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 the 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

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