The Mental Status Examination The Foundation of the Mental Health Assessment

Purpose  Provides an estimate on the quality of client’s functioning

Uses  Estimate functioning to determine need for further testing  Estimate functioning to determine treatment needs  Assess progress when functioning has declined in an emergency situation  Periodically assess insidious decline in functioning (e.g., dementias)  Estimate functioning to determine need for further testing  Estimate functioning to determine treatment needs  Assess progress when functioning has declined in an emergency situation  Periodically assess insidious decline in functioning (e.g., dementias)

Components  Assesses general quality of:  amnestic functions  cognitive processing and intellectual functions  form and content of thought  nature, expression, and appropriateness of affect  adaptive and maladaptive behaviors  Symptoms of psychopathology  Assesses general quality of:  amnestic functions  cognitive processing and intellectual functions  form and content of thought  nature, expression, and appropriateness of affect  adaptive and maladaptive behaviors  Symptoms of psychopathology

What an MSE isn’t  An intelligence test  A detailed memory test  A fully precise measure of cognition, affect, and behavior  An intelligence test  A detailed memory test  A fully precise measure of cognition, affect, and behavior

Prior to testing... Rapport - building is important in order to obtain the client’s cooperation and best effort in responding to the examination

Ways to Conduct a MSE  These components are assessed while interviewing the client about her concerns, circumstances, and history:  Thought form and content  Nature, expression, and appropriateness of affect  Behavior strengths and weaknesses (or adaptive behaviors)  These components are assessed while interviewing the client about her concerns, circumstances, and history:  Thought form and content  Nature, expression, and appropriateness of affect  Behavior strengths and weaknesses (or adaptive behaviors)

Ways to Conduct a MSE  These functions may be assessed informally during the interview, or formally through specific questions and tasks:  Amnestic functions  Cognitive processing and intellectual functions  These functions may be assessed informally during the interview, or formally through specific questions and tasks:  Amnestic functions  Cognitive processing and intellectual functions

The Mini-Mental Status Examination  A brief measure of amnestic and cognitive processing functions, used to  assess short-term changes in mental functioning in hospitals  assess changes in cognitive functioning in emergencies (e.g., injuries on the ball field)  Assess progressive changes in cognitive functioning in long term care settings  Obtain a “snapshot” of client’s functioning in outpatient mental health settings  A brief measure of amnestic and cognitive processing functions, used to  assess short-term changes in mental functioning in hospitals  assess changes in cognitive functioning in emergencies (e.g., injuries on the ball field)  Assess progressive changes in cognitive functioning in long term care settings  Obtain a “snapshot” of client’s functioning in outpatient mental health settings

MMSE  Original MMSE was the Mini - Mental State Examination (Folstein, Folstein, & McHugh, 1975)

MMSE  MMSE assesses:  Orientation  Short, recent, remote, remote memory  Sustained concentration  Executive functions  Recognition  Registration  Sequencing and organization  Comprehension  Perceptual - motor skills  MMSE assesses:  Orientation  Short, recent, remote, remote memory  Sustained concentration  Executive functions  Recognition  Registration  Sequencing and organization  Comprehension  Perceptual - motor skills

Mental Status Scores  Simple scoring system (point per item)  Scores range from  Scores below 24 indicative of dementia or cognitive deficit  Lower scores indicate greater deficits  Scores obtained from small sample of Caucasian males and females from middle US  Simple scoring system (point per item)  Scores range from  Scores below 24 indicative of dementia or cognitive deficit  Lower scores indicate greater deficits  Scores obtained from small sample of Caucasian males and females from middle US

Variations of MMSE  Extended MMSE (John Ashford, M.D.,& Associates, 1992)  St. Louis MMSE (1991)  Solomon “7 Minute Screen” (2000)  All these yield standardized scores  Standardization samples are small and not broadly representative of national population  Samples are not fully culture - fair  Extended MMSE (John Ashford, M.D.,& Associates, 1992)  St. Louis MMSE (1991)  Solomon “7 Minute Screen” (2000)  All these yield standardized scores  Standardization samples are small and not broadly representative of national population  Samples are not fully culture - fair

Comprehensive Mental Status Examination  These more fully assess cognitive- intellectual functions  Include assessment of thought form and content, affect, and behaviors/symptoms  These more fully assess cognitive- intellectual functions  Include assessment of thought form and content, affect, and behaviors/symptoms

Variations of MSEs  Practitioners tend to develop their own versions of comprehensive mental status examinations  As long as the protocol measures the areas typically assessed by these examinations, a wide range of specific items will serve the purposes  Clinicians should avoid using IQ and memory test items in their MSEs  Practitioners tend to develop their own versions of comprehensive mental status examinations  As long as the protocol measures the areas typically assessed by these examinations, a wide range of specific items will serve the purposes  Clinicians should avoid using IQ and memory test items in their MSEs

Assessing Thought Form  Thought form includes qualities of the way a person thinks and speaks  Sample of problems in thought form, reflected in one’s speech:  Circumstantial/tangential thought  Pressured speech  Flight of ideas  Unusual vocal qualities (too loud, soft, trembling)  Agnosia, aphasia, apraxia, echolalia, echopraxia  Organizational/executive deficits  Perseverative speech  Thought form includes qualities of the way a person thinks and speaks  Sample of problems in thought form, reflected in one’s speech:  Circumstantial/tangential thought  Pressured speech  Flight of ideas  Unusual vocal qualities (too loud, soft, trembling)  Agnosia, aphasia, apraxia, echolalia, echopraxia  Organizational/executive deficits  Perseverative speech

Assessing Thought Form  Blocking  Confusion/delirium  Confabulation  Poverty of speech  Flat speech  Blocking  Confusion/delirium  Confabulation  Poverty of speech  Flat speech

Content of Thought  What are pervasive themes or ideas in client’s thoughts, such as:  Hopeless thinking  Helpless thinking  Blaming/abdication of responsibility  Negativistic thinking  (Cleopatra Syndrome (queen of denial)  Positive thoughts  What are pervasive themes or ideas in client’s thoughts, such as:  Hopeless thinking  Helpless thinking  Blaming/abdication of responsibility  Negativistic thinking  (Cleopatra Syndrome (queen of denial)  Positive thoughts

Content of Thought  Content of thought assessment also includes:  Hallucinations (visual, auditory [including command], various others)  Delusions (reference, grandeur, persecution, jealousy, guilt, nihilistic, various others)  Poverty of thought content  Low thought complexity  Content of thought assessment also includes:  Hallucinations (visual, auditory [including command], various others)  Delusions (reference, grandeur, persecution, jealousy, guilt, nihilistic, various others)  Poverty of thought content  Low thought complexity

Assessment of Affect  Range of affect:  Restricted  Dull  Blunted versus flat  labile  Range of affect:  Restricted  Dull  Blunted versus flat  labile

Predominant Affect  Describes the types of affect exhibited during interview, verbal and nonverbal  Can exhibit more than one emotion during examination  Describes the types of affect exhibited during interview, verbal and nonverbal  Can exhibit more than one emotion during examination

Appropriateness and Responsiveness  Assess appropriateness of affect to topics discussed  Is client responsive to encouragement? Levity?  Assess appropriateness of affect to topics discussed  Is client responsive to encouragement? Levity?

Behaviors and Symptoms  Describe behaviors exhibited during the interview  Assess dominant symptoms described by client, even if you don’t observe them  See “Assessment Report” handout for representative symptoms  If needed, survey adaptive behaviors  Describe behaviors exhibited during the interview  Assess dominant symptoms described by client, even if you don’t observe them  See “Assessment Report” handout for representative symptoms  If needed, survey adaptive behaviors

The End  “Ye got all that??”