dr. joanna bennett. psychiatric nursing assessment central component is the patient/clinical...
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Mental Status Examination
Dr. Joanna Bennett
Psychiatric Nursing AssessmentCentral component is the
patient/clinical interviewPsychiatric evaluation – PsychiatristPsychiatric assessment within nursing
process as model of care – nurseBegins with 1st contactBased on establishing rapport/trust –
therapeutic relationship
Psychiatric Nursing AssessmentHistory of present illnessPast psychiatric historyHistory of substance useMedical historyDevelopment, psychosocial, socio-
culturalOccupational Family history
Psychiatric Nursing AssessmentLegal historyReview of systemsPhysical examinationMental Status ExaminationDiagnostic tests (psychiatric evaluation)Clinical formulationDiagnosisCare Plan
Mental Status ExaminationMental status examination (MSE) is a core
skill of mental health practitioners.
A key part of the initial psychiatric assessment
Entails systematic collection of data based on observation of the patient's behavior while the patient is in the clinician's view during the interview.
Mental Status ExaminationThe purpose of the MSE:
to obtain evidence of symptoms and signs of mental disorders
danger to self and othersinformation on the patient's insight, judgment, and capacity for abstract reasoning
Mental Status ExaminationSigns and symptoms must be those
present at the time of the interview
MSE is used to inform decisions about treatment strategy and an appropriate treatment setting
Mental Status ExaminationMSE is conducted in the manner of
an informal enquiry using open and closed questionsstructured tests to assess cognition
Information is usually recorded as free-form text using standard headings
Appearance & BehaviourIncludes apparent age, height,
weight, and manner of dress and grooming
Body type, Posture, Hair and nails Colorful or bizarre clothing unkempt, dirty clothes signs of malnutritionneedle track marks - drug abuse
Mental Status ExaminationMSE is used, together with the
psychiatric history, to generate a diagnosis, and a treatment plan.
Appearance & BehaviourGeneral behaviourLevel of distressDegree of eye contactAttitude towards the interviewer
Appearance & Behaviour
“Mr Y presents with good self-care and grooming. He was courteous and respectful throughout interview”
“Ms X is a 40 year old female looking older than stated age who was disheveled and malodorous at time of interview. She had a stooped posture and maintained poor eye contact”
Motor activity Level of psychomotor activityPresence of gait abnormalitiesPurposeless, repetitive unusual
posture or movementTremors, akathisia, dyskinesiasCatatonic posturingEchopraxia (imitating others movements)
SpeechRate, Rhythm, Volume, Amount etc.
Poverty of speechMutism Flight of ideas – accelerated with abrupt changes of topic
Pressured speech - rapid, accelerated, frenzied, jumbled and cluttered
http://www.youtube.com/watch?v=9Hpz-9rwuqA&feature=em-share_video_user
Speech
“ Mr Y’s speech was of normal rate, quality and form”.
Miss X’s speech was pressured and over inclusive when answering
Thought blocking appeared evident during the conversation with John
Mood & AffectMood – internal, subjective sustained
Depression, hypomania, dysphoria
Affect – externally observable, changeableIntensity, stability, appropriatenessEuphoria, anger, sadness Blunted (reduction) , flat (absence)
Thought processesFlow of ideas
VaguenessIncoherenceCircumstantiality – excessive or irrelevant details
Tangentiality – oblique, irrelevant Word salad – words & phrases lack comprehension
Thought contentWhat the person is actually thinking
(Ideas & beliefs)Suicide/homicidalDelusions (content and effect)
GrandiosePersecutionReligiousControl
Thought content“ Mr X described feelings of being followed and being under surveillance. He stated that Digicel had implanted two microchips into his brain through which they could monitor his thoughts. According to Mr X’s Mother he had locked himself in his room for days and would only come out for meals”.
“Mr Y stated that he was Jewish (according to family this is not the case), and that he was going to sail to Israel to lead the people in the liberation of their homeland.
PerceptionHallucinations perception absence of
external stimulusAny of the senses (Gustatory, Visual,
Olfactory, tactile) Auditory - most common voices
third person - running commentary on the patient’s actions
Second person – talking to the patient
CognitionLevel of Consciousness Orientation - person, place, time
situation
Concentration
Memory
InsightAwareness of problems and their
implications
Recognition of illness and benefits of treatment
Motivation to change - ambivalence to commitment
JudgementCapacity to make sound, reasoned
and responsible decisions use of standard hypothetical questions
More useful to relate to person’s own self-care, recent/current situation or behaviour
http://www.youtube.com/watch?v=NVRP9Umpz4M&feature=em-share_video_user