2. THE MENTAL STATUS ASSESSMENT

3. THE MENTAL STATUS EXAM IN CONTEXT Part of a comprehensive intake and assessment Although not a formal psychometric instrument, it is essential Informs any/all assessment procedures Can result in a provisional diagnosis (working hypothesis)

4. THERAPIST APPROACH TO THE MSE Orient to the task Establish rapport Position of the therapist Safety considerations Combination of therapist skills Observation Inquiry Observation/inquired MSE in the context of intake/work-up Record review Intake paperwork

5. THERAPIST APPROACH TO THE MSE (CONT.) Important!! When conducting a MSE, investigate, observe, notate, inquire! Counseling skills and approach are essential Counseling/therapy does not happen during the MSE **see Polanski reading pg. 361

6. MSE: TYPICAL DOMAINS Appearance Behavior/Activity Mood/Affect Speech & Language Thought Processes, Content, Perception Cognition Insight & Judgement

7. APPEARANCE Observation Grooming Poise Clothing (appropriate for weather) Body-type/nutrition Age Presentation of self Cultural sensitivity essential

8. BEHAVIOR/ACTIVITY Observed Quantitative & Qualitative Looking for: Psychomotor agitation Psychomotor retardation Akathesia

9. MOOD & AFFECT Inquired/Observed Mood –subjective report of “the way they feel” Emotion perceived by client Affect –How the client presents Examiner looking for: Congruence/incongruence Appropriateness

10. SPEECH & LANGUAGE Observed Describe it... Physical characteristics Relevance to topic Paralinguistic loudness Rhythm Intonation, phonation Articulation coherence

11. THOUGHT PROCESSES, CONTENT, PERCEPTION Observed/Inquired Perception Hallucination or illusions? Hallucination –false perception without sensory stimuli Auditory, Visual, Tactile, olfactory Illusion –misperception of sensory stimuli Auditory, Visual

12. THOUGHT PROCESSES, CONTENT, PERCEPTION (CONT.) Thought & Thought Content Form of thought –the way in which a person thinks and gets it across Flight of ideas Loose associations Tangentiality

13. THOUGHT PROCESSES, CONTENT, PERCEPTION (CONT.) Content of Thought Description of what the client is actually thinking about, what is inside their head... Delusions, paranoia, suicidal/homicidal Delusions: fixed false beliefs that are usually not bizarre and therefore believable

14. COGNITION/ SENSORIUM Observed/Inquired Alertness, Level of Consciousness Orientation to time Orientation to place Orientation to person Note: distinguish between dementia and disassociation

15. COGNITION/ SENSORIUM (CONT.) Memory Recent Remote Recent past Immediate retention Recall (Don’t forget to check it out)

16. COGNITION/ SENSORIUM (CONT.) Concentration & Attention Serial 7’s or 3’s Can you spell _______ backwards Errors in mood disorders

17. COGNITION/ SENSORIUM (CONT.) Check capacity to read/write Visual spatial ability (complex figure) Abstract thinking Fund of information Impulse control

18. INSIGHT & JUDGMENT Insight –refers to the awareness of how one’s own personality traits and behaviors contribute to what is troubling the client Judgment –process, and formulation that leads to a decision about an appropriate course of action to achieve realistic goals. Judgments require adequate insight and cognitive functions

19. UNDERSTANDING THE MSE -- BARRY http://youtu.be/6ss827LbbtA

20. PRACTICE In your groups: 1.Perform a MSE on your client – record it 2.Role play the client/therapist 3.Complete provisional axis diagnosis 4.Begin to choose your assessments