Mental Status Examination (MSE) And Its Significance In Psychiatry

What is the Mental Status Examination (MSE) process?

Discuss about the Mental Status Examination Process.

Mental status examination (MSE) is an integral component of clinical assessment procedure in the practice of psychiatry. It involves describing the patient`s psychological condition at a given point in time the domains of appearance, attitude and behavior, perception and judgment. MSE targets at obtaining a comprehensive description of the patient`s mental status. When this is combined with historical information, accurate diagnosis can be drawn which is essential for a coherent planning of treatment (Daniel and Gurczynski, 2010).

Thought content is the description of a patient’s delusions, phobias, overvalued ideas or preoccupations. To establish thought content abnormalities, it is important to explore the patient’s thoughts in the open ended conversation. This will enable establishments of salience, emotion-related thoughts and level of conviction with relation to the ideas (House, 2014).Delusion can be referred to as a false and unshakable belief or idea as a result of some educational or cultural background. Annabelle constantly asks for forgiveness for wronging me even when she has done nothing wrong; this means she is guilty hence possibility of a mental condition abnormality (Daniel and Gurczynski, 2010).

Thought form, on the other hand, may be an indication of specific problems. Possibility several disorder types like tangentiality and derailment and may also indicate psychosis. It is the formation of the process by which thought are coherent and determinable by how a person speaks and expresses their ideas. Usually, they may give very irrelevant comments and change from topic to topic frequently. Annabelle is excessively vague and full of nonsense. She interrupts me by frequently in our conversation claiming that every one of us is falling. Thought form may illustrate the quantity and pace of thought of an individual. It cannot be directly observed but inferred from how the patient speaks. Annabelle`s theory are so rapid that her speech may seem incoherent. By watching keenly, a chain of Sapphic relationships may be realized. This is the case of Annabelle. Thoughts could also retard in which ideas may move slowly with very few associations (House, 2014).

Define perception as it relates to an MSE and then discuss how we might interpret how Annabelle may have some disturbance in one or more of her senses?

An important concept in mental health is how one perceives the world around them. Mentally ill people may view thing differently from the normal counterparts. The perceptions and distortions can be corrected by therapy (Toni and Frossard, 2011).It us a broad sensory experience and is characterized by disturbances like hallucinations and illusions. Hallucination is the visual perception when an external stimulus is absent. It is experienced in objective space. On the other hand, an illusion is a false sensory perception when an external stimulus is present.  This means illusions are distortions on sensory experiences (Toni and Frossard, 2011).

Understanding Thought content and abnormalities in MSE

Pseudohallucinations are expertise in the subjective space; it is akin to fantasy (Voices in my head). In My case, Annabelle sobs continuously and makes statements suggesting she sees something we all cannot see. She even asks me I can hear what they are saying, this is pseudo hallucinations. The same can be characterized by the patient losing a sense of time or distortion of the sense of self and reality. Hallucination can occur in any of the five senses though it is common for the auditory and visual. Patients may hear voices telling them to commit suicide (Toni and Frossard, 2011).

It is important that screening is done for perceptual disturbance; this may enable detection severe mental illness. Psychosis is rare in young people but its peak the onset falls between 19 to 22 years. Annabelle seems to want to obey the voices that command her to perform some actions; this may engage them to perform behaviors that are dangerous to themselves or others. The feeling of anxiety brings them depersonalization and de- realization (Heine, 2015).

The human sense organs pass signals to the brain through the central nervous after receiving the stimulus. The mind interprets the information after that. People`s attitude and emotions can affect perception. A terrible experience might be ingrained in the brain such that Annabelle is not acting in a rational manner when encountered by similar experiences. This perception may even be false; she could even be hearing completely different words from what was originally spoken (Heine, 2015).

Define both ‘affect’ and ‘mood.' How would you describe Annabelle’s attitude and the range and intensity of her affect?

The two words have been commonly disagreed about regarding definition with respect MSE. Different scholars have defined them differently.  Mood, however, is the internal predominant state of an individual which normally is the prolonged disposition state. On the other hand, affect is the external manifestation of an individuals` internal state of emotional feelings which are differentiated and accurate (Hunt and Smyth, 2013).

 Mood can be defined from the words used by the patient; it can be described using the word like angry, euphoric, anxious or angry. Annabelle`s mood is dysphonic since she experiences a state of unease and dissatisfaction. This feeling may accompany depression or anxiety and agitation. It may also refer to not being comfortable in the current body. My patient is very restless.   Moods last longer than other feelings and results from tension and energy. Moods do not have to be triggered by certain stimuli (Schmid et al. 2011).

Understanding Thought form in MSE

Affect is the apparent emotion displayed by an individual’s nonverbal behavior; it may be sad or anxious. The parameters of appropriateness, intensity, and range may also convey affect. It can also be described as either appropriate or inappropriate depending on the current state. Annabelle displays an improper effect which can be described as exaggerated. This effect suggests that she could be suffering from certain personality disorders. Her affect is also mobile throughout the conversation. In an interview, it is important to analyze the patient's facial expression as to whether they are laughing, smiling, insulting happy or angry (Hunt and Smyth, 2013). Annabelle is suspicious of everybody around her. She is uncomfortable when she first sees me. She screams asking for forgiveness when the nurse and the guard get in (Schmid et al. 2011).The affect will be the immediately observed or expressed emotion when I interact with the patient. When the state of a feeling can be found, it then becomes an affect.

Giving examples from the Case Study, how would you describe her behavior and her appearance as set out in an MSE?

The distinction between abnormalities and normality as the ability to conduct one`s self by environment. Behavior entails observing what a person does during the mental examination process. To understand the behavior of a patient, it is important to pay attention to the behaviors which are described as the nonverbal communication. The behaviors can reveal a person’s attitude and emotional state. In studying behavior, the eye contact is observed. Her postures and mannerism are critical in an analysis. She has some trust in me to smile at me and asks me not to reveal our discussions with her to the mother. Mentally abnormal individuals portray these characteristics.

Annabelle is portraying a tensed behavior on her arrival to the hospital. Furthermore, she is very restless as she is moving up and down the corridors of the facility. Her staring to the ceiling or the staff members is intense. The manner in which she is gazing is apparently hostile, afraid and intrigued. She cannot sit still for longer periods of time. She even refuses to heed to her mother’s pleas to stay calm. Despite the adherence to enter into the room, she is still afraid of physical contact. When I enter the room to attend to her, she wrings her hands and sweats, with her pupils extremely dilated (Semple and Smyth, 2013). In relation to MSE, this instability and restlessness could be an indication of mental condition abnormality.

 Appearance is a component that clinicians assess to help them in the determination of the patient’s condition. Evaluations on appearances would be based on grooming, height, and the hygiene. Appearances guide on the quality of health care to give, the patient’s lifestyle and their living skills. Annabelle is in her early adulthood. Her dressing is concerning, she is in dirty jeans and T-Shirt. She is also bear foot with matted unkempt hair dyed in blue and pink. There are several piercing in her nose, lip, and eyebrow. This unusual appearance on her hair might suggest mania. The dirty clothes might also be an indication of depression (Shoemaker, 2010). These are all indications of mental condition abnormality.

References

Daniel, M. and Gurczynski, J., 2010. Mental status examination. In Diagnostic interviewing (pp. 61-88). Springer US.

Heine, S.J., 2015. Cultural Psychology: Third International Student Edition. WW Norton & Company.

House, R.M., 2014. The mental status examination.

Hunt, J. and Eisenberg, D., 2010. Mental health problems and help-seeking behavior among college students. Journal of Adolescent Health, 46(1), pp.3-10.

Schmid, P.C., Mast, M.S., Bombari, D., Mast, F.W. and Lobmaier, J.S., 2011. How mood states affect information processing during facial emotion recognition: an eye tracking study. Swiss Journal of Psychology.

Semple, D. and Smyth, R., 2013. Oxford handbook of psychiatry. Oxford University Press.

Shoemaker, D.J., 2010. Theories of delinquency: An examination of explanations of delinquent behavior. Oxford University Press.

Toni, L. and Frossard, P., 2011. MSE cross-layer optimization criteria: What else?. IEEE COMSOC MMTC E-Letter, 6(2), pp.13-16.