N: “Aam kea aam, guthliyon ke dam” se aap kya samjhte ho?
P: pta nahi.
Inference: Abstract thinking of the patient is impaired.

7. JUDGEMENT
(a) Social judgement question test
N: Agar aapke pados mein kahi aag lag jaye toh aap kya karoge?
P: Fire brigade ko phone karungi.

Inference: Patient has logical social judgment.

(b) Personal judgement question test

N: Agar aapko sadak par 500 ka note gira mile to kya karogi?
P: Nhi milega mujhe pata hai.

Inference: Personal judgement of the patient is appropriate

CONCLUSION (3RD DAY): In my last conversation, I come to know about his

cognitive function like orientation, attention, concentration, memory, judgement and also
about the knowledge regarding his disease condition

A. INSIGHT:
Q. How are you?
A. fine

Q. For what reason you came here?

A. I came here because one day complaint of my parents.
Remarks: Grade II. Awareness being sick but due to something unknown in himself.

Conclusion :

Myself Amit Das student of M.S.C Nursing 1st year. I am posted in Psychiatry ward in TMU
Hospital. My patient Mr. Nadeem with diagnosis of BPAD assigned to me. I learned about
this disorder and various psychiatric illnesses and their management and how to deal with

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mentally ill patient. I learnt all these things under the supervision of Miss, Luxmi I learnt
about pharmacology of BPAD patient and also about psychotherapies like family therapy,
behaviour therapy etc. It was a great learning experience for me and I will apply this
knowledge in my future.

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