The Mental Status 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 needs Assess progress when functioning
has declined in an emergency situation
Periodically assess insidious decline in functioning (e.g., dementias)
Components Assesses general quality of:
amnestic functions cognitive processing and intellectual
functions form and content of thought nature, expression, and appropriateness of
affect adaptive and maladaptive behaviors Symptoms of psychopathology
What an MSE isn’t An intelligence test A detailed memory test A fully precise measure of
cognition, affect, and behavior
Prior to testing . . .Rapport - building is important in
order to obtain the client’s cooperation and best effort in responding to the examination
Ways to Conduct a MSE These components are assessed while
interviewing the client about her concerns, circumstances, and history: Thought form and content Nature, expression, and appropriateness
of affect Behavior strengths and weaknesses (or
adaptive behaviors)
Ways to Conduct a MSE These functions may be assessed
informally during the interview, or formally through specific questions and tasks:
Amnestic functions Cognitive processing and intellectual
functions
The Mini-Mental Status Examination
A brief measure of amnestic and cognitive processing functions, used to
assess short-term changes in mental functioning in hospitals
assess 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 MMSE assesses:
Orientation Short, recent, remote, remote memory Sustained concentration Executive functions
Recognition Registration Sequencing and organization Comprehension Perceptual - motor skills
Mental Status Scores Simple scoring system (point per
item) Scores range from 0 - 30 Scores below 24 indicative of
dementia or cognitive deficit Lower scores indicate greater deficits Scores obtained from small sample of
Caucasian males and females from middle US
Variations of MMSE
Extended MMSE (John Ashford, M.D.,& Associates, 1992)
St. Louis MMSE (1991) Solomon “7 Minute Screen” (2000) All these yield standardized scores Standardization samples are small and not
broadly representative of national population Samples are not fully culture - fair
Comprehensive Mental Status Examination
These more fully assess cognitive-intellectual functions
Include assessment of thought form and content, affect, and behaviors/symptoms
Variations of MSEs Practitioners tend to develop their own
versions of comprehensive mental status examinations
As long as the protocol measures the areas typically assessed by these examinations, a wide range of specific items will serve the purposes
Clinicians should avoid using IQ and memory test items in their MSEs
Assessing Thought Form Thought form includes qualities of the way a
person thinks and speaks Sample of problems in thought form, reflected in
one’s speech: Circumstantial/tangential thought Pressured speech Flight of ideas Unusual vocal qualities (too loud, soft, trembling) Agnosia, aphasia, apraxia, echolalia, echopraxia Organizational/executive deficits Perseverative speech
Assessing Thought Form Blocking Confusion/delirium Confabulation Poverty of speech Flat speech
Content of Thought What are pervasive themes or
ideas in client’s thoughts, such as: Hopeless thinking Helpless thinking Blaming/abdication of responsibility Negativistic thinking (Cleopatra Syndrome (queen of denial) Positive thoughts
Content of Thought
Content of thought assessment also includes:
Hallucinations (visual, auditory [including command], various others)
Delusions (reference, grandeur, persecution, jealousy, guilt, nihilistic, various others)
Poverty of thought content Low thought complexity
Assessment of Affect Range of affect:
Restricted Dull Blunted versus flat labile
Predominant Affect Describes the types of affect
exhibited during interview, verbal and nonverbal
Can exhibit more than one emotion during examination
Appropriateness and Responsiveness
Assess appropriateness of affect to topics discussed
Is client responsive to encouragement? Levity?
Behaviors and Symptoms Describe behaviors exhibited during
the interview Assess dominant symptoms
described by client, even if you don’t observe them
See “Assessment Report” handout for representative symptoms
If needed, survey adaptive behaviors
The Endwww.iupui.edu/~flip/msenotes.htm
“Ye got all that??”