1 The Mental Status Exam & Screening for Neurological Injuries University of South Dakota Vermillion, South Dakota University of South Dakota Vermillion, South Dakota Dale Pietrzak, Ed.D., LPC-MH, CCMHC

2 Mental Status Exam: General u The MSE is analogous to the physical exam. The focus is the current signs, symptoms, affect, behavior and cognition. u Outline is the standard way of collecting the information u A good interviewer is not just listening to content. He or she is also observing affect, motor, speech, and thought processes.

3 Mental Status Exam: Outline u Appearance u Motor Behaviors & Skills u Speech u Affect u Thought Content u Thought Processes u Perception u Intellect u Insight u Mini-Mental Status Exam (pg 123) Zimmerman (1994) page

4 MSE: Appearance u Age u Sex, Race u Build u Position & Posture u Eye Contact u Dress u Grooming u Interaction Style u Attentiveness u Distinguishing features u Physical Abnormalities u Facial expression u Alertness Don’t I look good?

5 MSE: Motor u Retardation-Acceleration u Agitation u Abnormal Movements u Gait & Stance u Catatonia

6 MSE: Speech u Rate u Rhythm u Volume u Articulation u Spontaneity u Amount & Style And... Yabidy yabidy yabity yab...

7 MSE: Affect u Stability u range u Appropriateness u Intensity u Affect (in session) u Mood (patient’s report) I’m just so sad all the time. What should I do?

8 MSE: Thought Content u Suicide-Homicide u Obsessiveness, ruminations u Depressive u Phobias u Ideas of reference u Paranoia u Magical Ideation u delusions u Overvalued Ideas u Major themes I do not have a problem. My wife just does not understand I am a fish.

9 MSE: Thought Processes u Associations u Coherence u Logic u Stream of thought u Clang Associations u Perseveration u Neologisms u Blocking u Attention & Vigilance I am a special type of fish. I can be out of the water for... I see

10 MSE: Perception u Hallucinations u Illusions u Depersonalization u Derealization u Deja vu-Jamais vu I am telling you God spoke to me about it!

11 MSE: Intellect u Global evaluation (Below Average, Average, above Average) I am so bright... If he were any slower he could be outsmarted by his fish!

12 MSE: Insight u Current Awareness of Illness u Current Understanding of Causes u Current Acceptance of Treatment *$(%#

13 MSE: MMSE u 2nd Major aspect of MSE is to RULE OUT Neurological Difficulties u Screener for Gross Neurological Injury or Impairment u Late Adolescents, Adults and the Elderly

14 Why should the Mental Health Professional care? Hartlage (1990) It is almost inevitable that any practicing clinical, school, or counseling psychologist will encounter, in the course of professional practice, individuals who have sustained head injury.

15 Incidence Statistics l 9 million new cases a year l By age 60 the average American will have suffered 2 significant head injuries l Head injury is perhaps more common than any other single mental health etiology. l Typical head injury victim usually does not seek help (<1 in 20 hospitalized)

16 Brain Injury Fast Facts ï No linear relationship between severity of injury and severity of problems ï Mild injuries may not have lost consciousness, few overt signs of injury ï Often misdiagnosed depressed or PTSD ï IQ tests and related measures may mask some of the symptoms of head injury ï No single test type can screen for injuries ï Children often diagnosed ADHD

17 Some Symptoms of Injury l Depersonalization l Anxiety l Hostility l Irritability l Restlessness l Overactivity or underactivity l Balance Impairment l Nausea l Dizziness l Fatigue l Headaches l Malaise l Decreased Libido l Insomnia l Depression l Labile affect l Inappropriate Social Behavior

18 Fundamental Anatomy u Cerebrum u Cerebellum u Brain Stem u Cranial Nerves u Spinal Cord u Connective Nerves Central Nervous System

19 Assessment Components u History u Orientation u Screen Gross Motor Systems u Screen Fine Motor Systems u Screen Sensory Systems u Screen Mental Processes u Screen Verbal Processes u History u Orientation u Screen Gross Motor Systems u Screen Fine Motor Systems u Screen Sensory Systems u Screen Mental Processes u Screen Verbal Processes

20 OrientationOrientation u Time/Date u Place u Person u (body position /situation) Who am I? Where am I? What year is it?

21 Concentration & Attention u Vigilance (simple) u Vigilance (complex) u Concentration Are you on task?

22 Visual Processes u Tracking u Neglect u Suppression /Extinction u Tracking u Neglect u Suppression /Extinction Visual Quadrants

23 Auditory Processes u Hearing and Neglect u Suppression or Extinction What’d you say?

24 Tactile Sensation u Neglect u Suppression Reach out and touch someone.

25 Motor and Balance u Balance u Purposeful Movements Come on and move with me!

26 Language Processes u Auditory Comprehension u Written Comprehension u Confrontational Naming u Oral Expression u Written Expression What we have here is a failure to communicate.

27 u Short-Term Memory u Learning Curve u Recent Memory u Remote Memory u Retention u Short-Term Memory u Learning Curve u Recent Memory u Remote Memory u Retention Memory and Learning Now, what was I supposed to remember?

28 Construction/Spatial/Fine Motor u Bender u Clock Drawing u Complex Figure Test (Rey or Taylor) u Fine Motor Sequencing

29 Nonverbal & Tactile Processing u Rhythm u Tactile Comprehension u Rhythm u Tactile Comprehension

30 Reasoning & Judgment u Verbal Reasoning u Judgment & Problem Solving u Verbal Reasoning u Judgment & Problem Solving

31 The End Run for it!