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
http://youtu.be/6ss827LbbtA
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