1. Assessing Mental State
March 2002
Assessing Mental State Or
Looking, Listening and Asking
J Bryant NMMH

2. Mental State Assessment
Assessing Mental State
March 2002
Mental State Assessment
Mental state can and does change over a shift, day or week - important to document changes
Brief MSE on all patients, not just those with mental illness
Gives indication of person’s thinking (cognition) feeling (mood) and behaviour
J Bryant NMMH

3. Psychiatric Assessment
Assessing Mental State
March 2002
Psychiatric Assessment
Composed of two parts
history
mental state assessment (MSE)
History is static
previous psychiatric history, medical, personal including developmental, relationship, education, employment, social
MSE changes
J Bryant NMMH

4. Mental State Assessment
Assessing Mental State
March 2002
Mental State Assessment
General Description
Mood
Affect
Speech
Thoughts
Perceptions
Cognition
Insight
Judgement
J Bryant NMMH

5. General Description LOOKING
Assessing Mental State
March 2002
General Description LOOKING
Level of Consciousness
drowsy, alert, sleeping, fluctuating
Appearance
grooming, makeup, posture, clothing, obvious physical deformities or characteristics
Behaviour
eye contact, level of activity, body language, mannerisms, specific activities
J Bryant NMMH

6. Mood Affect ASKING LOOKING
Assessing Mental State
March 2002
Mood Affect ASKING LOOKING
Subjective
How do you feel?
How has your mood been lately?
How are your spirits?
How do you feel in yourself?
Objective
Facial and bodily expression of mood state
Appropriate to content?
Range
J Bryant NMMH

7. Assessing Mental State
March 2002
Speech - LISTENING
Physical qualities
amount, volume, tone, speed, clarity
Spontaneity
Impairments
Accents
J Bryant NMMH

8. Thoughts ASKING AND LISTENING
Assessing Mental State
March 2002
Thoughts ASKING AND LISTENING
Form
amount - poverty, flight of ideas, vague
continuity of ideas - incoherent, blocking, circumstantial, tangential, irrelevant
disturbance in meaning or use of language - neologisms, word salad
Content - delusions, obsessions, compulsions, suicidal ideation, phobias, preoccupations
Logical, can you understand what pt is saying? Do they stick to the topic?
Words that don’t exist, or conversations that don’t make sense
Content - what pt wants to talk about the most
Obsessions persistent thought that cannot be ignored - may be absurd or meaningless
Compulsions uncontrollable urges to repetitively perform an act.
Assessing for Delusions
Have you had any trouble getting on with other people?
Have you felt that someone is against you?
Has anyone been trying to harm you?
Do you feel (or believe) you have special powers?
Do you worry about your body a lot?
Have you thought others were talking about you when you went into a room (or a bus, train)?
Have things you've seen on T.V. or heard on the radio have special meaning for you?
Have you ever received special messages?
Do you have a special relationship with God?
Have you ever felt that your thoughts were being broadcast so others could hear them?
Have you ever felt that someone else was putting thoughts in your head?
Have you ever felt that your thoughts were being taken away by someone or something?
J Bryant NMMH

9. Questions to elicit suicidal/self-harm ideation
Assessing Mental State
March 2002
Questions to elicit suicidal/self-harm ideation
How do you feel right now?
How would you describe your mood?
Have you thought you would be better off dead? How strong are these thoughts?
Have you thought life is not worth living?
Have you thought of suicide?
Have you made a plan? If yes do they have access to means?
When would you do this?
J Bryant NMMH

10. Questions to assess dangerousness
Assessing Mental State
March 2002
Questions to assess dangerousness
I can see that you are angry.
Do you feel like hurting someone?
Am I safe with you?
What has made you angry?
J Bryant NMMH

11. Perceptions LOOKING, LISTENING, ASKING
Assessing Mental State
March 2002
Perceptions LOOKING, LISTENING, ASKING
Hallucinations
false sensory perception
any of the senses
occurs in the absence of a stimulus
Illusion
misinterpretation of sensory stimulus
J Bryant NMMH

12. Cognition ASKING and LISTENING
Assessing Mental State
March 2002
Cognition ASKING and LISTENING
Orientation
time, place, person, situation
Memory
Concentration
Attention
MMSE
J Bryant NMMH

13. Assessing Mental State
March 2002
INSIGHT JUDGEMENT
Are they aware that they are ill and understand the effects and implications?
Good, partial or poor?
Has patient history of impulsivity?
Can they accurately assess a situation and act appropriately in response?
Intact or impaired
J Bryant NMMH

14. Documenting Use everyday language
Assessing Mental State
March 2002
Documenting Use everyday language
Mr Brown has been quiet and withdrawn all day. He has refused all meals and he said he couldn’t be bothered to have a shower . He has stayed in bed facing the wall. When the wardsman came to shave him, said he didn’t want to be a burden. When questioned about his spirits he said they were “pretty low”. Denied suicidal ideation but said “it would be better for everyone if he died”.
J Bryant NMMH

15. Assessing Mental State
March 2002
Documenting
Miss Smith has been very confused today. She was upset at breakfast because she thought she should have been given an evening meal. She asked when her mother was going to take her to the shops. She put on her clothes inside out and kept going through other people’s lockers. She became angry and attempted to hit staff Told other patients that there were cameras in the ceiling. Said the year was 1964
J Bryant NMMH

16. Mini Mental State Examination
Assessing Mental State
March 2002
Mini Mental State Examination
Screening tool for cognitive impairment- mild to moderate
Does not differentiate between delirium and dementia
Used to detect impairment, to follow course of illness, to monitor treatment response
Affected by education, intelligence, age, literacy and culture
J Bryant NMMH