Transcript Mental Status Examination

Dr. Joanna Bennett
Psychiatric Nursing Assessment
 Central component is the patient/clinical
interview
 Psychiatric evaluation – Psychiatrist
 Psychiatric assessment within nursing
process as model of care – nurse
 Begins with 1st contact
 Based on establishing rapport/trust –
therapeutic relationship
Psychiatric Nursing Assessment
 History of present illness
 Past psychiatric history
 History of substance use
 Medical history
 Development, psychosocial, socio-cultural
 Occupational
 Family history
Psychiatric Nursing Assessment
 Legal history
 Review of systems
 Physical examination
 Mental Status Examination
 Diagnostic tests (psychiatric evaluation)
 Clinical formulation
 Diagnosis
 Care Plan
Mental Status Examination
 Mental 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 Examination
 The purpose of the MSE:
 to obtain evidence of symptoms and signs
of mental disorders
 danger to self and others
 information on the patient's insight,
judgment, and capacity for abstract
reasoning
Mental Status Examination
 Signs 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 Examination
 MSE is conducted in the manner of an
informal enquiry
 using open and closed questions
 structured tests to assess cognition
Information is usually recorded as freeform text using standard headings
Appearance & Behaviour
 Includes 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 malnutrition
 needle track marks - drug abuse
Mental Status Examination
 MSE is used, together with the psychiatric
history, to generate a diagnosis, and a
treatment plan.
Appearance & Behaviour
 General behaviour
 Level of distress
 Degree of eye contact
 Attitude 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 activity
 Presence of gait abnormalities
 Purposeless, repetitive unusual posture or
movement
 Tremors, akathisia, dyskinesias
 Catatonic posturing
 Echopraxia (imitating others movements)
Speech
 Rate, Rhythm, Volume, Amount etc.
 Poverty of speech
 Mutism
 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 & Affect
 Mood – internal, subjective sustained
 Depression, hypomania, dysphoria
 Affect – externally observable, changeable
 Intensity, stability, appropriateness
 Euphoria, anger, sadness
 Blunted (reduction) , flat (absence)
Thought processes
 Flow of ideas
 Vagueness
 Incoherence
 Circumstantiality – excessive or irrelevant
details
 Tangentiality – oblique, irrelevant
 Word salad – words & phrases lack
comprehension
Thought content
 What the person is actually thinking (Ideas
& beliefs)
 Suicide/homicidal
 Delusions (content and effect)
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Grandiose
Persecution
Religious
Control
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.
Perception
 Hallucinations perception absence of external
stimulus
 Any 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
Cognition
 Level of Consciousness

 Orientation - person, place, time situation
 Concentration
 Memory
Insight
 Awareness of problems and their
implications
 Recognition of illness and benefits of
treatment
 Motivation to change - ambivalence to
commitment
Judgement
 Capacity to make sound, reasoned and
responsible decisions
 use of standard hypothetical questions
 More useful to relate to person’s own selfcare, recent/current situation or
behaviour
 http://www.youtube.com/watch?v=NVRP9Umpz4M&
feature=em-share_video_user