Assessing Mental State

Assessing Mental State Or Looking, Listening and Asking

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

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

General Description Mood Affect Speech Thoughts Perceptions Cognition Insight Judgement Mental State Assessment

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

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 Mood AffectASKING LOOKING

Speech - LISTENING • Physical qualities • amount, volume, tone, speed, clarity • Spontaneity • Impairments • Accents

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

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?

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?

PerceptionsLOOKING, LISTENING, ASKING • Hallucinations • false sensory perception • any of the senses • occurs in the absence of a stimulus • Illusion • misinterpretation of sensory stimulus

CognitionASKING and LISTENING • Orientation • time, place, person, situation • Memory • Concentration • Attention • MMSE

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 INSIGHT JUDGEMENT

DocumentingUse 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”.

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

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

Assessing Mental State