Psychiatric Assessment and Mental Status Examination

Psychiatric Assessment

• A process of collecting, organizing, and analyzing data or information about the client to identify manifestations
• Also known as Psychosocial assessment with mental assessment
• An integral and essential skill to develop, usually performed by psychologists
• Purposes:
  • To construct a clear picture of the client's emotional state, mental capacity, and behavioral functions
  • To serve as a basis for planning to meet the client's needs
  • To evaluate the effectiveness of treatment and interventions

Mental Status Examination

• An integral and essential skill to develop, focusing on thought, behavior, and errands
• An accurate MSE helps elicit signs and symptoms of apparent mental illness and associated risk factors
• A structured tool and process that allows observers to assess the patient's current mental state
• Purposes:
  • To construct a clear picture of the client's emotional state, mental capacity, and behavioral functions
  • To identify signs and symptoms of apparent mental illness and associated risk factors

Factors Influencing Assessment

• Client's participation and feedback
• Client's health status
• Previous experience and misconception about healthcare
• Client's ability to understand

Kinds/Types of Data

• Objective: perceived by the nurse
• Subjective: kinocollect, inaanalyze

Mental Status Examination Components

• Posture and poise
• Gait
• Clothing type
• Hair and grooming
• Hygiene
• Appearance
• Motor behavior
• Negativism
• Mannerism
• Mutism
• Catatonia
• Hyperactivity
• Hypoactivity
• Tic
• Compulsive
• Aggression
• Attitude towards examiner

Mood and Affect

• Mood: a pervasive and sustained emotion subjectively experienced by the client
• Affect: the expression of emotion as seen by others
• Types of mood:
  • Euthymic: normal range of mood
  • Irritable: easily annoyed or provoked by anger
  • Elevated: more cheerful than normal with a sense of confidence and joy
  • Depressed: psychopathologic feeling of sadness
  • Anhedonia: loss of interest and withdrawal from pleasurable activities
  • Grief: sadness appropriate to a real loss
• Types of affect:
  • Constricted: clear, decreased in range and intensity
  • Blunted: emotional expression further reduced
  • Flat: no affective expression, monotonous voice
  • Bizarre: odd, illogical, grossly inappropriate, or unfounded
  • Appropriate: the patient's emotional response is in context with the subject being discussed### Expression of Grandeur
• May or may not be congruent with the mood
• Inappropriate affect for a quality of response found in some schizophrenia patients, where the patient's affect is incongruent with what they are saying

Quality of Affect

• Is the patient sad (dysphoric), agitated, euphoric, or neutral?
• Dysphoric means sad, while euphoric means extremely happy
• Flat affect means no emotional expression, monotonous voice, and no visible expression

Fluctuation of Affect

• Labile means sudden change of mood
• Intensity of affect can be normal, full, broad, or reduced

Speech

• Describe speech in terms of quantity, rate, production, and quality
• Pressured speech means rapid speech, increased amount, and difficult to interrupt
• Povert of speech means restricted amount, usually monosyllabic
• Stuttering means frequent repetition of prolonged sound syllable

Appropriateness of Affect

• Considered in context of what patient is discussing
• Appropriate affect means emotion is in harmony with what is being discussed
• Inappropriate affect means disharmony with emotion and thought/speech

Sensory Aphasia

• Cannot understand right, even if they can speak
• Paucity of content means they do not want to speak because they are paranoid

Disorganized Speech

• Sometimes called "word salad" because of the way the words are arranged
• Speech may follow grammatical rules, but the content makes little sense
• Sentences make little sense, and topics of conversations change a little or not at all

Characteristic of Speech

• Such as talkative, garrulous, voluble, taciturn, unspontaneous, or normally responsive to cues from the interviewer
• Rate of speech can be normal, rapid, slow, or pressured
• Latency of speech means the patient responds spontaneously, or there are long pauses between asking a question and the patient responding

Thought Process

• General disturbance in form of thought
• Psychosis means inability to distinguish reality from fantasy

Perceptual Disturbances

• Process by which physical stimuli are brought to mental awareness
• Hallucination means false sensory perception not based on reality
• Types of hallucinations include auditory, command, visual, tactile, olfactory, and gustatory

Disturbance of Thought

• Illogical thinking means thinking that has erroneous conclusions or internal contradictions
• Autistic thinking means thinking that gratifies unfulfilled desires with no regard for reality
• Neologism means creating new words
• Word salad means incoherent mixture of words and phrases
• Circumstantiality means indirect speech that is delayed in reaching the point
• Verbigeration means meaningless repetition of specific words or phrases
• Echolalia means psychopathological repeating of words or phrases of another person
• Loose associations means ideas shift from one subject to another in an illogical manner### Thought Disorders
• Flight of Ideas: a rapid, continuous, and constant shifting of topics
• Clang Association: association of words similar in sound but not in meaning
• Incoherence: disorganized, incomprehensible thought
• Perseveration: persistent response to a prior stimulus even if the stimulus has changed
• Blocking: interruption of a train of thought before completion

Delusions

• Fixed, false beliefs based on incorrect inference about reality without factual basis
• Types of Delusions:
  • Grandiose Delusions: exaggerated sense of self-importance
  • Paranoid Delusions: suspicious, accusatory, or persecutory beliefs
  • Somatic Delusions: beliefs about bodily changes or sensations
  • Nihilistic Delusions: denial of existence of part of self
  • Religious Delusions: obsessive religious beliefs
  • Thought Broadcasting: believing one's thoughts are heard by others
  • Thought Withdrawal: believing thoughts are removed from one's mind
  • Alien Control Delusion: believing one's actions are controlled by external forces

Thought Content

• Delusions of Reference: believing events or people are related to oneself
• Obsessions: persistent, recurring thoughts or feelings
• Overvalued Ideas: believing an idea is more important than it actually is
• Persecutory Delusions: believing one is being persecuted or threatened

Speech and Language

• Latency: delay in responding to a question or prompt
• Volume: loud or soft speech
• Rate: rapid or slowed speech
• Rhythm: abnormal rhythm or cadence
• Tone: reduced or monotonous tone
• Prosody: abnormal pitch, stress, or intonation
• Perseverative Speech: repetition of words or phrases

Cognition

• Content of Thought: actual thoughts and ideas
• Affective Content: emotional tone or feeling
• Formal Thought Disorder: disorganized, circumstantial, or tangential thinking

Consciousness, Sensorium, and Cognition

• Alertness and Level of Consciousness: awareness of environment and surroundings
• Disorientation: disturbance of orientation in time, place, or person
• Clouding of Consciousness: decreased awareness and disturbance of perception and attitudes

Memory

• Remote Memory: recall of childhood events and important past events
• Recent Past Memory: recall of past few months
• Recent Memory: recall of past few days
• Immediate Retention: ability to recall information immediately
• Amnesia: partial or total inability to recall past experiences
• Paramnesia: distortion of recall
• Confabulation: filling gaps in memory with imagined or false experiences

Concentration and Attention

• Distractibility: inability to concentrate attention
• Selective Attention: ability to focus on important information and filter out irrelevant information
• Hyper vigilance: excessive attention and focus on internal and external stimuli

Capacity to Read and Write

• Ability to read and write simple sentences
• Ability to follow instructions and perform basic tasks

Visuospatial Ability

• Ability to copy a figure or design

Abstract Thinking

• Ability to deal with concepts and abstract ideas

Judgement and Insight

• Ability to assess a situation correctly and act appropriately
• Ability to understand the true cause and meaning of a situation
• Levels of Insight:
  1. Complete denial of illness
  2. Slight awareness of being sick, but denying it at the same time
  3. Awareness of being sick, but blaming it on others or external factors
  4. Awareness that illness is due to something unknown
  5. Intellectual Insight: admission of being sick and acknowledging failure to adapt due to irrational feelings
  6. Emotional Insight: awareness of being sick and willing to follow instructions or take medication