HUBERT KAIRUKI MEMORIAL UNIVERSITY FACULTY OF MEDICINE DEPARTMENT OF BEHAVIORAL SCIENCE COURSE;BEHAVIORAL SCIENCE TOPIC:MENTAL STATUS EXAMINATION FACILITATOR : ISACK LEMA

GROUP MEMBERS MELUBO NYANGE MUHAJIRI MOHAMED BIYA MARYAM MGIMBA LIMBU SINGA GILYA GEOFREY MAZIKU JERINA

OBJECTIVES -To understand mental status examination -To be able to assess mental disorders -To understand how to apply mental status examination test in solving mental disorders

Outline .Definition of Terms .Introduction .Main body .Summary .Conclusion .Recommentation .Reference

Definition of Terms Affect-the observed expression of emotion Catatonia-A severe disturbance of motor functions ussualy indicated by decreased activity Circumstantiality-Talking more around a point before finally getting to it Compulsion-repetitive behaviour which the person feels compelled to perfom Depersonalization-A subjective sense of being unreal strange or unfamiliar

Definitions of Terms Derealization-A subjective sense that the enviroment is strange or unreal Insight-refers to borth the individual’s awarness of a problem or illness and to the nondelusional understanding of its causes Judgement-the process of forming an opinion or conclusion based on information about a situation and recognize the important elements of an issue

Introduction Mental status examination is a clinical assessment of the individual which reflect borth individual’s subjective report and experience, and the clinicians observations at the time of interview. Its used to establish a baseline, evaluate the change over time, facilitate diagnosis, plan effective care and evaluate response to treatment. Like any clinician mental status examination is one which enhanced through practice, clinal supervision and feedback. This learning package will be helpful to you as you acquare knowledge to conduct this important clinical skills.

Main body There is variations in how clinicians organize and conducts the assessment. However the following content areas should be addressed in any comprehensive assessment of the mental status.

APPEARANCE, ATTITUDE AND BEHAVIOUR Describing Appearance Appearance can provide valuable clues to a person’s mood, cognitive state, self awareness, presence of the thought disorders, motor condition and general physical health. Description of appearance in mental status examination should include unusual physical characteristics(shaved head,tattoos), approximate height and weight (obesity or thinness), hygien, level of eye contact, and fascial expression in relation to thought content.

Describing Attitude in describing attitude we consider borth individual’s attitudes towards the interview and interviewer. The individuals attitude may influnce the conents of informations obtained and may pose special challengs to an intrviewer. The clients attitude towards the interviewer may be described in terms such as cooperative or uncooperative, defensive, hostile or threatening.

Describing Behaviour description of behaviour should provide a mental image of a person during the interview. The documentation of behaviour in mental status examination should include abnormalities in the level of behaviour, any abnormal or involuntary motor activities or behaviour, repeated or distinictive behaviour. Its important to describe actual behaviour( e.g constantly wringing hands) rather than simply starting your interpretation of behaviour( e.g appear anxious).

MOOD AND AFFECT Describing mood is a sustained emotion, subjectively experienced and reported by an individual and observed by others. Clients should be encouraged to describe their emotional state in their own words. mood is often described as depressed(sad), happy, angry, anxious, apathetic,hypomanic.

Describing affect Affect is the observed expression of emotion. A person’s affective state consist of several components which are objectively observed. It should be monited throught the interview. Written descriptions of affect in the mental status examination should be characterized in term of its range, change pattern and intensity.

SPEECH AND LANGUAGE Describing the speech and Language In this portion the interviewer evaluates and documents the physical characteristics of the speech and individuals use of language. Evaluation of the speech and language can provide important clues to an individual’s physical and mental state, thought processes, cognitive organization and interlectual capacity. Specific characteristics of speech which should be described are Rate, Volume and Quality.

THOUGHT AND PERCEPTION In evaluation of thought and perception the interviewer assess how well a person formulates, organizes and express their thought as well as abnormalities in thought contents or perception. Evaluation of thought process Evaluation of thought involves assesment of process( the way aperson thinks) and contents( whats a person thinks). The comprehensive evaluation of thought process involves thought rate, thought flow and thought form.

Abnormalities in thought process Its important to assess and document the presence or absence of significant abnormalities in thought process. This assesment is inferred from communication or from direct questioning of the client regarding what their thought are like. The abnormalities includes Tangentiality, circumstantiality, flight of ideas, perseveration, neologism and thought blocking.

Evaluation of perception perceptual disturbances may be experienced in reference to the self or enviroment. The perceptual abnormalities includes -Hallucinations -Illusions -Depersonalization -Derealization

COGNITION Cognition is the ability to know and think using logic, reasoning, memory and all high cortical functions. In contract to other aspects of mental status exam, cognition is tested in structed way. In cognition the following will be assesed orientation, memory, calculations, reading, writing capacity and language.

Evaluation of orientation orientation to person,place and time is a basic cognitive function. Essentialy this mean that a person knows who they are, where they are, and the date or day of the week. A hospitilized person may not know the exact date, but should remains clear on month, season and year and be close to the day of the week.

Evaluating level of consciousness the overall level of consciousness should be documented. This is typically characterized as along a continuum from alert to drowsy. Evaluating attention and concentration Attention is the ability to focus and direct cognitive processes. Simple test of attention include asking the person to name 5 things that starts with the same letter.

Evaluation of memory memory impairement can be symtomatic of a number of conditions including depression and cognitive disorders. Its important to asses borth short and long-term memory. The aspects of memory which should be assessed are recall,recent and remote.

Evaluating reading and writing this may be evaluated by asking the person to read a sentence and then do what the sentence say. For instance ‘close your eyes’. The person should also be asked to write the short but complete sentence.

INSIGHT AND JUDGEMENT Insight and judgement are complex cognitive task which requires the utilization and intergration of mental functions. The ability to make a sound judgement require an adequate level of insight and insight require critical ability to evaluate the potential repercussions of one’s behaviour.

Evaluate insight Insight is the ability to be self aware. Involve the capacity to examine many aspects and consequences of issue before forming opinions or making a decision. Sample question to elicit degree of insight includes ‘what has brought you here today’, ‘what do you think is a problem’.

Evaluating judgement judgement is a process of forming an opinion or conclusion based on information about a situation that can lead to a decision or action. Example of questions in assesing the judgement includes. ‘what would you do if you the train comes towards you on the track?’

SUMMARY AND CONCLUSION To perform mental status examinatination, the medical personel should combine the following during assessment to give out the best treatment to the patient, apperance, attitude, behaviour, mood, affect, speech, language, thought, perception,cognition, insight and judgement.

RECOMMENTATIONS Mental status examination is very important in medical field since some patient do not show the symtoms of mental illness unless are examined using this test. By applying this test the mental illness will be discovered and treated effectivelly.

REFFERANCE -Mental status assessment, American journal of Nursing. August 1493-1517 -The psychiatry mental status examination, New York 1993 -www.heaIthforum.com