THE MENTAL STATUS ASSESSMENT THE MENTAL STATUS EXAM

THE MENTAL STATUS ASSESSMENT

THE MENTAL STATUS EXAM IN CONTEXT • Part of a comprehensive intake and assessment • Although not a formal psychometric instrument, it is essential • Informs any/all assessment procedures • Can result in a provisional diagnosis (working hypothesis)

THERAPIST APPROACH TO THE MSE • Orient to the task • Establish rapport • Position of therapist • Safety considerations • Combination of therapist skills • Observation • Inquiry • Observation/inquired • MSE in the context of intake/work-up • Record review • Intake paperwork

THERAPIST APPROACH TO THE MSE (CONT. ) Important!! When conducting a MSE, investigate, observe, notate, inquire! Counseling skills and approach are essential Counseling/therapy does not happen during the MSE **see Polanski reading pg. 361

MSE: TYPICAL DOMAINS • Appearance • Behavior/Activity • Mood/Affect • Speech & Language • Thought Processes, Content, Perception • Cognition • Insight & Judgement

APPEARANCE Observation • Grooming • Poise • Clothing (appropriate for weather) • Body-type/nutrition • Age • Presentation of self • Cultural sensitivity essential

BEHAVIOR/ACTIVITY Observed • Quantitative & Qualitative • Looking for: • Psychomotor agitation • Psychomotor retardation • Akathesia

MOOD & AFFECT Inquired/Observed • Mood –subjective report of “the way they feel” • Emotion perceived by client • Affect –How the client presents • Examiner looking for: • Congruence/incongruence • Appropriateness

SPEECH & LANGUAGE Observed • Describe it. . . • Physical characteristics • Relevance to topic • Paralinguistic • • • loudness Rhythm Intonation, phonation Articulation coherence

THOUGHT PROCESSES, CONTENT, PERCEPTION Observed/Inquired Perception • Hallucination or illusions? • Hallucination –false perception without sensory stimuli • Auditory, Visual, Tactile, olfactory • Illusion –misperception of sensory stimuli • Auditory, Visual

THOUGHT PROCESSES, CONTENT, PERCEPTION (CONT. ) Thought & Thought Content • Form of thought –the way in which a person thinks and gets it across • Flight of ideas • Loose associations • Tangentiality

THOUGHT PROCESSES, CONTENT, PERCEPTION (CONT. ) Content of Thought • Description of what the client is actually thinking about, what is inside their head. . . • Delusions, paranoia, suicidal/homicidal • Delusions: fixed false beliefs that are usually not bizarre and therefore believable

COGNITION/ SENSORIUM Observed/Inquired • Alertness, Level of Consciousness • Orientation to time • Orientation to place • Orientation to person Note: distinguish between dementia and disassociation

COGNITION/ SENSORIUM (CONT. ) • Memory • • • Recent Remote Recent past Immediate retention Recall (Don’t forget to check it out)

COGNITION/ SENSORIUM (CONT. ) Concentration & Attention • Serial 7’s or 3’s • Can you spell _______ backwards • Errors in mood disorders

COGNITION/ SENSORIUM (CONT. ) • Check capacity to read/write • Visual spatial ability (complex figure) • Abstract thinking • Fund of information • Impulse control

INSIGHT & JUDGMENT • Insight –refers to the awareness of how one’s own personality traits and behaviors contribute to what is troubling the client • Judgment –process, and formulation that leads to a decision about an appropriate course of action to achieve realistic goals. • Judgments require adequate insight and cognitive functions

UNDERSTANDING THE MSE -BARRY http: //youtu. be/6 ss 827 Lbbt. A

PRACTICE In your groups: 1. Perform a MSE on your client – record it 2. Role play the client/therapist 3. Complete provisional axis diagnosis 4. Begin to choose your assessments