Assessing Mental Status

1
Assessing Mental Status

• Observation
• Conversation
• Exploration
• Source Othmer Othmer(2002)

2
Opening the interview

• Immediately start to perceive signals and make
  first impressions
• Task is to stay alert to behavior and changes in
  behavior

3
Observation

• Register various behaviors and interpret their
  meanings
• Avoiding stereotypes
• Consider context

4
Appearance

• Sex and age
• Race and ethnic background
• Nutritional status
• Hygiene and dress
• Eye contact

5
Consciousness

• Changed by drugs , alcohol or some paroxysmal
  attacks ( fainting, seizures, )
• Lethargy could be related to medical condition
  or delirium, dementia, amnestic states, etc
• Psychogenic stupor motor immobility and mutism
  .Person is aware of what is going on

6
Psychomotor behavior

• Posture
• Psychomotor movements
• Goal directed
• Expressive
• symbolic
• Movements that express affect
• Abnormal complex movements

7
Conversation

• Tendency to be less guarded
• May start to uncover symptoms and problems
• Any trouble finding us?
• Weather?
• Where did you park?
• Small talk

8
Attention and Concentration

• When was appointment set (concentration,
  orientation , memory)
• Does person stay with questions?
• Does person concentrate when they talk and
  listen?
• Distractibility

9
Speech and Thinking

• Speech thinking, and affect
• Flow, pressure
• Fluency (word salad)
• Speech involves encoding and decoding
• Response rate, tone, inflection (or lack of),
  hesitation, volume

10
Speech and Thinking

• Concreteness of thinking
• Over inclusiveness
• Association
• Circumstantial speech
• Tangential speech
• Perseveration
• Flight of ideas, fragmented, rambling speech

11
Memory

• Immediate recall
• Past events
• Distorted memory
• Depression, mania,
• Schizophrenia injustices that never happened?
• Anti-social invent history

12
Affect

• visible and audible manifestation of the
  patients response to external and internal
  events
• Autonomic responses
• Posture
• Facial movements
• Reactive movements
• Grooming movements

13
Affect vs. Mood

• Affect momentary , mood lasts longer
• Affect is a response, mood can change
  spontaneously
• Affect is observed mood is inferred

14
Innate moods (Izard Darwin)

• Disgust
• Surprise
• Joy
• anger

• Fear
• Sadness
• Interest
• Shame
• contentment

15
Dimensions of Affect

• Quality
• Intensity
• Duration
• Appropriateness
• Range
• control

16
Exploration

• Probing into words, behaviors, facts

17
Mood

• Quality
• How do you feel most of the day?
• How do you feel now?
• Activities?, plans for the future?
• How is your sleep, appetite, sex life

18
Mood stability

• Stable
• Unstable
• Diurnal variation

19
Mood reactivity

• Responsiveness to change

20
Mood Duration

• Transient
• Depressed episode in mood disorder

21
Energy Level

• How easy is it to carry out activities?
• Daily routines, new tasks?
• Depression problems in planning, deciding,
  initiating and carrying through

22
Perception

• Disturbances in sensory receptors
• Insight into hallucinations

23
Content of Thinking

• Suicidal and homicidal tendencies
• Delusion
• Phobias
• Compulsions
• Obsessions

24
Executive Functioning

• Planning
• Organizing
• Sequencing
• Abstracting

25
Insight

• What do think about
• Do you need help?
• What are your strengths?

26
Judgement

• Choose appropriate goals, behaviors
• Integration of outside reality, internal states
  and living skills