The MentalStatus Examination The Foundation of the Mental Health Assessment
Purpose
Provides an estimate on the quality of client's functioning
Uses
Estimate functioning to determine need for further testing Estimate functioning to determine treatment needsAssess progress when functioning has declined in an emergency situationPeriodically assess insidious decline in functioning (e.g., dementias)
Components
Assesses general quality of:amnestic functionscognitive processing and intellectual functionsform and content of thoughtnature, expression, and appropriateness of affectadaptive and maladaptive behaviors
Symptoms of psychopathology
Whatan MSE isn't
An intelligence testA detailed memory testA fully precise measure of cognition, affect, and behavior
Priorto testing . . .
Rapport - building is important in order to obtain the client's cooperation and best effort in responding to the examination
Waysto Conduct a MSE
These components are assessed while interviewing the client about her concerns, circumstances, and history:Thought form and contentNature, expression, and appropriateness of affectBehavior strengths and weaknesses (or adaptive behaviors)
These functions may be assessed informally during the interview, or formally through specific questions and tasks:
Amnestic functions
Cognitive processing and intellectual functions
TheMini-Mental Status Examination
A brief measure of amnestic and cognitive processing functions, used to assess short-term changes in mental functioning in hospitalsassess 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
MMSE
Original MMSE was the Mini - Mental State Examination (Folstein, Folstein, & McHugh, 1975)
MMSE assesses:
OrientationShort, recent, remote, remote memorySustained concentrationExecutive functionsRecognitionRegistrationSequencing and organizationComprehensionPerceptual - motor skills
MentalStatus Scores
Simple scoring system (point per item)Scores range from 0 - 30Scores below 24 indicative of dementia or cognitive deficitLower scores indicate greater deficitsScores obtained from small sample of Caucasian males and females from middle US
Variationsof MMSE
Extended MMSE (John Ashford, M.D.,& Associates, 1992)St. Louis MMSE (1991)Solomon "7 Minute Screen" (2000)All these yield standardized scoresStandardization samples are small and not broadly representative of national populationSamples are not fully culture - fair
ComprehensiveMental Status Examination
These more fully assess cognitive-intellectual functionsInclude assessment of thought form and content, affect, and behaviors/symptoms
Variationsof MSEs
Practitioners tend to develop their own versions of comprehensive mental status examinationsAs long as the protocol measures the areas typically assessed by these examinations, a wide range of specific items will serve the purposesClinicians should avoid using IQ and memory test items in their MSEs
AssessingThought Form
Thought form includes qualities of the way a person thinks and speaksSample of problems in thought form, reflected in one's speech:Circumstantial/tangential thoughtPressured speechFlight of ideasUnusual vocal qualities (too loud, soft, trembling)Agnosia, aphasia, apraxia, echolalia, echopraxiaOrganizational/executive deficitsPerseverative speech
AssessingThought Form
BlockingConfusion/deliriumConfabulationPoverty of speechFlat speech
Contentof Thought
What are pervasive themes or ideas in client's thoughts, such as:Hopeless thinkingHelpless thinkingBlaming/abdication of responsibilityNegativistic thinking(Cleopatra Syndrome (queen of denial)Positive thoughtsContent of thought assessment also includes:Hallucinations (visual, auditory [including command], various others)Delusions (reference, grandeur, persecution, jealousy, guilt, nihilistic, various others)Poverty of thought contentLow thought complexity
Assessmentof Affect
Range of affect:RestrictedDullBlunted versus flatlabile
PredominantAffect
Describes the types of affect exhibited during interview, verbal and nonverbalCan exhibit more than one emotion during examination
Appropriatenessand Responsiveness
Assess appropriateness of affect to topics discussedIs client responsive to encouragement? Levity?
Behaviorsand Symptoms
Describe behaviors exhibited during the interviewAssess dominant symptoms described by client, even if you don't observe themSee "Assessment Report" handout for representative symptomsIf needed, survey adaptive behaviors
