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??”