The Comprehensive Mental Status Examination
QUESTION
For this assignment, list the parts of a comprehensive mental status examination (MSE) for mental health patients. Give examples of each and describe the significance to the advanced practice nurse.
The Comprehensive Mental Status Examination
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The Comprehensive Mental Status Examination
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The Comprehensive Mental Status Examination
The comprehensive mental health examination (MSE) consists of a structured assessment issued by the health physicians to evaluate their cognitive and behavioral functioning. It includes a wide range of the patient’s description, especially on their appearance, speech activity, general behavior, motor, level of consciousness, perception, and thought. Further, aspects such as the patient’s attitude, cognitive ability, mood, and effect during the exanimation also get examined. Specifically, cognitive functions such as patient alertness, abstract reasoning, language, memory, and constructional ability are clinically considered relevant. A nurse’s familiarity with these components is essential because they can help examine and differentiate psychiatric disorders (Arya and Rentala, 2020). This paper aims to explore the parts of a comprehensive mental status examination and their significances to the advanced practice nurse.
Parts of a Comprehensive Mental Status Examination
The first part of the examination is the appearance and general behavior of a patient. The physician examines the patient’s body appearances, such as grooming, interpersonal style, and the degree of eye contact. For example, a provocative dress code may imply a bipolar disorder, while a patient whose well-groomed and attentive to details such as tattoos and scars may imply depression. Patients exhibiting poor eye contact may suffer psychotic disorders and irritable behaviors due to anxiety. Another part of the test is motor activity, whereby facial, posture, and body movement. Restlessness or excessive body movement such as pacing and difficulty sitting still may indicate severe depression (Rentas et al., 2019). On the other hand, psychomotor retardation or slowed movement and emotional reaction may suggest symptoms of increased dosage of antipsychotic medication. Exaggerated body movements indicate the manic level of bipolar disorder and anxiety.
Speech quantity is another part of the test whereby the physician examines various aspects of speech such as volume, rate, fluency, and consistency of the speech. The test is done when the physician asks open-ended questions to locate articulation issues. An example of a patient who has Parkinson’s disease may exhibit halting speech with difficulty finding words. For schizophrenia or a depressed bipolar patient with anxiety, their speech might seem slow. The effect and mood are part of the test, which examines the patient’s immediate emotions and how long they can sustain their emotions (Martin et al., 2020). The physician asks the patient to record their moods for several weeks and not just asking about the moment. Inability to control one’s mood connects to depression, schizophrenia, anxiety, and bipolar disorder.
The patient’s thought process is a part of the test, which involves describing a patient’s reasoning and characterizes how they express their ideas. During the trial, the physician notes the patient’s rate and flow of thoughts. The exhibition of rapid pictures, also referred to as flight of ideas, may imply a patient has anxiety, depression, or is under the influence of a substance. Thought content entails the details of the patient’s thoughts. It could also be whether the ideas are absent, present, obsessive, suicidal, or delusional. The presence of either of the ideas calls for a detailed report on their specificity and intensity. Delusional thoughts are observable through obsessive behaviors and get fixed since they do not align with reality (Verma et al., 2020). Most times, patients realize their thoughts are intrusive and abnormal. However, bizarre delusions may imply the patient suffers from schizophrenia and disorders related to schizoaffective, while alcohol and drug abusers may exhibit acute delusions.
Hallucinations or perceptual disturbances which occur when a sensory stimulus is absent are part of the MSE. When examining this part, the physician constantly notes the sensory system involved in the hallucination. The hallucinations may occur in dissimilar sensory systems such as visceral, olfactory, auditory, gustatory, visual, or tactile. Examples of disorders associated with hallucinations include; illicit drug abuse, dementia, depression, bipolar disorder, schizophrenia, unipolar depression, withdrawal, delirium, and acute intoxication. Eliciting perceptual disturbances is difficult since patients may deny experiencing hallucinations, especially office visits (Rentas et al., 2019). However, the physician constantly notes hallucinations whenever the patient responds to internal stimuli such as hearing sounds.
The other part of MSE includes the evaluation of the functionality of a patient’s MSE essential components. Valuation of sensorium consists of the patient’s stability and level of consciousness. When the patient’s level of consciousness gets disturbed, it indicates delirium. The physician describes levels of consciousness through terms such as alert, lethargic, somnolent, and comatose. Graphic elements of sensorium status are concentration, attention, and memory. The physician assesses a patient’s level of awareness by asking them to spell terms back and forth or subtract figures (Martin et al., 2020). The memory gets assessed to discover the patient’s length of understanding, which refines and explains both short- and long-term memories.
The episodic type of memory includes remembering personal experiences such as what one had for breakfast. Semantic memory is the ability to maintain factual information experienced mainly by patients who have Alzheimer’s. Its difficulty may occur with those suffering from tumors, Parkinson’s disorder, cerebrovascular, etc. working level of cognitive element entails temporal maintenance of information such as recalling phone contacts. Its difficulty occurs in patients with delirium. When conducting the mental part of MSE is crucial to align the patient’s cultural background and educational level with the questions (Verma et al., 2020). Elements on the cognitive part of MSE include; abstract reasoning, language function, intellectual ability, executive function, attention, and memory.
Other parts of the MSE include insight and judgment. The insight part comprises the patient’s consciousness and understanding of their condition and willingness to take treatment. Evaluation of this part involves the physician assessing the degree of patient’s knowledge and level of psychiatric disorder and its impact on their life, relation with others, and will to change. The importance of evaluating a patient’s insight is that it helps in diagnosis and adherence to medication. Patients who have schizophrenia have difficulty processing their mental illness and respond poorly to medication. Dementia patients may also fail to get insight into their condition, and those with depression may experience problems. Judgment is the ability to acknowledge the values of actions and examined them by asking open-ended questions (Mothibi et al., 2019). Another measure for judgment includes compliance and adherence to judgment.
Significance of Comprehensive Mental Status Examination to a Nurse
There are significances of the knowledge of MSE for a practicing nurse, especially in evaluating the initial and subsequent encounters with a patient. The MSE, combined with vigorous psychiatric assessment, assists a nurse in diagnosing a mental health patient. During the psychiatric interview, the patient’s history of illness, both present, and past get recorded; medical history, history of substance abuse, laboratory data, physical examination, family and social history also get recorded. The MSE may help a nurse determine the chances of a patient getting treated as outpatient or inpatient (Martin et al., 2020). A comparison between past and present mental status evaluation can also aid the nurse in determining the progress of a patient’s symptoms. For example, aspects like the observation of motility could indicate if a patient is undergoing medication side effects.
References
Arya, S., & Rentala, S. (2020). MENTAL STATUS EXAMINATION: AN ASSESSMENT KEY TO REHABILITATION WITH IMPLICATION IN NURSING. Retrieved from https://jmpas.com/admin/assets/article_issue/1627667606JMPAS_MAY-JUNE_2021.pdf
Martin, A., Krause, R., Jacobs, A., Chilton, J., & Amsalem, D. (2020). The mental status exam through video clips of simulated psychiatric patients: an online educational resource. Academic Psychiatry, 44(2), 179-183. Springer. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082206/
Mothibi, J. D., Jama, M., & Adefuye, A. O. (2019). Assessing the knowledge of emergency medical care practitioners in the Free State, South Africa, on aspects of pre-hospital management of psychiatric emergencies. The Pan African Medical Journal, 33. NCBI. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6754841/
Rentas, K. G., Buckley, L., Wiest, D., & Bruno, C. A. (2019). Characteristics and behavioral health needs of patients with patterns of high hospital use: Implications for primary care providers. BMC Health Services Research, 19(1), 1-8. biomedcentral. Retrieved from https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-019-3894-7
Verma, D. K., Khanra, S., Goyal, N., Das, B., Khess, C. R. J., Munda, S. K., & Ram, D. (2020). Absconding during inpatient care from a tertiary psychiatric hospital: a comparative study. Indian Journal of Psychological Medicine, 42(5), 456-463. SAGEPUD. Retrieved from https://journals.sagepub.com/doi/full/10.1177/0253717620929182