WEEK 2: MENTAL HEALTH ASSESSMENT Flashcards
1
Q
WHAT IS THE MSE? (MENTAL STATE EXAMINATION)
A
- Standardised format for documenting our observations of mental health consumers
- Provides insight into the operation of mental health consumers minds
- Aims to (objectively) uncover the subjective experience of the consumer and to determine the current mental state (focused on a particular moment in time)
2
Q
WHY HAVE FORMALISED MEANS OF ASSESSMENT?
A
- We need standardised, routinely used forms of assessment so that professionals and consumers can work collaboratively with the greatest effect and efficiency
- Standardised instruments and approaches ensure that assessments are thorough, accurate and readily shared within the multidisciplinary team
3
Q
WHEN AND WHERE DO NURSES CONDUCT THE MSE?
A
- Anywhere and anytime
- In the inpatient setting, the MSE is largely integrated into routine nursing interactions/conversations (observations of behaviour, appearance, mood etc)
- In the outpatient setting, the info that informs an MSE can only be gained from the brief interactions that are shared between nurse and consumer
- MSEs can be part of a comprehensive assessment or as a stand alone assessment
4
Q
WHAT DO WE GET FROM MSE
A
- A comprehensive assessment of a person’s social, emotional, relational, behavioural, cognitive and functional wellbeing
- A means to gauge the mental health of the person (what the person is experiencing and how these experiences affect them)
- Info for clinical decision making
- Ongoing MSEs establish a baseline of expectations around an individual’s mental state
5
Q
COMPONENTS OF MSE
A
- Appearance
- Behaviour
- Affect
- Mood
- Speech
- Thought form
- Thought content
- Perception
- Cognition and intellectual functioning
- Insight and judgement
- Risk
6
Q
APPEARANCE
A
- How does the person look/appear
- Observe and document (no judgement or labels)
- Distinctive features (scars, tattoos, wounds)
- Clothing (appropriateness to climate, social appropriateness)
- Hygiene and grooming (clean, unkempt, dishevelled, body odour)
- Build/body type (slight, medium, obese)
7
Q
BEHAVIOUR
A
- What is the person doing? Behaviour and attitude
- Cooperativeness, rapport developed, engagement with interview, response and interaction with health professional
- Body language and gestures, eye contact, posture
- Compulsive behaviours
- Bizarre behaviour (include description)
Psychomotor activity
- Hyperactivity→ Pacing, restless, psychomotor agitation (more movement)
- Hypoactivity→ Slow reactions, psychomotor retardation (less movement)
8
Q
AFFECT AND MOOD
A
- What can you observe about the person’s emotional state and how does the person feel
- Affect→ The outward expression of emotion, observable by others. It manifests in facial expression, voice to tone, body language and posture
- Mood→ A term that describes a pervasive and sustained emotional state, subjectively experienced and described by the individual. It ‘colours’ the individual’s perception of the world
- Generally one has a broad range of affect that changes over time and in response to environmental changes
- Consumers can be asked to rate their mood on a scale of 1 to 10 where 1 is the lowest it has ever been, 10 is the highest
- Terms to describe mood and affect include: dysphoric, flat, elevated, depressed, anxious, labile, restricted, euthymic
9
Q
SPEECH
A
- How is the person talking→ Consider the quantity, quality, rate, volume and tone
- Quantity→ (increases) talkative, pressure of speech or (decreased) poverty of speech, monosyllabic, mute
- Quality: Slurred, mumbled, stuttering, whispered, poverty of content/little info conveyed (even singing)
- Rate: Pressured, rapid, slow
- Volume: Loud, quiet, whispered
- Tone: Monotone, deep, regular
10
Q
THOUGHT FORM
A
- How are the persons thoughts constructed?
- How does the person put his/her ideas together- assessed through persons speech and expression of ideas.
- Amount of thought and rate of production: poverty of ideas, thought blocking, flight of ideas, slow thinking
- Continuity of ideas: Ability to connect ideas/maintain logical order and flow, may not be able to stick to topic of conversation
- Disturbances in language: Using words that do not exist, conversations don’t make sense, disorganisation
- Direction: Is the language goal directed, or circumstantial and tangential
11
Q
FEATURES OD PATHOLOGICAL THOUGHT FORM
A
- Loosening of associations: Loss in the usual structure of thinking, ideas shift from subject to subject in an unrelated or loosely related way
- Circumstantial: Speech is indirect and long winded
- Tangentiality Gives irrelevant or oblique replies to questions, might refer to topic but not a complete answer. E.g. “Did you take your medication today. “Yes I take medication but I exercised after morning tea”
- Thought blocking: Thoughts become absent for a few seconds unrelated to distraction or anxiety and can’t be retrieved
- Flight of ideas→ Person’s ideas are too rapid for them to express, speech is fragmented and incoherent
- Neologisms→ made up words
12
Q
THOUGHT CONTENT
A
- What is the person actually thinking about/ What themes are coming up in their speech
Consider: - Delusions,
- Suicidal/homicidal intent/plan- risk assessment,
- Preoccupations-persistent/repetitive topics
- Obsessions
- Phobias
13
Q
PERCEPTION
A
- How does the person experience the world around them?
- Does the person hear voices, or strange or unusual sounds?
- Observed by behavioural cues and/or person relating their experience
- Sensory misinterpretations or distortions
- Perceptions may be heightened (or dulled), so noises, colours and the environment seem more intense or vivid (how does the person experience/sense themselves in relation to the world around)
- Depersonalisation and derealisation may occur
14
Q
COGNITION AND ORIENTATION
A
- Is the person alert and oriented to time and place, aware of their surroundings, able to concentrate?
- Ascertains basic brain process and cognitive state (thinking) and functioning
- Assessment of consciousness, orientation, memory, concentration, attention, capacity to read and write, visuo-spatial ability and abstraction
- Levels of consciousness/alertness→ alert, clouding, fluctuating, delirium, stupor, drowsy etc
- Abstract thinking→ The ability to understand concepts and juggle more than 1 idea at a time- need to consider the age, and linguistic/cultural background of the consumer
memory→ Immediate/remote - Remote; childhood
- Recent past; e.g. last few months
- Recent: E.g. what was eaten for breakfast that day
- Recall: e.g. immediately repeat the names of 3 objects back to the interviewer and then again after 5 and 15 mins
15
Q
INSIGHT AND JUDGEMENT
A
- How aware if the person of their situation
- Consider the person’s degree of awareness and understanding of the origin of their problem/symptoms and its meaning
- Partial- E.g. Aware of a problem(s) but believes it originates with another who is considered responsible for it
- Absent- No awareness that a problem of a psychological nature exists not originates within the self
- Complete/true- The individual has awareness and understanding of his/her illness
- Acknowledgement of a possible MH problem
- Attributing the symptoms experienced to the illness
- Understanding possible treatment options and a willingness to engage in treatment
