Mental State Exam (MSE) and Mental Status Assignment (Essay Sample)

MENTAL HEALTH
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MENTAL HEALTH
Part 1: Mental State Exam (MSE) –
Diagnosis: a mental status examination is normally performed by psychiatrist as a diagnostic tool to check the mental health of a person. When one presents symptoms of an abnormal behavior, a MSE will form a foundation for further investigations of any other underlying medical conditions such as Alzheimer’s disease which presents with symptoms of deteriorating memory. Mental disorders like schizophrenia can be assessed by an MSE.
The Main Objectives of the MSE
An MSE gives a picture of one’s psychological function at a point in time.
Assessment of a patient to determine the mental state gives an individual’s capacity to function as a psychiatric follow –up to establish the recovery level after a treatment. This will give an idea of the effectiveness of the treatment given and enable the physician to make any necessary changes in treatment in terms of providing an alternative drug, increasing or decreasing the dosage or recommend for further laboratory investigation.
Mental State exam is also used as a check for the adverse effects of certain drugs, for instance, when cancer patients are administered with chemotherapeutic drugs like methotrexate, this has shown its potential to causing very adverse side effects to the brain function.
Mental state exam is additionally useful in charting the course of disease by observing the changes from the normal brain function. This helps to infer extent of a disorder and assists in making the right medical care for the patient.
When Should a Mental Status Exam be used?
Mental status Exam should be used when:
When abnormal behaviors are seen in persons who have been behaving normally.
A clinician wants to review the progress of a patient’s healing.
Used when a court of law wants to pass a fair verdict in highly complicated case where there is doubt concerning the mental status of the accused during the event.
When a drug is implicated to cause mental disorders e.g. the case of chemotherapeutics.
It should be used when suicide prevalence is noted in a populationto unravel whether it could be the root cause of such.
The 10 Key Components of a Standard MSE and Examples from Clinical Practice
There are ten principal components of a standard Mental Status Examination that are followed by psychiatrists during an interview with a patient. These components include appearance, behavior, mood, affect, speech, thought, cognition, insight/ judgment, perception and rapport.
Appearance
The general appearance of a person in terms of facial outlook, self-care, dressing, grooming and any visible physical abnormalities are observed to give the necessary inferences. Apparent age, weight and height are necessary too (Schmitz, et al., 2012). Examination of physical appearances can infer a lot about the patient, for instance, stains of nicotine on teeth, marks of needle on the skin due to intravenous injection of drugs, teeth erosion, and malnutrition indicative of alcoholism and drug abuse. In case mania disorder, one will dress in funny clothes while in a schizophrenic condition, a person will be in filthy and carelessly dressed. Losses in weight may suggest physical illness, depression or anorexia nervosa.
Clinical example: The patient is young lady who appears older than her stated age with wrinkled face, wearing a large unfitting grey tunic. She wears a pair of black rubber shoes. She has long untrimmed finger nails, unkempt hair and generally not neat. She does not maintain eye contact looking down most of the times.
Behavior
It is worth noting the non-verbal communication of the patient as it gives a lot of information on the health of the person. This is manifested in form of gestures, eye contact, psychomotor activity, and cooperation levels with the psychiatrist, posture, and common features such as tremors as in the case of Parkinson’s disease or the side effects of an antipsychotic drug, level of arousal and aggression levels. Some movements like the imitation of other people’s walking style may suggest catatonia. Eye movements should as well be noted because they infer a lot, for example frequent eye movements occur when experiencing hallucinations, lack of eye contact may reflect autism or depressed state.
Clinical example 2: The patient sits in a composed posture and maintains eye contact throughout the examination. He readily responds to questions. However, he imitates my hand movement and has mild tremor.
Mood and affect
Mood is the predominant internal feeling that can only be expressed by the interviewee through words while affect is the transient feeling that is externally expressed. A patient is asked by the interviewer to say what he/she feels so as to give the mood, but the psychiatrist only observes the appearance to infer the affect, for example, anxiety or sadness that is demonstrated by nonverbal cues (Schmitz, et al., 2012).
Affect can either be described as congruent or incongruent with ones thinking, appropriate or inappropriate with the current situation. An occasion where a patient explains a very distressing ordeal while emotionless may indicate a schizophrenic condition. The stability of affect is described as labile or stable, while the intensity can blunted/ flat in schizophrenia or sharp/ heighted in personality disorders (Van, Botha & Seedat., 2012).
Mood is described by the terms happiness (ecstatic, elevated, angry, anxious, apathetic or lowered), irritability (irritable, explosive or calm) and stability. When one suffers from anhedonia, there is lack of pleasure, while in situation of Alexithymic, one cannot explain his/her feelings (Chehil & Kutcher, 2013).
Clinical example 3: subjectively she reports feeling angry and distressed because of loneliness due to neglect by husband. Objectively she appears sad, angry and tense. Her emotion/mood is labile and appropriate to content.
Speech
It is very essential to take keen interest in the presentation as well as the content of the speech as this may reveal much about the patient. Unusual speech may be implicated to anxiety, schizophrenia and depression. Aspects of speech considered are speech rate (fast, reduced tempo, pressured), volume, quantity, content (normal, fluency, and consistency), rhythm and tone (Van, Botha, & Seedat, 2012).
Clinical example 4: she speaks spontaneously and very fast, sometimes pressurized though uninterruptible. At times she speaks loudly. Some words are not understood because of the high rate of speech though the rhythm and tone are normal.
Rapport
The attitude of the interviewee is examined and recorded. This is the response towards examination and the cooperation or the lack of cooperation by the patient. Psychoanalysis such as discomfort, by the examiner needs be recorded.
Thought
The flow, content and quantity of thoughts are analyzed. Since thoughts are never seen, they will obviously be inferred through keen interest in the behavior and the speech of the parent. Thought disorder may be perceived in form of derailment neologisms manifesting psychosis. The amount and the rate of thoughts is also an important factor to consider whereby a slowed thinking occurs in bradyphrenia whereas the quantity of thoughts is reduced in dementia and depression disorders. The content of thought helps identify the risks attached such as delusional thinking where one is convinced of a false believe, or obsessive thought such as suicide thoughts(Van, Botha, & Seedat, 2012).
Thought process is subject to determination here. One may have extreme repetition of vague words, use words with no information at all, shift from topic frequently, pressured speech or use mixed up words that ultimately lose meaning.
Clinical example: Her thoughts are logical and relevant to the topic though at times she gets emotional and gives irrelevant details. There is some drift of thoughts when distracted.
Cognition
It is an examination of the person’s ability to recognize the current environment, time and person. If a problem with cognition is noted, then the examiner may request for further investigation of the underlying mental condition by the mini mental state examination.
Clinical example: She has good orientation of time, place and person.
Perception
These are the sensory experiences that are recognized in the patient. They are said to manifest in form of visual, auditory, olfactory, tactile or gustatory although the most prevalent in mental illnesses are the first two in the list. The major forms of perturbing perceptions are the hallucinations, pseudohallucinations and the illusions. Hallucinations are sensory perceptions that happen without an external stimulus but occur externally, while illusions are distorted sensory perceptions. Psudohallucinations are fantasies. Sometimes, a person may not realize self. Hallucinations manifest psychoses or drug intoxication (Cramer et al., 2013).
Clinical example: She describes hearing voices of unknown people accusing her of killing her neighbors. Sometimes she experiences nightmares and runs out of her homestead to flee the attackers. These were the only occasions of hallucinations though the nightmares recur in the same form almost every night.
Insight
It is analyzed by assessing person’s ability to explain ones mental condition. It has three components that include recognition of one’s mental condition, ability to sense abnormal mental events such as illusions, and the knowledge of treatment options. A psychosis depraves one of insights (Van, Botha, & Seedat, 2012).
Judgment
Someone’s ability to make sound decisions in a problem solving process also needs to be looked into. Impaired judgment generally indicates a mental condition that possibly aff...