Dr. Joanna Bennett

 Central component is the patient/clinical interview
 Psychiatric evaluation – Psychiatrist
 Psychiatric assessment within nursing process as model of care – nurse
 Begins with 1 st contact
 Based on establishing rapport/trust – therapeutic relationship

 History of present illness
 Past psychiatric history
 History of substance use
 Medical history
 Development, psychosocial, socio-cultural
 Occupational
 Family history

 Legal history
 Review of systems
 Physical examination
 Mental Status Examination
 Diagnostic tests (psychiatric evaluation)
 Clinical formulation
 Diagnosis
 Care Plan

 Mental status examination (MSE) is a core skill of mental health practitioners.
 A key part of the initial psychiatric assessment
 Entails systematic collection of data based on observation of the patient's behavior while the patient is in the clinician's view during the interview.

 The purpose of the MSE:
 to obtain evidence of symptoms and signs of mental disorders
 danger to self and others
 information on the patient's insight, judgment, and capacity for abstract reasoning

 Signs and symptoms must be those present at the time of the interview
 MSE is used to inform decisions about treatment strategy and an appropriate treatment setting

 MSE is conducted in the manner of an informal enquiry
 using open and closed questions
 structured tests to assess cognition
Information is usually recorded as freeform text using standard headings

 Includes apparent age, height, weight, and manner of dress and grooming
 Body type, Posture, Hair and nails
 Colorful or bizarre clothing
 unkempt, dirty clothes
 signs of malnutrition
 needle track marks - drug abuse

 MSE is used, together with the psychiatric history, to generate a diagnosis, and a treatment plan.

 General behaviour
 Level of distress
 Degree of eye contact
 Attitude towards the interviewer

 “Mr Y presents with good self-care and grooming.
He was courteous and respectful throughout interview”
 “Ms X is a 40 year old female looking older than stated age who was disheveled and malodorous at time of interview. She had a stooped posture and maintained poor eye contact”


 Level of psychomotor activity
 Presence of gait abnormalities
 Purposeless, repetitive unusual posture or movement
 Tremors, akathisia, dyskinesias
 Catatonic posturing
 Echopraxia (imitating others movements)

 Rate, Rhythm, Volume, Amount etc.
 Poverty of speech
 Mutism
 Flight of ideas – accelerated with abrupt changes of topic
 Pressured speech - rapid, accelerated, frenzied, jumbled and cluttered

 http://www.youtube.com/watch?v=9Hpz-
9rwuqA&feature=em-share_video_user

 “ Mr Y’s speech was of normal rate, quality and form”.
 Miss X’s speech was pressured and over inclusive when answering
 Thought blocking appeared evident during the conversation with John

 Mood – internal, subjective sustained
 Depression, hypomania, dysphoria
 Affect – externally observable, changeable
 Intensity, stability, appropriateness
 Euphoria, anger, sadness
 Blunted (reduction) , flat (absence)

 Flow of ideas
 Vagueness
 Incoherence
 Circumstantiality – excessive or irrelevant details
 Tangentiality – oblique, irrelevant
 Word salad – words & phrases lack comprehension

 What the person is actually thinking (Ideas
& beliefs)
 Suicide/homicidal
 Delusions (content and effect)
 Grandiose
 Persecution
 Religious
 Control

“ Mr X described feelings of being followed and being under surveillance. He stated that Digicel had implanted two microchips into his brain through which they could monitor his thoughts. According to Mr X’s Mother he had locked himself in his room for days and would only come out for meals”.
 “Mr Y stated that he was Jewish (according to family this is not the case), and that he was going to sail to
Israel to lead the people in the liberation of their homeland.

 Hallucinations perception absence of external stimulus
 Any of the senses (Gustatory, Visual, Olfactory, tactile)
 Auditory - most common voices
 third person - running commentary on the patient’s actions
 Second person – talking to the patient

 Level of Consciousness

 Orientation - person, place, time situation
 Concentration
 Memory

 Awareness of problems and their implications
 Recognition of illness and benefits of treatment
 Motivation to change - ambivalence to commitment

 Capacity to make sound, reasoned and responsible decisions
 use of standard hypothetical questions
 More useful to relate to person’s own selfcare, recent/current situation or behaviour

 http://www.youtube.com/watch?v=NVRP9Umpz4M& feature=em-share_video_user