2. State the purpose of doing mental status examination.

Mental status examination is essential to the development of an appropriate plan of care. The mental status examination is a description of all the areas of the clients mental functioning.
The purpose of the MSE is to obtain a comprehensive cross-sectional description of the patient's mental state, which, when combined with the biographical and historical information of the psychiatric history, allows the clinician to make an accurate diagnosis and formulation, which are required for coherent treatment planning.

3. Give the descriptive of the following categories to be explored during mental status examination. 3.1 Appearance Including apparent age, height, weight, and manner of dress and grooming. Colorful or bizarre clothing might suggest mania Unkempt, dirty clothes might suggest schizophrenia or depression. If the patient appears much older than his or her chronological age this can suggest chronic poor self-care or ill-health. Clothing not typical of the patient's gender, might give clues to personality Observations of physical appearance might include the physical features of alcoholism or drug abuse such as signs of malnutrition, nicotine stains, dental erosion, a rash around the mouth from inhalant abuse, or needle track marks from intravenous drug abuse. Observations can also include any odor which might suggest poor personal hygiene due to extreme self-neglect, or alcohol intoxication. Look out for weight loss; this could signify a depressive disorder, physical illness, anorexia nervosa or chronic anxiety.

3.2 Behavior
observations of specific abnormal movements, as well as more general observations of the patient's level of activity and arousal, and observations of the patient's eye contact and gait tremor or dystonia may indicate a neurological condition or the side effects of antipsychotic medication. The patient may have tics (involuntary but quasi-purposeful movements or vocalizations) which may be a symptom of Tourettes syndrome. Stereotypies (repetitive purposeless movements such a rocking or head banging) or mannerisms (repetitive quasi-purposeful abnormal movements such as a gesture or abnormal gait) may be a feature of chronic schizophrenia and autism An inability to sit still might represent akathisia, a side effect of antipsychotic medication. eye movements (repeatedly glancing to one side can suggest that the patient is experiencing hallucinations), and the quality of eye contact (which can provide clues to the patient's emotional state). Lack of eye contact may suggest depression or autism.

3.3 Affect is described by labeling the apparent emotion conveyed by the person's nonverbal behavior (anxious, sad etc.). Describe as appropriate or inappropriate to the current situation, and as congruent or incongruent with their thought content. bland affect when describing a very distressing experience would be described as showing incongruent affect, which might suggest schizophrenia. The intensity of the affect may be described as normal, blunted, exaggerated, flat, heightened or overly dramatic. A flat or blunted affect is associated with schizophrenia, depression or post-traumatic stress disorder,

Heightened affect might suggest mania, and an overly dramatic or exaggerated affect might suggest certain personality disorder.

3.4 Mood is described using the patient's own words, and can also be described in summary terms such as neutral, euthymic,dysphoric,euphoric,angry,anxious or apathetic or Alexthymic individuals may be unable to describe their subjective mood state. An individual who is unable to experience any pleasure may be suffering from anhedonia. 3.5 Speech The nurse assesses the clients speech for quantity and quality, and any abnormalities Does the client talk nonstop? Does the client perseverate (seem to be stuck on one topic and un able to move to another idea? Are responses a minimal yes or no without elaboration? Is the content of the clients speech relevant to the question being asked? Is the rate of speech fast or slow? Is the tone audible or loud? Does the client speak in a rhyming manner? Does the client use neologism (invented words that have meaning only for the client)? Stuttering or other speech impairments, or lisping 3.6 Thought Content Is what the client actually says. Thought that pre-occupy such as compulsions and reorientation, as if talking or paying attention to someone or something else. Suicidal or homicidal ideas Obsessions Paranoia/ suspiciousness

Magical thinking Religiosity Phobia Poverty of content (vague, meaningless responses)

3.7 Thought Process Refers to how the client thinks. The nurse can infer a clients thought process form speech and speech patterns. 3.7.1 From Flight of ideas Loss association Circumstantial thinking Tangential thinking Poverty of speech (restriction in the amount of speech) Thought insertion Thought withdrawal Word salad

3.7.2 Delusions a persistent false belief held in the face of strong contradictory evidence, especially as a symptom of a psychiatric condition 3.7.3 Disorders of Perception Hallucinations

a. b. c. d. e. Illusions

Auditory Visual Tactile Olfactory Gustatory

Depersonalization (altered perception of the self) Derealization (altered perception of the environment)

3.7.4 Phobias 3.8 Intellectual Functions Assesses the clients ability to use abstract thinking which is to make association or interpretations about a situation or comment. Example a stitch in time saves nine. 3.9 Insight Clients ability to describe realistically the strengths and weakness of his her behavior. 3.10 Judgment Judgment refers to the ability to interpret ones environment and situation correctly and to adapt ones behavior and decisions accordingly. Problems with judgment may be evidenced as the client describes recent behavior and activities that reflect a lack of reasonable care for self or others. 3.11 Cognition Level of abstract thought Cognitive abilities are essential for many important tasks, including making decisions, solving problems, interpreting the environment, and learning new information. 3.12 Consciousness Observe clients awareness of what is going on around 3.13 Memory

Assess memory, both recent and remote, by asking questions with verifiable answers. What is the name of the current president? Short and long term memory