Brief introduction and history
In nursing, nurses use different methods to obtain information from the patient to diagnose, such as physical assessment, review of systems, and history of the patients. On the other hand, psychiatrists use the Mental Status Examination (MSE) to assess the mental status of patients with mental disorders. In most cases, mental status examination explains the patient’s current state when the interview or the evaluation is being conducted. Adolf Meyer developed mental status examination in 1918 to set a standard outline to be used to assess the patient mental health status for the health professionals to avoid confusion in diagnosis (Voss RM, 2021). For the health professionals to obtain patient data, they combine passive observation and direct questioning of the patients to determine their mental status exam. The information of the data is to allow the health team or the interview to make mental health diagnoses and monitor the signs and symptoms. The mental status examination tool has different components, and each component describes or assesses a specific part of the mental function to obtain the subjective and objective assessment data. Other practitioners may organize the mental status examination tool differently, but they will collect information from the same area of focus. The tool is divided into broad categories: appearance, behavior, thinking disorders, perception disorders, mood and affect, judgment, insight, cognition, and vegetative symptoms (Liu et al., 2020). The broad categories are then subdivided into sections to allow adequate access to patient information for appropriate diagnosis and monitoring of the patients.
Population and why I select the assessment
In health care, mental status examination assessment tool is used by different healthcare professionals to obtain the current state of the patient’s mental state. For instance, nurses in the wards can use the mental status exam tool to assess the patient’s mental status. Together with the application of other assessment tools like the physical exam, a review of systems and the patient’s history can be used together with the mental status exam tool to provide actual problems that help give appropriate nursing intervention. However, the mental status exam is much more appropriate to be used by the health care professionals who are taking care or working in veteran facilities (Fu et al., 2021). Working with the veterans in the VA medical center is an excellent opportunity to use the assessment ideally, and it can help assist the veterans in need. I choose the mental examination assessment toll because most veterans go to war, and from their experiences, they have post-traumatic stress disorder that causes cognition impairment (Voss RM, 2021). This is because the veterans are passing through threatening, and the war is catastrophic, which causes mental disturbances, thus causing impairment of attention and memory. Because of the memory and attention impairment among the veterans, it will be instrumental for me to use the mental status examination assessment on the veterans since this will allow a proper assessment of the veterans and identify the clients’ needs. The tool will help me as a healthcare professional make the mental diagnosis and give the appropriate treatment and interventions that can help the veterans come out from their mental health problems.
The mental status examination has different categories or components that can be organized differently by the health care professionals. When dealing with the veterans, I can start with an appearance that describes the client’s general appearance. It entails the client’s grooming, hygiene, nutritional status, and prominent scars. This entails how the patient looks when conducting the assessment or observing the client. These observations are made within the first few seconds when the client interacts with the interviewer, while some are obtained throughout the interview process (Liu et al., 2020). After I check if the client looks older or younger than their actual age, I will also assess whether the client has any development delay and if the client is dressed inappropriately. From my observation, when the patient looks much older than the stated age, the client may be undergoing a severe medical condition. This may be due to either drug or substance abuse or the patient’s poorly controlled mental health illness. The client’s dressing or grooming and hygiene will tell the patient level of functioning(Voss RM, 2021). If the patient’s grooming and hygiene status are poor, the patient level of function is poor. This can be due to depression, negative symptoms of psychosis disorder, and neurocognitive disorder. The importance of scars and tattoos observation will help identify the client’s personality, behaviors, and personal history to help make a diagnosis. And to maintain a continuous conversation, the health practitioner must maintain trust between them and help clarify issues from the patient.
I will move to assess the patient’s behavior and movement. This entails how the patient acts during the interview. It is the role of the interviewer to identify whether the client is distressed or not, and the patient may feel distressed because of the underlying medical conditions that are causing the discomfort. It may mean the patient was brought into the clinic without their permission. The patient may also be paranoid, and when the hallucinations are severe, it can also cause a particular client to have discomfort. Behavior also entails the description of the interaction, whether the patient is corporative or non-corporative (Liu et al., 2020). I will also assess if the client’s behavior is congruent with the situation. If the other involuntary officers bring the client, I should not expect the client to be happy and smiling. I will assess if the patient can maintain eye contact and patient attitude toward me when conducting the interview. I will also check the movement, which describes how the patient is moving and what kind of movement the patient makes.
Assessment of motor activity is helpful to determine whether the client has any neurological and mental disorders(Voss RM, 2021). Moreover, I will include the posture and mannerisms of the client. Gait and posture will assess whether the patient is walking in an upright posture and steady, and any abnormal movements can lead to bradykinesia. The next step is to assess the speech that was evaluated passively when conducting the interview. The speech assessment will be described in rate, tone, rhythm, fluency, verbalization, and volume. I will assess the amount of speech the patient is speaking since it can signal the patient is suffering from anxiety or mood disorders when it is lower than usual. The speech is classified as either pressured, delayed, or slurred speech. Pressured client’s speech indicates that the patient suffers from a neurocognitive disorder.
The mood is the subjective description. This means the patient is to report how he is feeling at that moment. I will ask the patient to describe how they feel at this step. I will describe the mood using the quotation of how the patient states. The effect is the accurate description observed expression of the non-verbal language. The terms used to describe affect are restricted, elated, blunted, happy, sad, labile, agitated, euthymic, and flat. The mood and affect must be congruent with each other. The next step is to assess the thinking disorders. Thinking disorders include the thought process and thought content. The thought process is the expression of how the patient organizes thoughts. When the patient’s thought process is normal, it is goal-directed. The thought content is also the patient’s subject matter (Voss RM, 2021). So to assess the thought content, I will be listening to what the patient is saying and continuously questioning the client. So in thought content, I will assess the suicidal ideations, compulsions, delusions, phobias, and obsessions.
I will move to a perception that describes different types of illusion and hallucinations. I will assess the five different type’s hallucinations, tactile, gustatory, auditory, visual, and olfactory hallucinations. Usually, hallucination is the perception of something without an external stimulus, while illusion is the misperception of objects. I will then further assess cognition which consists of different branches; abstract reasoning, memory, orientation, concentration, and alertness (Fu et al., 2021). I will check the memory’s recent, immediate, and recall memory retention. The orientation is also divided into person, place, and time. I will assess abstract reasoning by asking the patient what he will do if given a particular object. Concentration will be assessed by using serial seven or serial three to assess the calculation ability of the patient. The final steps are insight, judgment, and vegetative symptoms(Voss RM, 2021). Insight is the patient’s awareness of being sick and within the facility. I will ask the patient whether he is aware of the place and why he is in the facility. Judgment is the ability of the patient to make a critical decision. I will also give the patient a scenario and expect a given an answer. A vegetative symptom includes the patient libido, sleep pattern, and appetite.
Summary of the findings
For the appearance, the patient may be addressed appropriately with the site, no odor, well-nourished, and no scars and tattoos. Behavior and movement; can be reported as upright and steady gait, no mannerisms and tics. The behavior can also be reported as calm and corporative and maintaining eye contact. Mood and affect; the mood is either euthymic, sad, or happy, while affect is blunted, elated, labile, and flat. Though the process can be retarded thought process, tangentially, circumstantiality, and flights of ideas, thought content is whether the patient denies any suicidal ideations, phobias, compulsions, obsessions, and delusions(Voss RM, 2021). Perception includes hallucination, and illusion can be poor or good, while judgment and insight might be poor or sound, and cognition also can be excellent or poor.
How it informs my clinical practice
The application of the mental status examination, when used together with other tools such as obtaining patient history, physical examination, review of systems, and laboratory test, can promote holistic care to the patient. When working with the patient, I would put it as a culture and include the MSE as part of the patient’s history. This is because mental status examination helps the health care team detect any psychiatric signs and symptoms. The assessment is also helpful in my clinical practice since it allows the health team to diagnose mental illness. It also allows me to identify the underlying condition of the problem and determine the patient’s levels of severity of the illness(Voss RM, 2021). Therefore I support that all healthcare teams should be trained on the use of mental status examination to be equipped with the skills to observe and monitor the patient progress of treatment.
Fu, X., Yu, W., Ke, M., Wang, X., Zhang, J., Luo, T., Massman, P. J., Doody, R. S., & Lü, Y. (2021). Chinese Version of the Baylor Profound Mental Status Examination: A Brief Staging Measure for Severe Alzheimer’s Disease Patients. The Journal of Alzheimer’s disease prevention, 8(2), 175–180. https://doi.org/10.14283/jpad.2020.72.
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Voss RM, M Das J. Mental Status Examination. [Updated 2021 Sep 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546682/