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Chapter 8 – The Mental Status Examination

Chapter 8 – The Mental Status Examination. Chapter 8 – The Mental Status Examination. Objectivity It is very difficult to be objective Too often we’re very subjective, but think we’re being objective Be sure to keep your emotional sensitivity in your MSE process.

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Chapter 8 – The Mental Status Examination

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  1. Chapter 8 – The Mental Status Examination

  2. Chapter 8 – The Mental Status Examination • Objectivity • It is very difficult to be objective • Too often we’re very subjective, but think we’re being objective • Be sure to keep your emotional sensitivity in your MSE process

  3. Chapter 8 – The Mental Status Examination • What is a Mental Status Examination • It is a method of organizing and evaluating clinical observations during an interview • It is very common to medical settings • It usually results in one medium-length paragraph describing the client’s mental status

  4. Chapter 8 – The Mental Status Examination • The Generic MSE includes the following content areas: • Appearance • Behavior/psychomotor activity • Attitude toward the examiner • Affect and mood • Speech and thought

  5. Chapter 8 – The Mental Status Examination • The Generic MSE (Cont.) • Perceptual disturbances • Orientation and consciousness • Memory and intelligence • Reliability, judgment, and insight

  6. Chapter 8 – The Mental Status Examination • Individual and Cultural Differences • It is imperative to keep in mind the many ways individuals vary in their behavior and abilities • Normal behavior within one culture, may appear disturbed or irrational within another culture

  7. Chapter 8 – The Mental Status Examination • Appearance in a MSE focuses on physical characteristics • Grooming • Dress • Make-up • Facial expressions • Weight/height • Body piercing/tattoos • Others?

  8. Chapter 8 – The Mental Status Examination • Behavior or Psychomotor Activity in a MSE focuses on physical movement • Excessive or limited movement • Eye contact and eye movement • Grimacing or fidgeting • Gestures • Posture

  9. Chapter 8 – The Mental Status Examination • Attitude Toward the Examiner in a MSE refers to how the client behaves toward the interviewer; examples include: • Cooperative • Hostile • Indifferent • Manipulative • Open • Seductive • Suspicious

  10. Chapter 8 – The Mental Status Examination • Affect and Mood refers to moment-to-moment emotional tone as observed by the interviewer (affect) and the client’s subjective and self-reported mood state • Affect is usually judged in terms of content, range/duration, appropriateness, and depth/intensity • Mood is based on client self-report

  11. Chapter 8 – The Mental Status Examination • Speech and Thought • Speech is evaluated on the basis of • Rate (speed) • Volume (loudness) • Amount (density) • Thought is evaluated in terms of both process and content

  12. Chapter 8 – The Mental Status Examination • Thought Process descriptors include: • Blocking • Circumstantiality • Clanging • Loose Associations • Neologisms • Perseveration • Word salad

  13. Chapter 8 – The Mental Status Examination • Thought Content descriptors indicative of psychopathology primarily include: • Delusions (of persecution, grandiosity, etc.) • Obsessions

  14. Chapter 8 – The Mental Status Examination • Perceptual Disturbances include hallucinations and illusions • Hallucinations may occur in any sensory modality, but are most commonly auditory • Illusions have some basis in reality

  15. Chapter 8 – The Mental Status Examination • Orientation and Consciousness refers to a client’s awareness of his/her self and situation • Clients are evaluated in terms of their orientation to person, place, and time • Consciousness is rated from Alert to Comatose

  16. Chapter 8 – The Mental Status Examination • It can be quite risky to assess Memory and Intelligence in a short interview, but some general statements are usually made • Remote, recent, and immediate memory can be assessed • Because intelligence is often based on verbal facility, special care should be taken when working with diverse clients

  17. Chapter 8 – The Mental Status Examination • Reliability, Judgment, and Insight • Reliability refers to a client’s credibility or trustworthiness • Judgment involves client ability to make constructive or adaptive choices • Insight refers to the client’s understanding of his/her problems

  18. Chapter 8 – The Mental Status Examination • When to Use MSEs • MSEs are more appropriate as the client’s suspected level of psychopathology increases • MSEs must be used with great caution with culturally diverse clients

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