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The Mental Status Exam & The Mental Status Exam & Screening for Neurological Screening for Neurological

InjuriesInjuries

The Mental Status Exam & The Mental Status Exam & Screening for Neurological Screening for Neurological

InjuriesInjuries

University of South Dakota

Vermillion, South Dakota

University of South Dakota

Vermillion, South Dakota

Dale Pietrzak, Ed.D., LPC-MH, CCMHCDale Pietrzak, Ed.D., LPC-MH, CCMHC

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Mental Status Exam: GeneralMental Status Exam: General

The MSE is analogous to the physical exam. The focus is the current signs, symptoms, affect, behavior and cognition.

Outline is the standard way of collecting the information

A good interviewer is not just listening to content. He or she is also observing affect, motor, speech, and thought processes.

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Mental Status Exam: OutlineMental Status Exam: Outline

Appearance Motor Behaviors &

Skills Speech Affect Thought Content

Thought Processes Perception Intellect Insight Mini-Mental Status

Exam (pg 123)

Zimmerman (1994) page 120-125

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MSE: AppearanceMSE: Appearance

Age Sex, Race Build Position & Posture Eye Contact Dress Grooming Interaction Style

Attentiveness Distinguishing

features Physical

Abnormalities Facial expression Alertness

Don’t I look good?

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MSE: MotorMSE: Motor

Retardation-Acceleration Agitation Abnormal Movements Gait & Stance Catatonia

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MSE: SpeechMSE: Speech

Rate Rhythm Volume Articulation Spontaneity Amount & Style

And ... Yabidy yabidy yabidy yabity yab ...

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MSE: AffectMSE: Affect

Stability range Appropriateness Intensity Affect (in session) Mood (patient’s report)

I’m just so sadall the time. Whatshould I do?

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MSE: Thought ContentMSE: Thought Content

Suicide-Homicide Obsessiveness,

ruminations Depressive Phobias Ideas of reference

Paranoia Magical Ideation delusions Overvalued Ideas Major themes

I do not have aproblem. My wife

just does not understandI am a fish.

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MSE: Thought ProcessesMSE: Thought Processes

Associations Coherence Logic Stream of thought Clang Associations

Perseveration Neologisms Blocking Attention & Vigilance

I am a special typeof fish. I can be outof the water for ...

I see

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MSE: PerceptionMSE: Perception

Hallucinations Illusions Depersonalization Derealization Deja vu-Jamais vu

I am telling youGod spoke tome about it!

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MSE: IntellectMSE: Intellect

Global evaluation (Below Average, Average, above Average)

I am so bright...

If he wereany slowerhe could beoutsmartedby his fish!

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MSE: InsightMSE: Insight

Current Awareness of Illness Current Understanding of Causes Current Acceptance of Treatment

*$(%#

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MSE: MMSEMSE: MMSE

2nd Major aspect of MSE is to RULE OUT Neurological Difficulties

Screener for Gross Neurological Injury or Impairment

Late Adolescents, Adults and the Elderly

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WhyWhy should the Mental should the Mental Health Professional Health Professional carecare??

Hartlage (1990)

It is almost inevitable that any practicing clinical, school, or counseling psychologist will encounter, in the course of professional practice, individuals who have sustained head injury.

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Incidence StatisticsIncidence StatisticsIncidence StatisticsIncidence Statistics

9 million new cases a year By age 60 the average American will have

suffered 2 significant head injuries Head injury is perhaps more common than

any other single mental health etiology. Typical head injury victim usually does not

seek help (<1 in 20 hospitalized)

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Brain Injury Fast FactsBrain Injury Fast Facts

No linear relationship between severity of injury and severity of problems

Mild injuries may not have lost consciousness, few overt signs of injury

Often misdiagnosed depressed or PTSD IQ tests and related measures may mask

some of the symptoms of head injury No single test type can screen for injuries Children often diagnosed ADHD

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Some Symptoms of InjurySome Symptoms of Injury Depersonalization Anxiety Hostility Irritability Restlessness Overactivity or

underactivity Balance Impairment Nausea

Dizziness Fatigue Headaches Malaise Decreased Libido Insomnia Depression Labile affect Inappropriate

Social Behavior

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Fundamental AnatomyFundamental AnatomyFundamental AnatomyFundamental Anatomy

Cerebrum Cerebellum Brain Stem Cranial Nerves Spinal Cord Connective Nerves

Central Nervous SystemCentral Nervous System

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Assessment ComponentsAssessment ComponentsAssessment ComponentsAssessment Components

History Orientation Screen Gross Motor Systems Screen Fine Motor Systems Screen Sensory Systems Screen Mental Processes Screen Verbal Processes

History Orientation Screen Gross Motor Systems Screen Fine Motor Systems Screen Sensory Systems Screen Mental Processes Screen Verbal Processes

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OrientationOrientationOrientationOrientation

Time/Date Place Person (body

position /situation)

Who am I?Where am I?What year is it?

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Concentration & AttentionConcentration & AttentionConcentration & AttentionConcentration & Attention

Vigilance (simple) Vigilance (complex) Concentration

Are you on task?

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Visual ProcessesVisual ProcessesVisual ProcessesVisual Processes

Tracking Neglect Suppression

/Extinction

Tracking Neglect Suppression

/Extinction

Visual QuadrantsVisual Quadrants

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Auditory ProcessesAuditory ProcessesAuditory ProcessesAuditory Processes

Hearing and Neglect Suppression or Extinction

What’d you say?

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Tactile SensationTactile SensationTactile SensationTactile Sensation

Neglect Suppression

Reach out and touch someone .

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Motor and BalanceMotor and BalanceMotor and BalanceMotor and Balance

Balance Purposeful

Movements

Come on and move with me!

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Language ProcessesLanguage ProcessesLanguage ProcessesLanguage Processes

Auditory Comprehension Written Comprehension Confrontational Naming Oral Expression Written Expression

What we have hereis a failure to communicate.

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Short-Term Memory Learning Curve Recent Memory Remote Memory Retention

Short-Term Memory Learning Curve Recent Memory Remote Memory Retention

Memory and LearningMemory and LearningMemory and LearningMemory and LearningNow, what

was I supposedto remember?

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Construction/Spatial/Fine MotorConstruction/Spatial/Fine Motor

Bender Clock Drawing Complex Figure Test (Rey or Taylor) Fine Motor Sequencing

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Nonverbal & Tactile ProcessingNonverbal & Tactile Processing

Rhythm Tactile Comprehension

Rhythm Tactile Comprehension

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Reasoning & JudgmentReasoning & JudgmentReasoning & JudgmentReasoning & Judgment

Verbal Reasoning Judgment & Problem Solving

Verbal Reasoning Judgment & Problem Solving

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The EndRun for

it!