Transcript Assessing Mental State - Charles Darwin University

Assessing Mental State
Or
Looking, Listening and Asking
Mental State Assessment
• Mental state can and does change over
a shift, day or week - important to
document changes
• Brief MSE on all patients, not just those
with mental illness
• Gives indication of person’s thinking
(cognition) feeling (mood) and
behaviour
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Psychiatric Assessment
• Composed of two parts
– history
– mental state assessment (MSE)
• History is static
• previous psychiatric history, medical, personal
including developmental, relationship,
education, employment, social
• MSE changes
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Mental State Assessment
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General Description
Mood
Affect
Speech
Thoughts
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Perceptions
Cognition
Insight
Judgement
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General Description
LOOKING
• Level of Consciousness
– drowsy, alert, sleeping, fluctuating
• Appearance
– grooming, makeup, posture, clothing,
obvious physical deformities or
characteristics
• Behaviour
– eye contact, level of activity, body
language, mannerisms, specific activities
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Mood
ASKING
Affect
LOOKING
• Subjective
• How do you feel?
• How has your mood
been lately?
• How are your
spirits?
• How do you feel in
yourself?
• Objective
• Facial and bodily
expression of mood
state
• Appropriate to
content?
• Range
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Speech - LISTENING
• Physical qualities
– amount, volume, tone, speed, clarity
• Spontaneity
• Impairments
• Accents
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Thoughts
ASKING AND LISTENING
• Form
– amount - poverty, flight of ideas, vague
– continuity of ideas - incoherent, blocking,
circumstantial, tangential, irrelevant
– disturbance in meaning or use of language
- neologisms, word salad
• Content - delusions, obsessions, compulsions,
suicidal ideation, phobias, preoccupations
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Questions to elicit suicidal/selfharm ideation
• How do you feel right now?
• How would you describe your mood?
• Have you thought you would be better off
dead? How strong are these thoughts?
• Have you thought life is not worth living?
• Have you thought of suicide?
• Have you made a plan? If yes do they have
access to means?
• When would you do this?
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Questions to assess
dangerousness
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I can see that you are angry.
Do you feel like hurting someone?
Am I safe with you?
What has made you angry?
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Perceptions
LOOKING, LISTENING,
ASKING
• Hallucinations
– false sensory perception
• any of the senses
• occurs in the absence of a stimulus
• Illusion
– misinterpretation of sensory stimulus
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Cognition
ASKING and LISTENING
• Orientation
– time, place, person, situation
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Memory
Concentration
Attention
MMSE
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INSIGHT
• Are they aware that
they are ill and
understand the
effects and
implications?
• Good, partial or
poor?
JUDGEMENT
• Has patient history
of impulsivity?
• Can they accurately
assess a situation
and act
appropriately in
response?
• Intact or impaired
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Documenting
Use everyday language
Mr Brown has been quiet and withdrawn all
day. He has refused all meals and he said he
couldn’t be bothered to have a shower . He has
stayed in bed facing the wall. When the
wardsman came to shave him, said he didn’t
want to be a burden. When questioned about
his spirits he said they were “pretty low”.
Denied suicidal ideation but said “it would be
better for everyone if he died”.
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Documenting
Miss Smith has been very confused today. She
was upset at breakfast because she thought she
should have been given an evening meal. She
asked when her mother was going to take her to
the shops. She put on her clothes inside out and
kept going through other people’s lockers. She
became angry and attempted to hit staff Told
other patients that there were cameras in the
ceiling. Said the year was 1964
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Mini Mental State
Examination
• Screening tool for cognitive impairment- mild
to moderate
• Does not differentiate between delirium and
dementia
• Used to detect impairment, to follow course
of illness, to monitor treatment response
• Affected by education, intelligence, age,
literacy and culture
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