Mental status examination

1. Interview Techniques & Mental
State Examination: A workshop

2. • Facilitator's Role
• Students’ Role
• Silence: non participation, not cooperative,
doesn’t know

3. • Part I:
– Learning Outcomes
– Brief introduction on interview techniques
• Part II
– Video
– Discussion
• Part III
– Interview patients
– Patients’ feedback
– Students’ presentation of findings & feedback
– Discussion

4. Learning Outcomes
• Demonstrate therapeutic communication skills
• Demonstrate gathering information skills
(including eliciting sensitive personal
information)
• Demonstrate the cultural & ethical sensitivity
• Elicit basic psychopathology (diagnostic)
• Present a coherent & well organized
psychiatric assessment findings

5. Psychiatric Interview
Vs
History Taking

6. Objectives of Psychiatric Interview
• To Gather information:
– To make diagnosis
– formulation of patients
• Diagnosis important but our aim is to go beyond that.
• To understand ‘why patient has presented to us with this
presentation at this moment in time
– planning of patient’s management
• Establish therapeutic relationship

7. Basic Structure of History
• Patient’s profile
• Presenting complaints (PC)
• History of presenting illness (HOPI)
• Past Psychiatric History
• Past Medical History
• Gynaecological & Obstetric History
• Family History
• Personal History
– Childhood history
– Education History
– Occupational history
– Relationship & marital history
• Social history & Substance misuse
• Forensic history
• Pre-morbid personality

8. Physical Examination
MSE

9. Interview setting
• Setting of the assessment place.
• Giving patient chance to be interviewed alone.
• Arrange for collateral information.

10. Before you proceed....
• Gather pre-existing information.
• Decide where to interview.
• Ensure your safety.

11. Components of the MSE
• Appearance & Behavior
• Speech
• Mood
• Affect
• Perceptual disturbance
• Thought
• Cognitive Function
– Orientation: T/P/P
– Memory: Immediate/Intermediate/Longterm
– Attention
– Intelligence & Abstract thinking
– Judgement
– Insight

12. Format of Interview
I. Starting an interview: establish rapport
– Introduction
– Purpose
– Professionalism
II. Progressing an interview: eliciting
information
III. Ending an interview: concluding

13. I. Starting an interview
• Introduce self & purpose of interview
• Assures confidentiality
• Let patient introduce himself
• Starts with non-threatening & open-ended questions: eg. Can you tell
me a bit about yourself
• Guiding the interview:
– Fascilitates
– Intervene appropriately: recognize the cue
– Bring back the patient to focus of interview
• Non-verbal cues:
– Eye contact
– Facial expression & other non-verbal to encourage patient to talk: nodding,
etc
• Attentive & active listening

14. II. Progressing an interview
• Intervene appropriately:“we may come to that later”
• Guiding patient to focus on particular period of time to
get full syndrome
• Follow through/ clarify on clues of symptoms (vs
stressor) provided by the patient
• Exploring the symptom in depth:
– Suicide: so u said u have thoughts of committing suicide,
did you make plans?
– Depression: I’d like to go back to the depression that you
felt, can u tell me more about it?
• Once on the right track, allow the patient to talk

15. II. Progressing an interview (cont.)
• Give clear indication when u want to switch topic:
I’d like to go back to the depression that you told
me earlier, can u tell me more about it?
• Begin with open-ended questions to explore
different symptom: eg. How about your energy?
• Close-ended questions to get the details: did you
manage to sleep well throughout the night?”
• Summarizing: so this is what happened to u?
• Empathetic listening: I am sorry to hear that
• Non-judgemental

16. III. Ending an interview
• Allow the patient to ask questions
• Thanking the patient

17. Boundaries
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18. Boundaries: Brene Brown
• The most compassionate people are also the most boundered
• Definition
• Lacking boundaries lead to being hateful & resentful
• It allows U to maintain your integrity and make the most generous
assumption about others: people are doing the best they can with
what they have
• Nothing is sustainable without boundaries
• It allows empathy the skill needed to be compassionate: to
communicate deep love to people so they know they are not alone
• RESPECT
19/09/2018 18

19. Empathy # feeling for people
Empathy = feeling with them.
19/09/2018 19

20. Mental Status Exam (MSE)
• The psychological equivalent of a physical
exam that describes the mental state and
behaviors of the person being seen.
• Both objective observations of the clinician
and subjective descriptions given by the
patient.

21. Mental Status Exam (MSE)
• The psychological equivalent of a physical
exam that describes the mental state and
behaviors of the person being seen.
• Both objective observations of the clinician
and subjective descriptions given by the
patient.

22. Why do we do them?
• Provides information for diagnosis and assessment of
disorder and response to treatment.
• A snap shot at a point in time
• If another provider sees your patient it allows them
to determine if the patients status has changed
without previously seeing the patient

23. • To properly assess the MSE information about
the patients history is needed including
education, cultural and social factors
• It is important to ascertain what is normal for
the patient. For example some people always
speak fast!

24. Presenting your findings
• “This is a [age]-year-old [gender] with a history of [major
history such as bipolar disorder] who presented on [date]
with [major symptoms, such as auditory hallucinations]
since [onset] which worsened in the past [course] MSE
showed a …… [Tests done] showed [results].
Reporting Progress:
• Yesterday, the patient [state important changes, new plan,
new tests, new medications].
• This morning the patient feels [state the patient’s words],
and the psychiatric and physical exams are significant for
[state major findings]. Plan is [state plan].

25. Thank you