Mental Status Examination

Dr. Joanna Bennett

Psychiatric Nursing AssessmentCentral component is the

patient/clinical interviewPsychiatric evaluation – PsychiatristPsychiatric assessment within nursing

process as model of care – nurseBegins with 1st contactBased on establishing rapport/trust –

therapeutic relationship

Psychiatric Nursing AssessmentHistory of present illnessPast psychiatric historyHistory of substance useMedical historyDevelopment, psychosocial, socio-

culturalOccupational Family history

Psychiatric Nursing AssessmentLegal historyReview of systemsPhysical examinationMental Status ExaminationDiagnostic tests (psychiatric evaluation)Clinical formulationDiagnosisCare Plan

Mental Status ExaminationMental status examination (MSE) is a core

skill of mental health practitioners.

A key part of the initial psychiatric assessment

Entails systematic collection of data based on observation of the patient's behavior while the patient is in the clinician's view during the interview.

Mental Status ExaminationThe purpose of the MSE:

to obtain evidence of symptoms and signs of mental disorders

danger to self and othersinformation on the patient's insight, judgment, and capacity for abstract reasoning

Mental Status ExaminationSigns and symptoms must be those

present at the time of the interview

MSE is used to inform decisions about treatment strategy and an appropriate treatment setting

Mental Status ExaminationMSE is conducted in the manner of

an informal enquiry using open and closed questionsstructured tests to assess cognition

Information is usually recorded as free-form text using standard headings

Appearance & BehaviourIncludes apparent age, height,

weight, and manner of dress and grooming

Body type, Posture, Hair and nails Colorful or bizarre clothing unkempt, dirty clothes signs of malnutritionneedle track marks - drug abuse

Mental Status ExaminationMSE is used, together with the

psychiatric history, to generate a diagnosis, and a treatment plan.

Appearance & BehaviourGeneral behaviourLevel of distressDegree of eye contactAttitude towards the interviewer

Appearance & Behaviour

“Mr Y presents with good self-care and grooming. He was courteous and respectful throughout interview”

“Ms X is a 40 year old female looking older than stated age who was disheveled and malodorous at time of interview. She had a stooped posture and maintained poor eye contact”

Motor activity Level of psychomotor activityPresence of gait abnormalitiesPurposeless, repetitive unusual

posture or movementTremors, akathisia, dyskinesiasCatatonic posturingEchopraxia (imitating others movements)

SpeechRate, Rhythm, Volume, Amount etc.

Poverty of speechMutism Flight of ideas – accelerated with abrupt changes of topic

Pressured speech - rapid, accelerated, frenzied, jumbled and cluttered

http://www.youtube.com/watch?v=9Hpz-9rwuqA&feature=em-share_video_user

Speech

“ Mr Y’s speech was of normal rate, quality and form”.

Miss X’s speech was pressured and over inclusive when answering

Thought blocking appeared evident during the conversation with John

Mood & AffectMood – internal, subjective sustained

Depression, hypomania, dysphoria

Affect – externally observable, changeableIntensity, stability, appropriatenessEuphoria, anger, sadness Blunted (reduction) , flat (absence)

Thought processesFlow of ideas

VaguenessIncoherenceCircumstantiality – excessive or irrelevant details

Tangentiality – oblique, irrelevant Word salad – words & phrases lack comprehension

Thought contentWhat the person is actually thinking

(Ideas & beliefs)Suicide/homicidalDelusions (content and effect)

GrandiosePersecutionReligiousControl

Thought content“ Mr X described feelings of being followed and being under surveillance. He stated that Digicel had implanted two microchips into his brain through which they could monitor his thoughts. According to Mr X’s Mother he had locked himself in his room for days and would only come out for meals”.

“Mr Y stated that he was Jewish (according to family this is not the case), and that he was going to sail to Israel to lead the people in the liberation of their homeland.

PerceptionHallucinations perception absence of

external stimulusAny of the senses (Gustatory, Visual,

Olfactory, tactile) Auditory - most common voices

third person - running commentary on the patient’s actions

Second person – talking to the patient

CognitionLevel of Consciousness Orientation - person, place, time

situation

Concentration

Memory

InsightAwareness of problems and their

implications

Recognition of illness and benefits of treatment

Motivation to change - ambivalence to commitment

JudgementCapacity to make sound, reasoned

and responsible decisions use of standard hypothetical questions

More useful to relate to person’s own self-care, recent/current situation or behaviour

http://www.youtube.com/watch?v=NVRP9Umpz4M&feature=em-share_video_user