Comprehensive Mental Health Examination

Sample Answer

A comprehensive mental status examination (MSE) is vital in psychiatric assessment as it helps to identify, evaluate, and analyze patients’ signs and symptoms and establish a diagnosis. It involves clinical observation, asking questions, keen listening, and noting both positive and negative findings from the examination. The purpose of the paper is to describe the elements of an MSE and discuss its significance to the advanced practice nurse (APN).

Appearance

Appearance is the first element assessed in an MSE. It is a description of how the patient looks through observation. It includes an age estimation compared to the stated patient’s age, dressing, grooming, hygiene, and scars and tattoos (Neto et al., 2019). The APN needs to note that the level of patient functioning affects their grooming and hygiene. Poorly groomed patients are associated with poor functioning in conditions such as depression, schizophrenia, and organic brain damage.

Age estimation is important, especially when a patient appears older than they look, and may indicate conditions, such as severe medical and mental conditions or substance and alcohol abuse. Scars may indicate patients at risk of self-harm or injection sites for substance abuse.

Behavior

Behavior is a description of how the patient acts during the interview. According to Renn and John (2019), behavior includes general demeanor during the interview, rapport with the examiner, eye contact, and gait. This is significant to the APN as depressed patients are often anxious and apathetic, while patients with schizophrenia are often hostile, agitated, avoid eye contact, and are catatonic. The APN should identify motor abnormalities, such as acute dystonia and tardive dyskinesia, associated with first-generation antipsychotics.

Speech

Speech is evaluated as rate, rhythm, structure, and volume. Speech can help the APN diagnose various conditions. For instance, a slow rate is common in depression and anxiety, while an increased speech rate is common in manic patients (Neto et al., 2019). Besides, low volume is observed in depressed patients, while a loud volume is common in manic states.

Mood and Affect

Mood is a patient’s subjective expression of emotion, while affect is the objective observation of patient-expressed emotion. Neto et al. (2019) describe affect using terms such as euthymic, elated, depressed, irritated, angry, agitated, restricted, blunted, flat, broad, bizarre, full, labile, anxious, bright, elated, and euphoric. Affect can further be described as appropriate or inappropriate in relation to the emotion expressed. Mood and affect are significant to the APN as depressed and schizophrenic patients display blunt to flat affect, while manic patients commonly exhibit a labile affect.

Thought

Assessment of thought includes both content and process. The thought process is the logical organization of thoughts. It includes flight of ideas in manic patients, neologism in schizophrenic patients, and thought block in anxiety patients, which can help the APN make a diagnosis. Thought content includes what is in the patient’s mind and can be poverty of content or delusions. Renn and John (2019) describe delusions as firm, false beliefs not part of a cultural belief system and persist despite reasoning. Delusions can be paranoid, bizarre, persecutory, jealous, grandiose, nihilistic, or erotomanic, as seen in psychotic patients. The APN can suspect dementia and neurocognitive disorders in patients with poverty of content.

Perception

Perception is the process of transferring physical stimulation into psychological information or the mental processes by which sensory stimuli are brought to awareness. The common abnormality of perception is hallucinations, which are perceptions not based on a real stimulus. Hallucinations can be visual, auditory, gustatory, olfactory, or tactile (Renn & John, 2019). This is relevant to the APN as olfactory and gustatory hallucinations are common in epileptic patients, visual hallucinations in organic brain damage, tactile hallucinations in schizophrenia, and auditory hallucinations in schizophrenia, mania, and organic brain damage.

Cognition

Cognition includes consciousness, orientation, attention and concentration, memory, intelligence, and abstraction. The level of consciousness varies from alert to coma state. The APN can identify various causes of altered levels of consciousness, such as head injury, substance abuse, or severe medical conditions like Alzheimer’s. Orientation is the awareness of self and surroundings. Noone et al. (2020) describe delirium as a common neuropsychiatric manifestation of certain medical conditions that often result in loss of orientation. Thus, the APN must rule out delirium in patients with disorientation.

Attention and concentration entail assessing focus, evaluated by serial sevens, serial three, months of the year, or days of the week. This is relevant to the APN because anxious, manic, and depressed patients often show distractibility. Memory assessment is divided into registration and recent and remote memory (Renn & John, 2019). Breijyeh and Karaman (2020) describe memory loss as a neuropsychiatric manifestation of ongoing medical and psychiatric conditions. This is important as patients with chronic organic brain disease such as Alzheimer’s show memory loss that is often progressive.

Intelligence is the ability to understand, recall, mobilize, and constructively integrate previous learning in meeting new situations, often altered by dementia and mental retardation. Renn and John (2019) assert that intelligence can be assessed by a patient’s ability to read and write or solve simple mathematical questions. Abstraction is the ability to appreciate nuances of meaning and multidimensional thinking with the ability to use metaphors and hypotheses appropriately, often proverbs (Renn & John, 2019). The absence of abstract thought is often seen in schizophrenia and neurocognitive disorders.

Insight

Insight is a person’s ability to understand the cause and meaning of a situation or illness. Insight can be present, partial, or absent (Renn & John, 2019). The APN can identify the absence of insight, which is common in schizophrenic and some depressed patients.

Judgment

Judgment forms the basis of decisions made. According to Gilla et al. (2021), assessment of judgment is done by giving patients a situation and asking them how they would respond. Judgment can be fair, poor, or limited based on the patient’s response. Assessing judgment is significant to the APN as impaired judgment commonly occurs in psychosis and depression.

Conclusion

The MSE is an important part of psychiatric evaluation employed by mental health practitioners. The comprehensive MSE includes different sections used to assess patients through observation, asking questions, and listening. The assessment helps in establishing a diagnosis and prognosis of psychiatric patients.

References

• Breijyeh, Z., & Karaman, R. (2020). Comprehensive Review on Alzheimer’s Disease Causes and Treatment. Molecules (Basel, Switzerland), 25(24), 5789. https //doi.org/10.3390/molecules25245789
• Gilla, D., Rana, D. K., & Deepak, K. P. (2021). Application of mental status examination in homeopathic prescribing. International Journal of Homoeopathic Sciences, 5(3), 224-230. https //doi.org/10.33545/26164485.2021.v5.i3d.427
• Neto, H. G. R., Estellita-Lins, C. E., Lessa, J. L. M., & Cavalcanti, M. T. (2019). Mental State Examination and Its Procedures-Narrative Review of Brazilian Descriptive Psychopathology. Frontiers in psychiatry, 10, 77. https //doi.org/10.3389/fpsyt.2019.00077
• Noone, R., Cabassa, J. A., Gardner, L., Schwartz, B., Alpert, J. E., & Gabbay, V. (2020). Letter to the Editor New onset psychosis and mania following COVID-19 infection. Journal of psychiatric research, pp. 130, 177–179. https //doi.org/10.1016/j.jpsychires.2020.07.042
• Renn, B. N., & John, S. E. (2019). Mental Status Examination. Diagnostic Interviewing, 77–102. https //doi.org/10.1007/978-1-4939-9127-3_4