Assessing Mental State March 2002 Assessing Mental State Or Looking, Listening and Asking J Bryant NMMH

Mental State Assessment Assessing Mental State March 2002 Mental State Assessment Mental state can and does change over a shift, day or week - important to document changes Brief MSE on all patients, not just those with mental illness Gives indication of person’s thinking (cognition) feeling (mood) and behaviour J Bryant NMMH

Psychiatric Assessment Assessing Mental State March 2002 Psychiatric Assessment Composed of two parts history mental state assessment (MSE) History is static previous psychiatric history, medical, personal including developmental, relationship, education, employment, social MSE changes J Bryant NMMH

Mental State Assessment Assessing Mental State March 2002 Mental State Assessment General Description Mood Affect Speech Thoughts Perceptions Cognition Insight Judgement J Bryant NMMH

General Description LOOKING Assessing Mental State March 2002 General Description LOOKING Level of Consciousness drowsy, alert, sleeping, fluctuating Appearance grooming, makeup, posture, clothing, obvious physical deformities or characteristics Behaviour eye contact, level of activity, body language, mannerisms, specific activities J Bryant NMMH

Mood Affect ASKING LOOKING Assessing Mental State March 2002 Mood Affect ASKING LOOKING Subjective How do you feel? How has your mood been lately? How are your spirits? How do you feel in yourself? Objective Facial and bodily expression of mood state Appropriate to content? Range J Bryant NMMH

Assessing Mental State March 2002 Speech - LISTENING Physical qualities amount, volume, tone, speed, clarity Spontaneity Impairments Accents J Bryant NMMH

Thoughts ASKING AND LISTENING Assessing Mental State March 2002 Thoughts ASKING AND LISTENING Form amount - poverty, flight of ideas, vague continuity of ideas - incoherent, blocking, circumstantial, tangential, irrelevant disturbance in meaning or use of language - neologisms, word salad Content - delusions, obsessions, compulsions, suicidal ideation, phobias, preoccupations Logical, can you understand what pt is saying? Do they stick to the topic? Words that don’t exist, or conversations that don’t make sense Content - what pt wants to talk about the most Obsessions persistent thought that cannot be ignored - may be absurd or meaningless Compulsions uncontrollable urges to repetitively perform an act. Assessing for Delusions Have you had any trouble getting on with other people? Have you felt that someone is against you? Has anyone been trying to harm you? Do you feel (or believe) you have special powers? Do you worry about your body a lot? Have you thought others were talking about you when you went into a room (or a bus, train)? Have things you've seen on T.V. or heard on the radio have special meaning for you? Have you ever received special messages? Do you have a special relationship with God? Have you ever felt that your thoughts were being broadcast so others could hear them? Have you ever felt that someone else was putting thoughts in your head? Have you ever felt that your thoughts were being taken away by someone or something? J Bryant NMMH

Questions to elicit suicidal/self-harm ideation Assessing Mental State March 2002 Questions to elicit suicidal/self-harm ideation How do you feel right now? How would you describe your mood? Have you thought you would be better off dead? How strong are these thoughts? Have you thought life is not worth living? Have you thought of suicide? Have you made a plan? If yes do they have access to means? When would you do this? J Bryant NMMH

Questions to assess dangerousness Assessing Mental State March 2002 Questions to assess dangerousness I can see that you are angry. Do you feel like hurting someone? Am I safe with you? What has made you angry? J Bryant NMMH

Perceptions LOOKING, LISTENING, ASKING Assessing Mental State March 2002 Perceptions LOOKING, LISTENING, ASKING Hallucinations false sensory perception any of the senses occurs in the absence of a stimulus Illusion misinterpretation of sensory stimulus J Bryant NMMH

Cognition ASKING and LISTENING Assessing Mental State March 2002 Cognition ASKING and LISTENING Orientation time, place, person, situation Memory Concentration Attention MMSE J Bryant NMMH

Assessing Mental State March 2002 INSIGHT JUDGEMENT Are they aware that they are ill and understand the effects and implications? Good, partial or poor? Has patient history of impulsivity? Can they accurately assess a situation and act appropriately in response? Intact or impaired J Bryant NMMH

Documenting Use everyday language Assessing Mental State March 2002 Documenting Use everyday language Mr Brown has been quiet and withdrawn all day. He has refused all meals and he said he couldn’t be bothered to have a shower . He has stayed in bed facing the wall. When the wardsman came to shave him, said he didn’t want to be a burden. When questioned about his spirits he said they were “pretty low”. Denied suicidal ideation but said “it would be better for everyone if he died”. J Bryant NMMH

Assessing Mental State March 2002 Documenting Miss Smith has been very confused today. She was upset at breakfast because she thought she should have been given an evening meal. She asked when her mother was going to take her to the shops. She put on her clothes inside out and kept going through other people’s lockers. She became angry and attempted to hit staff Told other patients that there were cameras in the ceiling. Said the year was 1964 J Bryant NMMH

Mini Mental State Examination Assessing Mental State March 2002 Mini Mental State Examination Screening tool for cognitive impairment- mild to moderate Does not differentiate between delirium and dementia Used to detect impairment, to follow course of illness, to monitor treatment response Affected by education, intelligence, age, literacy and culture J Bryant NMMH