Obj 2: Mental Status Exam (MSE)

What is a MSE?

-It is equivalent to the physical examination in medicine

-Its a critical tool used to assess and evaluate the clients current mental, psychological, emotional, social and neurological functioning

-It reflects the interviewers observations, and impressions at the time of interview and is used in a variety of setting to determine clients mood and how they are feeling

-May have to do MSE multiple times

-Current well being of client

why is the MSE significant?

-Aids in collecting and organizing objective data at the time of the interview

-Helps determine the client's abilities strengths capabilities and need for support

-Provides an overview, guidelines, and direction in determining the plan of care (treatment, referrals, etc) for the client and their needs

-Mental status varies over time

Factors influential in completing the MSE

-ability to participate or give feedback

-physical health

-emotional well being

-ability to communicate

-culture

-the interviews approach

9 Components of the MSE

general appearance and behavior

appearance, movements, facial expression, eye contact and attitude

appearance

looks stated age, height, weight, grooming, hygiene, teeth, clothing, visible characteristics-scars, tattoos, piercing, glasses, hearing aids

movements

posture, gait, coordination, pacing mannerism, gestures (tics, tremors)

facial expression

relaxed, tense, smiled

eye contact

makes or avoids contact

attitude

towards interviewer (hostile, shy, suspicious, cooperative)

speech

how does the client speak?

-rate, quality, quantity, volume

note: mumbling, impediments, accent, consider education

rate of speech

slow, rapid, pressured, fast

quality of speech

coherent

-Can you understand the client?

-Do they speak with ease?

Quantity of speech

amount (talkative, poverty of speech, do they answer slowly/quickly?)

volume of speech

soft, loud, high-pitched voice

mood/affect

what the client says about their current emotional state "In their own words"

-Ask: How are you feeling?

-How would you describe your mood? (good, miserable, sad, anxious, angry)

-Euthymic

-Euphoric

-Dysphoric

Suicidal/homicidal ideations

Euthymic

normal mood

Euphoric

elated mood

Dysphoric

depressed mood

Affect

Based on your observation of the client's emotional response. You observe/note the client's facial expression and behaviors

-Range

-Intensity

-Appropriateness

Range

full:emotions are consistent with stated feelings, congruent with certain situation

Constricted: little outward expression

Intensity

blunt (little to no emotional reaction)

Flat affect-almost absent

Labile-not in control of emotions bipolar)

Appropriateness

consider the meaning of an event/culture, appropriate expression for the event (bipolar)

suicidal and homicidal ideation

-Suicidal (self) and homicidal (others) ideation

-Any thoughts or intents to harm self or others

-Any plans to hurt self or others

-Plans (clear or unclear)

-Lethality (how?)

Documenting: appropriate terms (died by suicide)

thought formation

thoughts are not directly observed; however are assessed in terms of process (formed) and content

because we obviously cant see peoples thoughts

thought process

ASK: Are the client's comments logical and presented in an organized manner?

It entails the way thoughts are formed and expressed

-Relevance

-Organization

-Flow of conversation (logic)

-Goal-directed

what are some types of alterations of speech that include difficulties with the thought process?

-Circumstantiality

-Tangentiality

-Flight of ideas

-Word salad

-Clang association

-Echolalia

-Thought blocking

-Neologism

-Preservation

-Loosening of association

cirumstantiality

Provides excess unnecessary information and details but eventually makes a point (beat around the bush, common in bipolar disorder)

tangentality

Diverts from the main topic of discussion/question and "goes off on tangent" (a person is asked if they have a good appetite and may respond, "I eat when I'm hungry" they do not respond specifically to the question and never reach an intended point

flight of ideas

jumps from one topic to another ( a connection between topics exists but may be difficult to identify) commonly seen in mania e.g. like the color blue, do you feel blue? feelings change everyday, its a nice day. (all over the place-common with bipolar and mania)

Word Salad

incoherent mixture of words/phrases that has no meaning together (exhibited in schizophrenia) to listener (charts pile swim red)

Clang association

words with similar sounds but are not associated in meaning (blue, shoe, sue), unsure if its related to a disease or behavior

Echolia

parrot like repetition of overheard words or phrases (ASD)

thought-blocking

sudden cessation of a thought mid sentence; client is unable to continue the train of thought, may take a while for the client to come up with an answer

Neologism

made up words created by an individual that only has meaning for the individual (schizophrenia disorders) "I bawked the whole idea"

Perservation

individual gives the same verbal response to various questions (cog. impairment disorders), "Yes yes yes"

Loosening of association

-illogical and confused thinking

-interrupted connections in thoughts

-No logical relationship between thoughts/ideas

-Disconnected phrases and topics

Thought content

-What the client is thinking about? (ideas, beliefs, preoccupations and obsessions)

-Is there evidence of:

-Delusional ideas-fixed false belief not true to fact

-Obsessional ideas: insistent thought (OCD) keep going over and over in your head

-Phobias: irrational fear

-Suicidal/homicidal ideations

Delusions

are false fixed beliefs based on an incorrect inference about reality; not shared by others; cannot be corrected by reasoning; thus interferes with thinking and reality

Delusions of persecution

belief that one is being harassment or threatened by others

delusions of grandeur

belief one is super important and has great powers ex: client thought they were part of the royal family

somatic delusions

client has false belief that their sick

Delusions of jealousy

paranoia that your partner is cheated on

religion delusions

superior being

Thought broadcasting

belief that one's thoughts are being broadcast (others can hear what one is thinking)

Ideas of reference

client believes that certain situations relates specifically to them when do they not (A TV personality is specifically referring to the him/her)

Perceptions

-Taking in sensory information from one's surroundings/environment and processing this into mental representations. It is the way an individual views himself, the environment, and relationships to others in that environment

-Perceptual disturbances associated with mental illness are hallucinations and illusions

What are hallucinations

Sensory perception not associated with external stimuli and are not shared by others

-there are visual, auditory, olfactory, gustatory and tactile

Illusions

are misperceptions or misrepresentations of real sensory stimuli

-e.g., when vacuuming the floor, you could swear the phone/doorbell rang

-e.g., Piece of wool on clothing may be perceived as an insect (As you get closer you realize the difference)

what does Sensorium and Cognition evaluate?

-Level of consciousness

-Orientation

-memory (immediate or short term, recent, or history events)

-Concentration and atention

-Abstract reasoning (proverbs, similarities)

What tasks would you use to assess someones level of consiousness

alert, responsive, confused, delirious

Is the client easily aroused? Can they focus on your question?

Orientation

persons name and DOB

Place

ask them where they are, time (date, month, season, year)

memory

Remote (long ago)-birthplace

Recent (what client had for breakfast)

Immediate or short term (list 3 words and recall them in 5 mins time)

Concentration and attention

ask client to spell the word "WORLD" backwards or count down from 20 in increments of 3

-Can they perform simple addition, and multiplication? (At their level of education)

Comprehension-abstract reasoning

how are apples/oranges similar/different?

Higher functioning interpretation

ask the client to interpret a proverb

ex: "Rome wasn't built in a day"

Insight

-Persons ability to examine ideas, thoughts and feelings, solve problems and think abstractly

-Extent to ones understanding of illness

"What lead to you admission to hospital"

Judgement

One's ability to reach a logical decision about a situation after reviewing/contemplating options or possibilities. What would you do if you found a wallet? What would you do if a picked up someone cell phone?

Suicide

-Inquire about suicidal and homicidal ideation

-Frequency-how often do the thoughts occur?

-Intent- do you wish to die, is there intent to die?

-Plan- is there a plan? Is it vague or specific?

-Lethality (how violent)

-Means to carry it out (gun, meds)

-Opportunity to carry out plan

MMSE

Mini-mental status exam

-used to measure cognitive impairment (dementia)

-MMSE is a 30-point questionnaire which is used to measure cognitive impairment

-It is a brief test that is used as a means of quantifying cognitive impairment and decline

-MMSE takes approx. 5-10 mins and examines functions as:

-Attention and recall

-Recall

-Language

-Ability to follow simple commands and orientation

how do you examine a child/adolescent?

-Note the child's appearance, and behaviors (posture, tone of voice, eye contact mannerisms)

-Level of activity

-Difficulty focusing, answer questions

-Interactions/impulsive behaviors

-Listen for sentence structure/vocab

-Ability to connect with nurses? Is the child interested or disinterested?

-Speech: rapid, slow (depression, psychosis, anxiety)

-Young children: may shift from topic to topic; however teens should continue one train of thought