The Mental Status Examination The Foundation of the Mental Health Assessment.

The Mental Status Examination

The Mental Status Examination

The Foundation of the Mental Health Assessment

The Foundation of the Mental Health Assessment

PurposePurpose

Provides an estimate on the quality of client’s functioning

Provides an estimate on the quality of client’s functioning

UsesUses

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)

ComponentsComponents

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’tWhat 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 . . .Prior to testing . . .

Rapport - building is important in order to obtain the client’s

cooperation and best effort in responding to the examination

Rapport - building is important in order to obtain the client’s

cooperation and best effort in responding to the examination

Ways to Conduct a MSEWays 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 MSEWays 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

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

MMSEMMSE

Original MMSE was the Mini - Mental State Examination

(Folstein, Folstein, & McHugh, 1975)

Original MMSE was the Mini - Mental State Examination

(Folstein, Folstein, & McHugh, 1975)

MMSEMMSE

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 ScoresMental Status Scores

Simple scoring system (point per item) Scores range from 0 - 30 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 0 - 30 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 MMSEVariations 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

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 MSEsVariations 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 FormAssessing 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 FormAssessing Thought Form

Blocking Confusion/delirium Confabulation Poverty of speech Flat speech

Blocking Confusion/delirium Confabulation Poverty of speech Flat speech

Content of ThoughtContent 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 ThoughtContent 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 AffectAssessment of Affect

Range of affect: Restricted Dull Blunted versus flat labile

Range of affect: Restricted Dull Blunted versus flat labile

Predominant AffectPredominant 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

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 SymptomsBehaviors 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

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“Ye got all that??” “Ye got all that??”