This slide contains information regarding assessment in psychiatry. This can be helpful for proficiency level and bachelor level nursing students. Your feedback is highly appreciated.

1. Unit 2
Mental Health Assessment
Nabina Paneru

2. Mental Health Assessment
Psychiatric mental health assessment is the gathering, organizing, and
documenting of data about the psychiatric and mental health needs of
the client and family.

3. Components
The components of Mental Health Assessment are:
 Psychiatric History Taking
Mental Status Examination
Psychological tests

4. Psychiatric History Taking
Objectives
- To build up good interpersonal relationship.
- To identify the redisposing factors and causes of mental illness.
- To formulate nursing diagnosis and plan and implement nursing
intervention.

5. Points to Remember
• Build good rapport
• A consistent scheme (though interview need not follow a fixed
method)
• See pt. first
• Place pt. Comfortably and develop empathetic relationship.
• Be good listener (do not hurry)
• Observe patient’s interaction with his/her relatives

6. Contd.
• Avoid too much exploration in first interview (may increase anxiety
and pt. may not be cooperative)
• Confidentiality
• Observe and note non verbal communication and any abnormalities.

7. Psychiatric History Taking
Is carried out under the following headings:
• Personal bio data: Includes name, age, sex, address, I.P no,
diagnosis, date of admission, education, occupation, economic status,
marital status, religion, nationality, language spoken etc.
• Informant: Name, age, education, occupation, relationship with the
patient and duration of relationship
• Source of referral and reason for coming at this particular period

8. Contd.
• Presenting Complaints (with duration) Chronological order
 According to patients
According to the informants

9. Contd.
• History of Present Illness (HOPI)
 Mode of onset: sudden (within 48 hours), abrupt (more than 48 hours
but within 2 weeks)/ acute (1-2wks)/ subacute (more than 2 wks)/
insidious (more than 4 wks)
 Duration of illness: Total duration of the illness and total duration of
this episode

10. * Mode of onset and duration gives clues to the cause and its
implications on prognosis

11. HOPI contd.
• Course: (continuous/ episodic/ fluctuating/ deteriorating/ improving/
unclear associated with other symptoms
• Precipitating factors: Events that occur shortly before the onset of illness
or appear to induce illness.
• Description of present illness (chronological description of abnormal
behavior associated problems like suicide, homicide, disruptive behavior)

12. Contd.
• Biological functioning (sleep, appetite, bowel, bladder functions),
social functioning ( managing day activities, hobbies, leisure time
activities) occupational functioning, changes in ADLs)
• Mental functioning: Concentration, thought content, speech, mood
states, abnormal perception, interest, attitude etc.
• Interpersonal relations: quality of relationship with family members
• Loses beloved persons, property, financial matters

13. History Taking contd.
• Past Medical and Psychiatric History
Hospitalization
History of substance use
History of medical illness e.g. TB, DM, HTN, Neurological illness
Treatment history of mental illness (Name of drug, dose, route, side-
effects if any)
ECT, Psychotherapy, Family Therapy, Rehabilitation

14. Contd.
• Family History
 Family Tree
 Types of family (joint/ nuclear/ extended)
Consanguinity: Present/Absent
 Family Health History: History of mental illness/ Suicide/ Alcohol or drug
abuse/ personality problems etc.
Socio economic

15. Index of Family Tree
: Death
: Female
: Male
: Psychiatric Disorder
: Sex unknown
: Indicates Consanguinity
: Monozygotic twins
: Dizygotic twins
: Child adopted out of family
: Child adopted in to the family
: Separation/Divorce
: Present Patient

16. Contd.
• Personal History
(Brief and comprehensive information of the patient right from the
prenatal period onwards)
 Birth: Type of birth, any complications during pregnancy, birth
weight, any complications during birth
Developmental milestones: motor, psychosocial, immunization etc

17. Personal History contd.
Schooling
Psychosexual History
Menstrual History
Work Record/ Occupational History
Marital History

18. Contd.
• Premorbid Personality: (Collect from the informant)
- Inter personal relationship with family members, friends, coworkers etc.
• Mood: optimistic, pessimistic, cheerful, anxious, etc. Attitude towards work
and responsibility (acceptance of responsibility, decision making,
flexibility)
• Moral religious standards
• Use of alcohol/ tobacco
• If any other specify

19. Contd.
• Health Patterns
- Hygiene, eating habits, rest and sleep habits, elimination etc
• Physical Examination
- General/ Systematic examination
- Record of any significant abnormality after the examination so that it
would be helpful for the management of patient illness.

20. Mental Status Examination
• Definition: “Assessment of general motor behavior, thought,
emotional functioning along with evaluation of insight and judgement
of the patient’s present status.” : Bimala Kapoor, 2002
• Systematic evaluation of behavior, emotion, cognitive functions of the
individual. – K. Lalitha, 2007

21. Purpose of Mental Status Examination
• Provides an overview of the individuals functioning
• Monitor changes over time
• Helps with diagnosis
• Helps with treatment – where to start, evaluation
• Support Multidisciplinary collaboration
• Standardized recording

22. Aspects of Mental Status Examination
1. General appearance and behavior
2. Speech or Talk (attitude)
3. Mood or Affect
4. Thought
5. Perceptual changes

23. Contd.
Higher Mental Function
6. Consciousness
7. Orientation
8. Attention and Concentration
9. Memory
10. Fund of Knowledge
11. Abstraction
12. Judgement
13. Insight

24. 1. General Appearance and Behavior
• Level of Consciousness: Conscious/ Cloudy/ Stupor/ Unconscious/
Comatose
• Body Built: (average/ underweight/ healthy/ thin/ petite/ stocky),
looking one’s age/ older/ younger
• Facial Expression: Anxiety, fear, apprehension ( a feeling of worry or
fear about what might happen), Depression, sadness, Anger, hostility

25. Contd.
• Hygiene/ grooming: Good, neglected, poor, satisfactory, adequate.
Dress: Casual, ok for work, ok for age, stylish, ok for weather, dirty
• Psychomotor Activity: Under activity/ over activity: Movement:
appropriate, awkward, purposeful, aimless, self injuries, destructive
mannerisms, tics (Spasm) , grimace (make a face) , echopraxia
• Posture Coordination and Gait: Relaxed, strange/ odd posture,
tensed, catalepsy

26. Contd.
• General Attitude: Co-operation/ guardedness/ hostility/
combativeness, argumentative/ haughtiness, attentiveness, interested/
disinterested/ apathetic, perplexity
• Eye contact: Normal eye contact/ hesitant eye contact/ staring at the
examiner, staring vacantly. (Maintained/ difficult/ not maintained).
• Rapport: Spontaneous/ difficult/ not established

27. 2. Speech
• Initiation: Spontaneous/ speaks when spoken to/ minimal/ mute
• Reaction time: Normal/ delayed/ shortened/ difficult to assess
• Rate/ Speed: Normal/ slow/ rapid
• Productivity: Monosyllabic/ elaborate/ replies/ pressured
• Volume: Normal/ increased/ decreased
• Tone: Normal variation/ monotonous
• Relevance: fully relevant

28. 3. Mood and Affect
• Mood: Subjective feeling of the patient. (How do you feel?), If the
client does not answer ask the leading question including all types of
mood state example, happy, sad, normal, excited, anxious etc.
• Affect: Objective data: assess depth or intensity of affect (normal,
increased, or blunted) and appropriateness of affect (in relation to
thought and surrounding environment).

29. 4. Thought Process
i. Disorder in stream and form of thought
ii. Disorder in content

30. i. Disorder in stream and form of thought
• Normal/ racy thoughts (pressured thought)/ retarded thinking (poverty of
thought)/ thought block/ muddled or unclear thinking/ flight of ideas
• Associative looseness
• Circumstantialities
• Tangentialities
• Neologism
• Alogia

31. Contd.
• Stereotype
• Flight of ideas
• Word salad
• Stuttering
• Clang association
• Echolalia
• Perseveration
• Verbegeration

32. ii. In content
a. Ideas or delusion of: Worthlessness/ hopelessness/ guilt/ hypocondriacal/
poverty/ nihilistic/ death wishes/ suicidal/ grandiose/ reference/ control
persecution/ bizarre
b. Thought alienation phenomena: Thought insertion/ thought withdrawal/
thought broadcasting
c. Obsessional/ compulsive phenomena: Thoughts/ images/ ruminations/
doubts/ impulsive rituals

33. 6. Consciousness
• Conscious/ cloudy/ comatose

34. 7. Orientation
• Time: appropriate time/ day/ night/ date/ month/ year
• Place: kind of place/ area/ city
• Person: self/ close associates/ hospital staffs

35. 8. Attention/ Concentration
Attention
• Normally aroused/ aroused with difficulty
• Digit forward: 1,2,3….100
Concentration
• Normally sustained/ sustained with difficulty/ distractible
• Digit backward: 100 – 7 or 40 – 3
• Name of months (backwards)
• Name of weekdays (backwards)

36. 9. Memory
i. Immediate:
• Immediate registration: name three unrelated objects and ask to recall
immediately (example: tree, house and chair)
• Recall: Recall same name as in immediate registration after 3 – 5
minutes
ii. Recent: enquire recent events up to 24 hours, recent happening –
last meal, visitors etc. verbal recall

37. Contd.
iii. Remote:
• Personal events: birthdays, SLC passed year, graduation date, date and
place of marriage, children’s birthdays etc.
• Illness related events
Inferences: Intact or impaired

38. 10. Fund of Knowledge/ Intelligence
Based on his/her educational background
• Simple arithmetic calculation (mathematical calculation – to find the
percentage of profit if buys something in Rs 100 and sells in Rs 120)
• General knowledge – current president of America, highest mountain,
neighboring country, president of Nepal
• Reading/ writing
Inferences: average, below average, above average

39. 11. Abstraction
Assess patient’s concept formation:
• Proverb testing e.g. nachna najanne agan tedho, much ma ram ram
bagalima chhura, hune biruwako chillo pat.
• Similarities and difference between familiar objects e.g. table and
chair, banana and orange, dog and lion, eye and ear, bird and airplane
etc
Inferences: normal in abstraction, poor in abstraction

40. 12. Judgement
i. Personal Judgement: e.g. future plan
ii. Social Judgement
iii. Test Judgement
• House on fire
• Baby on busy road
• Snake on road
Inferences: good/ Poor/ Impaired

41. 13. Insight
Insight absent if client says:
1. Complete denial of illness.
2. Slight awareness of being sick and needing help, but denying at the
same time
Insight partially present if client says:
3. Awareness of being sick, but it attributed to external or physical
factors.
4. Awareness of being sick, due to something unknown in self.

42. Contd.
Insight present if client says:
5. Intellectual insight: Awareness of being ill and that the symptoms/
failures in social adjustment are due to own particular irrational
feelings/ thoughts; yet does not apply this knowledge to the current/
future experiences.
6. True emotional insight: It is different from intellectual insight in
that the awareness leads to significant basic changes in the future
behavior.
Baseline data: Height, weight, vital signs