MAMATA COLLEGE OF NURSING KHAMMAM Date: Time: SUBJECT: CLINICAL SPECIALTY PSYCHIATRY- II TOPIC : MENTAL STATUS EXAMINATION GUIDE:

MRS.ASHA KUMARI ASST. PROFESSOR PRESENTED BY: UDAYA SREE.G M.Sc. (N) II YEAR SEMINAR ON MENTAL STATUS EXAMINATION
MES is used to identify the persons present mental status. DEFINITION Assessment of general motor behavior, thought, emotional functioning along with evaluation of insight and judgment of the patients present status. -BIMLA KAPOOR, 2002 Systematic evaluation of behavior, emotions, cognitive functions of an individual. -K. LALITHA, 2007 ASPECTS OF MES 1. General behavior and appearance 2. Speech or talk 3. Mood or affect 4. Thought 5. Perceptual changes 6. Orientation 7. Memory 8. Judgment 9. Insight 10. Attention 11. Concentration GENERAL BEHAVIOUR Well kempt/ moderately kempt/ ill kempt/ overtly kempt Conscious/ cloudy/ withdrawn/ stupor/ drowsy/ unconscious or coma Nature of medication being received by the client The degree of cooperativeness/ non cooperativeness Understanding 1

Effect of drugs Alert/ woken up from sleep; looks comfortable/ uncomfortable Dressing: adequate/ any peculiarities Comprehension: intact/ impaired Mode of entry: come willingly/ persuaded/brought by using physical force Eye to eye contact: maintained/ difficult/ not maintained Psychomotor activity Attitudes towards examiner: cooperative/ guardedness/ hostility/ attentiveness Rapport: spontaneous/ difficult/ not established/ empathetic relationship Gestures: grimace/tics or mannerisms/ normal/odd/ exaggerated/ compulsion/ rituals Posture: open or closed / catatonic posture Physique and body built: height and weight Gait: staggering/ small steps/ confident walk Facial expressions: closed eyes, sad looks or happy looks on the face Motor activity: normal/ increased/decreased Extra pyramidal symptoms/ abnormal movements,(tics/ tremors/ akathisia) Sleep and eating pattern Pseudo seizures, possession state Compulsive acts, rituals or habits(eg nail biting) Reaction time

SPEECH OR TALK Initiation: spontaneous/ speaks when spoken to/ minimal/ mute/ hesitant or mumbled Talk: relevant/coherent/ spontaneous/ retarded/ irrelevant/ some times off targeted Tone and volume: tempo/ modulations/increased / decreased / low/ high/ normal pitch Speech activity: unusual pattern/ unusual words Rate: normal/ rapid or over talkative / talking little/ slow Productivity: monosyllabic/ pressured speech/ elaborate replies Stream: normal/ circumstantiality/ tangentiality Coherence: fully coherent/ loosening of association Others: rhyming/ echolalia/perseverance/ neologism/ clang association Sample of speech: responses to open-ended questions Speech pattern to: frighten/command/ distract

MOOD OR EFFECT It is a pervasive feeling tone which is sustained. Affect is the subjective immediate experience of emotions Appearance is the index of mind Intensity of happiness Sadness Irritability Anger Suspiciousness 2

Fear Worry Restlessness Labile Blurred Flattened moods Consistency of mood and related to the topic Shallowness/ superficiality/ absence of mood/ euphoria Reactivity Diurnal variations Congruity Liability Subjective and objective feeling

THOUGHT PROCESS Observation of the clients attitudes towards various people and things in the environment in the forms of ideas Stream: flight of ideas/ circumstantiality/ perseverance/thought block/ tangentiality/ clang association/neologism/racy thought/ unclear thinking/ poverty of thoughts or retardation of thoughts Content: Delusions Phobias Guilty Hypochondriasis Religiosity Obsessions Grandiose Form: normal/ formal thought disorders Ideas: hopelessness/worthlessness/ suicidal ideas/ helplessness Poverty/reference/ control/ bizarre/ persecution Doubts/ impulsive rituals Thoughts alienation phenomenon: thought insertion/ withdrawal/ thought broadcasting Obsessions/ compulsions/ thought images Abstract thinking: ability to assume a mental set voluntarily Shift voluntarily from one aspect of situation to another Keep in mind simultaneously the various aspects of a situations PERCEPTION 3

Illusions Hallucinations: auditory/ visual/ olfactory/gustatory/tactile Modalities Abnormal vestibular sensations Passivity (somatic 0 9 presence of strange sensations described by the patient as being imposed on the body by some external agency, patient will be passive recipient o Depersonalization/ derealisation o o o o o CONGNITIVE FUNCTIONS Level of consciousness: conscious or alert/ confusion/ clouding/delirium/ stupor/coma Time: correct time/ orientation to date/ day/ month/ year/season Place: area name/ city/ nation/ location Person: himself and recognizes self Attention: normally reacting to the call/ aroused/aroused with difficulty/sustained ( digits counting forward and back ward test) Concentration: normally sustained/ sustained with difficulty/ distractibility Name of months and weeks days( forward and back ward) Memory: Immediate memory: telling and ask the client to grasp and repeat immediately Recent memory: ask the client who brought him to hospital, when he came, give an address to memorize and ask to recall 15 minutes later Remote memory: personal events like marriage date, situations during marriage or the job, impersonal events- situation related to environment. Events related to illness- with what complaints the illness started, where he has taken treatment. Intelligence: It is the ability to think logically, act rationally and deal effectively with the environment Enquire about clients- scholastic performance general knowledge and general information Arithmetic ability Interpretation of proverbs Similarities and dissimilarities between paired objects Refer to psychologist to carry out intelligence tests INSIGHT It is the degree of awareness and understanding that the patient has regarding his illness. Clinical rating of insight on point scale Complete denial of illness Slight awareness of being sick and needing help, but denying it at the same time Awareness of being sick, due to something unknown in self Awareness of being sick but it is attributed to external or physical factors Intellectual insight: awareness of being ill and the symptoms or failures in social adjustment are due to own particular irrational feelings/ thoughts. 4

 True emotional insight: the awareness leads to significant changes in the future behavior and personality

JUDGEMENT Judgement is based on his knowledge, educational levels, intelligence, alert. Judgement is made regard to client and his social setting. It is the ability to assess a situation correctly and act appropriately within that situation For example, testing by means of interpreting proverbs giving a problematic situation and asking for salvation of problem Types: Social judgement Test judgement- asking the client, to test certain situations Personal judgement ABSTRACTABILITY Similarity, differences, interpretation of given situation

SUMMARY Mental status examination is very important for to detect behavioral abnormalities of the client. It is used to identify the persons present mental status. It consist of general behavior, speech, mood, perceptions, orientation, memory, judgement, insight, attention and concentration. BIBLIOGRAPHY

K.P. Neeraja. Essentials of mental health and psychiatric nursing, Volume-1; Jayapee brothers publication, 2008 Bimla Kapoor. Psychiatric nursing, Volume-2, Pearsons publications, 2005 Sreevani. Psychiatric nursing, Volume-1, Suresh kumar publications 2004 Mary C. Townson. Psychiatric and mental health nursing, Jayapee brothers publications, 2009

Madhavi K. Essentials of mental health and psychiatric nursing for nurses, Vijams series publications, 2009: 34- 42
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MAMATA COLLEGE OF NURSING KHAMMAM Date: Time: SUBJECT: CLINICAL SPECIALTY PSYCHIATRY- II TOPIC : MENTAL STATUS EXAMINATION GUIDE: MRS.ASHA KUMARI ASST. PROFESSOR PRESENTED BY: UDAYA SREE.G M.Sc. (N) II YEAR

MASTER PLAN ON MENTAL STATUS EXAMINATION I. II. III. Introduction Definition Aspects of mental status examination
i. ii. iii. iv. v. vi. vii. viii. ix. x. xi. General behavior and appearance Speech or talk Mood or affect Thought Perceptual changes Orientation Memory Judgment Insight Attention Concentration

IV. V.

Summary Bibliography
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