Nursing Interview and Mental Status Examination

Patient-Centered Nursing Process

-The pt’s goals, ideals, and values central to the nursing process and assessment

-Collaborative caring should promote: Development of pt’s insight/judgement, Autonomy with exception to safety issues

-Nursing process: assessment, nursing diagnosis, prioritization/planning, intervention, and evaluation

MSE: The nurse-client interview

-Gathering data regarding the overall health status of clients with psychiatric disorders (and all patients!) is a critical process

-The primary tool of the MSE is you… the nurse interviewer

-Quality use of therapeutic communication can lead to a fuller assessment

Appearance

-Level of Comfort and Distress

-Dress, Grooming, Hygiene

-Development

-POsture

-Gait

-Remarks/Marks

Attitude

-Assessment of the interactions with the interviewer

-Cooperative, non-cooperative

-Apologetic

-Hostile

-Friendly

-Seductive

-Guarded

-Congenial

-Eye Contact: Note, important in a myriad of disorders

Behavior and Activity

-Behavior: Hypoactivity or hyperactivity; Rigid, relaxed, restless or agitated movements, Facial grimacing, Gestures, Mannerisms, Passive

-Pathological Behaviors: Tremors, Tics, Dystonia, Dyskinesia, Cataplexy, Stereotype/mannerisms, Echopraxia, Combative, Bizarre

Speech

-Quality

-Quantity

-Rate

-Pitch

-Tone

-Volume

Mood and Affect

-Mood: is what the patient says they are feeling. This is the only subjective party of the MSE

-Affect: the observable expression of emotion. It is what you observe

Mood and Affect Incongruity

-Mood/affect incongruity occurs when there is a mismatch between a patient’s reported mood and their observed affect

-Possible Causes: Psychiatric Disorders, Neurologic Conditions, Substance use, Personality Disorders

Thought Process

-Thought process refers to how thoughts are formed, organized, and expressed. It involves the flow and coherence of ideas

-Speed: Thought blocking, Flight of ideas

Organization

-Circumstantial

-Tangential

-Loose associations

-Word salad

Thought Content

-Refers to the themes, ideas, and beliefs that occupy a pt’s mind. It includes the presence of any delusions, obsessions, or preoccupations

Descriptors:

-Logical vs. Illogical

-Abstract vs. concrete

-Magical thinking, Obsessions, Ruminations, Delusions

-Ideas of Reference, Thought Broadcasting, Thought insertion, Thought withdrawal

Perception

-Abnormalities in how one perceives their environment

-Hallucinations: perceptions without an external stimulus. Perception is fully deluded

-Auditory: Hearing sounds or voices that are not present

-Visual: Seeing objects or figures that are not there

-Olfactory: Smelling odors that are not present

-Tactile: Feeling sensations on the skin that are not real

-Gustatory: Tasting flavors that are not there

-Illusions: Misinterpretations of real external stimuli. Perception has no delusions

-Abnormalities in how one perceives their environment:

-Depersonalizations: Feeling detached from oneself, as if observing oneself outside the body

-Derealization: Feeling that the external world is unreal or distorted

Suicidal and Homicidal Thinking

-History: History of suicide attempts, Family history of suicide, Active substance use

-Suicidal Thinking: Specific plan, Availability of means, Absence of protective factors, Rehearsal of suicidal behavior

Judgement

-Ability to assess and evaluate situations, make rational decisions, understand consequences of behavior, and take responsibility for actions

Key Questions:

-Can the pt make sound decisions?

-Do they understand the consequences of their actions?

Insight

-Ability to perceive and understand the cause and nature of one’s own and others’ situations

Key Questions:

-Do they understand their illness?

-Do they have insight into their relationships with others?

Reliability

-Judgement of the accuracy and completeness of the information provided

Assessment Considerations

-Consistency: Is the story consistent over time and across soucres?

-Corroboration: Does it align with reports from family, caregivers, or records?

-Observations: Does the patient’s behavior, mood, and thought process support the reliability of their account?