Mental Status Examination

Sarfraz Masih

1Sarfraz Masih, Karachi

Objectives

By the end of the session, the students will be

able to

1. Define mental status examination (MSE)

2. Describe the purposes to assess MSE

3. Identify and describe components of MSE

4. Demonstrate the ability of assessing patients

with psychiatric illness.

2Sarfraz Masih, Karachi

Mental Status Examination (MSE)

Mental status examination is an organized,

systemic approach to assessment of an

individual’s current psychiatric conditions.

(Boyd, 2002)

The mental status examination is a structured

description of diagnostic signs and symptoms

exhibited by the patient during conversation.

(Stevens, 2001)

3Sarfraz Masih, Karachi

Mental Status Examination (MSE)

MSE is cornerstone in he evaluation of any

patient with medical, neurological, or

psychiatric disorder that affects thought,

emotion, or behavior.

(Stuart & Laraia, 2005)

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Why To Perform MSE?

To

Assess the pt.’s psychological functioning.

Identify the underlying or precipitating cause

of his/ her current problems.

Understand the pt.’s coping mechanism.

Formulate care plan

Determine the progress and the effectiveness

of the treatment.

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Components of MSE

General description

Emotional state

Thinking

Perceptions

Cognitive function

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Components of MSE cont…

General Description

Appearance

Speech

General Behavior

Emotional State

Mood

Affect

Thinking

Thought content

Thought Process 7Sarfraz Masih, Karachi

Components of MSE cont…

Perceptions

Hallucinations

Illusions

Cognitive Function

Level of consciousness and orientation

Memory

Abstract thinking

Judgment

Insight

Level of concentration8Sarfraz Masih, Karachi

General Description

Appearance

Speech

General Behavior

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Appearance

Record pt.’s apparent age

Ethnic background

Grooming & hygiene

Posture & motor activity

Observe facial expressions (eye contact)

Nutritional status

Gait

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Speech

Document pt’s speech

Rate

Volume

Amount

Characteristics

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General Behavior

Interaction

Record pt.’s facial expressions & attitude towards examiner

Interested

Appeared bored

Hostile

Defensive

Friendly

Cooperative

Guarded

Relaxed 12Sarfraz Masih, Karachi

General Behavior cont…

Motor activity

is concerned with patient’s physical movement.

Level of activity

Type of activity

Unusual gestures and mannerisms

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Emotional State

Mood

Affect

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Mood

Mood is the patient’s self- report of the prevailing

emotional state and reflects the patients’ life situation.

(Stuart & Laraia, 1998)

Anxious

Sad

Happy

Fearful

Tired

Hopeless

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Affect

Objective expressions of emotional feelings

Emotional display or observable behaviors that are the expression of an experienced, subjective feeling.

(Stuart & Laraia, 1998)

Euthymic

Flat

Blunted

Smiling16Sarfraz Masih, Karachi

Thinking

Thought content

Thought Process

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Thought Content

False fixed beliefs. “What” the pt. is thinking

Delusions (false fixed beliefs)

Grandiose

Religious

Persecutory

Erotomatic

Jealousy

Thought insertion

Ideas of reference Obsession (repeated thoughts)

Compulsion (repeated behaviors)

Phobias

Magical thinking

Depersonalization 18Sarfraz Masih, Karachi

Thought Process

“How” the pt.’s self expressions throughout the pt.s speech.

Looseness of association

Flight of ideas

Racing

Tangentially

Circumstantiality

Word salad

Derailment 19Sarfraz Masih, Karachi

Thought Process cont…

Neologism

Clanging

Thought blocking

Poverty of thought

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Perceptions

A perception is a sensation of

an external object.

Hallucinations

Illusions

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Hallucination

Perceptual distortions occurring in the absence of

an external stimuli

Auditory

Visual

Gustatory

Tactile

Olfactory

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Illusions

Distorted perceptions in which a real external

object is perceived inaccurately.

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Cognitive Function

Level of consciousness and orientation

Memory

Abstract thinking

Judgment

Insight

Level of concentration

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Level of Consciousness &

Orientation

Confused

Drowsy

Unconscious

Oriented to time place and person

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Memory

Immediate

Recent

Remote

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Abstract Thinking

Abstract/ Concrete thinking

Assess pt.’ s ability to determine similarities

Assess pt.’s ability to understand proverbs

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Judgment

Judgment involves making decisions

that are constructive and adaptive.

It involves the ability to understand

facts and draw conclusions from

relationships.

(Stuart & Laraia, 1998)

Evaluate pt.’s problem solving

abilities via scenario. 30Sarfraz Masih, Karachi

Insight

Refers to the client’s self- awareness and

understanding of the meaning and reason

for his/ her behavior or motives.

(Antai-otong, 2003)

This is an assessment of how the patient

is aware about of his/ her own mental

state.

Assess pt.’s understanding of his/ her

level of illness/ problem/ behavior.31Sarfraz Masih, Karachi

Level of Concentration &

Attention

Assess for attention and concentration

Assess for simple calculation

(Subtraction questions)

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ReferencesBrannon, G. E. (2002). History and Mental

Status Examination.

Antai-otong, D. (2003). Psychiatric Nursing: Biological & Behavioral Concepts. Canada: Thomson: Delmar Learning.

Frisch. N. C., & Frisch, L. E. (1998). Psychiatric Mental Health Nursing. London: Delmar Publishers

Stevens, L. (2001). Psychiatry. Churchill Livingstone.

Stuart, G. W., & Laraia, M. T. (2005). Principles and Practice of Psychiatric Nursing 6th (ed.). New York: Mosby.

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It Is Time For ………….

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