Scenario 4

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1. Mental Status Findings
2. Preferred Diagnosis
3. Management Plan
4. Watch Video Discussion

Mental Status Findings

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MODEL ANSWERS

Behaviours and Appearance:

Nigel is a young European man in his 20’s who was neatly presented, clean and wearing a blue shirt. There was good rapport. He was cooperative through most of the interview but became slightly irritated with some of the questions. There was minimal blinking. He also appeared to be staring at the doctor with not much spontaneous movements of his face or his limbs.

Orientation and Cognition:

He was oriented to place, date and person. Though not formally assessed, his cognition appeared intact.

Affect and Mood:

Affect was limited in range and reactivity. He had limited facial expression. Mood was subjectively reported as “fine”. Objectively, mood was frightened and dysphoric.

Thought Form:

He was logical and coherent. He did not have formal though disorder.

Speech:

He had normal volume, rate and rhythm. It was not pressured. However, his pitch did not vary much and sounded monotonal.

Thought Content:

Nigel experienced several delusions. He had bizarre delusions involving Microsoft and Bill Gates wanting to control the world using nanobots. These nanobots penetrated humans through the skin, food or drink. He had delusions of control. He believed that the nanobot was attempting to control his thinking. The nanobot was releasing toxins to his face causing it to rot. This is a form of somatic delusion.

Perceptual Disturbances:

The voice from the nanobot sounded like Bill Gates. It was initially in his right ear. Later, the voice was all over his head. Initially, the nanobot was telling him that he is a “good person”. It also told him to wash his hands. Later it was telling him that he was worthless and that he needed to die. If he did not kill himself, he will be killed by it. The voice became louder when he was near cars. It screamed at him to hurl himself in front of a car. He also had a form of tactile hallucination. He felt that his right cheek was becoming numb. There was no evidence for visual, gustatory or olfactory hallucinations.

Insight and Judgment:

Nigel had no insight into his condition. Judgment was poor as evidenced by his decision to drive a drill bit into his ears causing them to bleed. He showed good judgment by seeking assistance with the doctor regarding his situation.

Safety Concerns:

Though he did not want to end his life, he had a high risk of injuring himself seriously. He was also quite desperate in his situation. There was no evidence that he wants to harm others, though these should have been asked further. Questions about wanting to strike against the corporation should have been pursued.