Mental Status Examination. Behavioral & Cognitive Aspects
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1 Mental Status Examination Behavioral & Cognitive Aspects
2 A key mental health assessment approach grounded within the psychiatric discipline. Definition: It is a method of organising and evaluating clinical observations during an interview. It result in one medium length paragraph describing the client s mental status.
3 Generic MSE content areas: Appearance Behavior/psychomotor activity Attitude toward the examiner Affect and mood Speech and thought Perceptual disturbances Orientation and consciousness Memory and intelligence Reliability and judgement
4 Individual and cultural considerations It is imperative to keep in mind the many ways individuals vary in their behaviour and abilities. Normal behaviour within one culture may appear disturbed or irrational within another culture.
5 Guidelines to avoid generalisation When you spot a single symptom or client feature of particular interest begin the scientific mindedness process. Remember that hypothesis are hypotheses and not conclusions; that is why hypothesis require additional support. Dont make wild inferential without first consulting colleagues and supervisors. It is easier to become confident and make inappropriate judgements when working in isolation.
6 Appearance Appearance in a MSE focuses on physical characteristics: Grooming, dress, makeup, facial expressions, weight/ height, body piercing/tattoos Ex. Bright, colourful clothes mania Stooped posture, leaning forward depression
7 Behavior and Psychomotor Activity Behavior and psychomotor activity focuses on physical movement: Excessive or limited movement, eye contact and eye movement, grimacing or fidgeting, gestures, posture Ex. tremor, restless appearance, lip smacking drug side effects
8 Attitude toward examiner Attitude toward examiner in a MSE refers to how the client behaves toward the interviewer. Examples include; aggressive, cooperative, guarded, hostile, impatient, indifferent, manipulative, negativistic, open, seductive, suspicious
9 Affect and Mood Affect and mood refers to moment to moment emotional tone as observed by the interviewer and the client s subjective and self reported mood states. Affects is observed by the interviewer and usually judged in terms of content, range/duration, appropriateness, intensity. Mood is reported by the client; lasts longer, changes lass spontaneously; normal mood, lowest mood in the last two weeks, highest mood in the last two weeks.
10 Affect and Mood 1. Affective content Sadness, euphoria, irritability, fearful, anger, guilty, remorseful, happy, joyful, ashamed, anxious
11 Affect and Mood 2.Affective range and duration Stable X Labile; mania, hysterionic Flat; severe depression, schizophrenia, Parkinson Blunted; emotional response under the surface, but displayed in a restricted manner Constricted; compulsive personality
12
13 Affect and Mood 3.Affective appropriateness Appropriateness with speech content and life situation La belle indifference; conversion disorder, somatization, dissociative disorders
14 Affect and Mood 4. Affective intensity/depth Mutluyum çünkü gülümsüyorum.
15 Speech and Thought Speech is evaluated on the basis of rate (speed), volume (loudness), amount (density). Thought is evaluated in terms of both process and content.
16 Speech and Thought (Speech) Rate: normal, very slow, rapid, pressure of speech Flow: spontaneous, stuttering, speak only on questions Also volume, amount, tone (fluctuations or monotonous), coherence, relevance
17 Speech and Thought (Thought Process) Blocking (sudden stops) Circumstantiality (too much detail) Clanging (combining unrelated words due to similar sounds) Korktuğum zaman, aman, saman, yaman Loose associations Mutism Neologism (invention of new words) Perseveration Tangential speech Sizi seviyorum. Geçim hayatın bir görevi. Sizi kilisede görüyor muyum?
18 Speech and Thought (Thought Content) Thought content descriptors indicative of psychopathology primarily include: Delusions (persecution, grandiosity, paranoid, somatic, reference) Obsessions (about illness, plans, recurrent ideas of suicide, persistent, irrational fear)
19 Perceptual Disturbances Percetual disturbances include hallucinations, illusions and flashbacks Hallucinations may occur in any sensory modality but are mostly auditory. Illusions have some bias on reality. Flashbacks consist of sudden and vivid recollections of previous experiences Asking about perceptual disturbances Help the patient feel comfortable sharing info Uncovering topic associated with delusional beliefs Determine client s insight and distance from the symptoms
20 Orientation or Consciousness Orientation and consciousness refers to a client s awareness of his or her self and situation. Orientation of the clients are evaluated in terms of self, place, time, situation. Consciousness of the clients; alert, confused, clouded, stuporous, unconscious, comatose
21 Memory and Intelligence It can be risky to assess Memory and Intelligence in a short interview. Memory; remote, recent, immediate, episodic, semantic, skill working memory Confabulation; fabrication or distortion of the memories Pseudodementia; emotionally based memory problems
22 Memory and Intelligence Intelligence Education level, language comprehension, responses to knowledge questions, response to abstract thinking questions, questions to social judgement abstract thinking questions: similarities btw similar looking objects, meaning of simple proverbs
23 Reliability, Judgment and Insight Reliability refers to a client s credibility or trustworthiness. Judgement involves client ability to make constructive or adaptive choices. - what patient do when neighbour s house is on fire Insight refers to the client s understanding of his/her problems. complete denial, slight awareness, awareness of being sick but blaming others or external factors, awareness that illness is due to something unknown, intellectual insight, true emotional insight
24 When to Use MSE MSEs are more appropriate as the client s suspected level of psychopathology increases. MSEs must be used with great caution with culturally diverse populations. If clients are getting help on an outpatient basis for problems associated with daily living, MSE is less important. As in all evaluation procedures, client culture background, age, significant events and other identity and situational factors should be considered and integrated into evaluation reports
25 Mental Durum Muayenesi Raporu Gary Sparow, 42 yaşında, beyaz bir erkektir; hastanenin acil servisine geldiğinde dağınık ve bakımsız olduğu rapor edilmiştir. Görüşme süresince heyecanlı ve huzursuz bir tutum sergilemiş, sıklıkla koltuk değiştirmiştir. Değerlendiriciyle iletişiminde sabırsız ve bazen kaba olduğu görülmüştür. Bay Sparow, bugün hayatının en mutlu günü olduğunu çünkü profesyonel golf ligine katılmaya karar verdiğini bildirmiştir. Duygulanımı, değişkendir fakat konuşmasının içeriği ile tutarlıdır. Konuşması yüksek sesli, baskılı ve fazla detaylıdır. Düşünce uçuşmaları olduğu ve düşünceler arası bağlantıları kaybettiği görülmüştür. Atletik performansı ile ilgili büyüklük sanrıları tanımlanmıştır. İşitsel halüsinasyonlar rapor etmiştir (Tanrı ona işi bırakmasını ve profesyonel bir golfçü olmasını söylemiş) ve atletik ve cinsel başarıları konusunda takıntılıdır. Zaman ve yer yönelimi vardır ancak Arnold Palmer in gayri meşru oğlu olduğunu iddia etmektedir. Bay Sparow yargılamada zayıflıklar sergilemektedir.
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Author(s): Rachel Glick, M.D., 2009 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Noncommercial Share Alike 3.0 License: http://creativecommons.org/licenses/by-nc-sa/3.0/