Mental Status Exam Flashcards
what is the purpose of the mental status exam
- to assess the psychological, emotional, social and neurological functioning of the patient
- objectively describe the behaviours, thoughts, feelings and perceptions of the patient thru out the interview
How is the MSE done?
- during the interview (woven in)
- gather objective data (only from me) & subjective from patient
When is the MSE done?
- during initial assessment
- throughout treatment process to establish changes in baseline, response to treatment
- when behavioural changes are evident
- after an event to injury that may impact mental status
- all the time!
what are the 9 components of an MSE
- appearance & behaviour
- mood & affect
- speech
- thought form/process
- thought content
- perception
- cognition
- insight & judgement
- risk assessment
what is included under “appearance”
- Sex (M/F/NB/Trans etc)
- apparent age
- height/weight
- ethnicity/race
- grooming/hygiene
- distinguishing features
- eye colour, hair colour & length
what’s included under “behaviour”
- psychomotor retardation or agitation
- hyperactivity, restlessness, repetitive movements
- eye contact (prolonged, intense, minimal etc)
- attentiveness
- mannerisms, gestures
- general attitude (uncooperative, withdrawn etc)
- attitude towards interviewer (neutral, positive etc.)
what’s included under “mood”
- subjective data
- “how are you feeling today?”
- “is there any pattern to these mood changes?”
what’s “affect”
- objective data
- elated, bright, animated
- blunted, flat, downcast
what does blunted mean
little emotion
what does flat mean
no emotion (schizophrenia/negative symptoms)
Affect not congruent with mood can indicate
= negative symptom of psychosis, or can indicate what someone is dealing with internally/internalizing feelings
what’s “speech”
- objective data
- rate of speech
- volume/tone
- characteristics: accent, language
- ## response time (latency?poverty of speech?)
what is meant by “thought form/process”
- objective and subjective data
- determined by the flow of conversation and quality of thoughts
- “how” the person is thinking
- determined by speech and how they describe thinking
- e.g., logical, organized, goal directed vs. illogical, disorganized, racing thoughts etc.
what is “thought content”
- objective and subjective data
- “what” the client is thinking about
- looking for: bothersome thoughts, symptoms of psychosis, delusions, phobias or obsessions
what are delusions
thoughts or beliefs (i.e., paranoia, grandiosity etc)
what are hallucinations
5 senses: experiencing things that are/aren’t there
- auditory
- visual
- gustatory
- olfactory
- somatic/tactile
what are Illusions
different from hallucination as an illusion is a misrepresentation of an object that exists (e.g., interpreting pen as a snake = illusion; hallucination = seeing a snake when nothing is there)
what is “perception”
- objective and subjective data
- hallucinations
- command hallucinations
- illusions
- objective data: responding to internal stimuli?
- assess the content of hallucinations
“cognition” or cognitive functioning
- objective and subjective data
- MMSE
- level of arousal
- orientation
- concentration & attention
- memory (short & long term)
- intellectual capacity/knowledge
- abstraction/concrete
what is “insight”
- awareness of situation, context
- recognition of illness, need for help
- understanding of factors contributing to illness
- motivation to work on identified problems
- understanding of what you should or shouldn’t do
- stated as “full, partial, limited, impaired or no”
what is “judgement”
- the behavioural manifestation of insight
- the process one uses to reach a decision or take action
- ability to consider the pros and cons of decisions/choices
- “poor judgement” may be demonstrated by impulsivity, engaging in actions with damaging consequences
if someone knows they have an addiction that is negatively affecting their life but they continue to use drugs every day they have what kind of insight / judgement?
good insight but poor judgement
what is included under “risk assessment” (self)
- risk assessment to themselves: self harm or suicide (assess for both)
- considers suicidal thoughts, plan, intent, means, impulsivity, risk and protective factors
- inform level of risk (low, moderate, high)
what are examples of suicide risk factors
- age
- sex (women more likely to try, men more likely to follow thru)
- hx of psych disorder
- current psych diagnosis
- characteristic symptoms e.g., hopelessness, depression, guilt etc.
- previous hx of suicidal behaviour
- hx of abuse/trauma
- substance use
- situational risk factors/life stressors
- family hx of suicide & psych disorders
- living alone
- social relationship problems
- access to lethal means
-physical health issues
what are examples of suicide protective factors (individual & work)
- individual factors = strong sense of competence, & purpose, effective interpersonal skills, problem solving skills, adaptive coping skills, self understanding, optimistic outlooks, religious affiliation
-work factors = sense of accomplishment, positive peer support, supportive work environment, core values, access to employee assistance programs
what are examples of suicide protective factors (family & community)
- family = sense of responsibility to family, relationships characterized by warmth and belonging
- community = opportunities to participate, affordable accessible resources, hope for future, community self determination and solidarity
what are the suicide levels of risk
non-existent, mild, moderate, high, imminent
what is included under “risk assessment” (others)
- thoughts of harming or killing others
- plan/intent to harm others
- means to harm others
- hx of violence
- substance abuse
- psychotic processes
