Before moving through diagnostic decision making, a social worker needs to conduct an interview that builds on a biopsychosocial assessment. New parts are added that clarify the timing, nature, and sequence of symptoms in the diagnostic interview. The Mental Status Exam (MSE) is a part of that process. The MSE is designed to systematically help diagnosticians recognize patterns or syndromes of a person’s cognitive functioning. It includes very particular, direct observations about affect and other signs of which the client might not be directly aware. When the diagnostic interview is complete, the diagnostician has far more detail about the fluctuations and history of symptoms the patient self-reports, along with the direct observations of the MSE. This combination greatly improves the chances of accurate diagnosis. Conducting the MSE and other special diagnostic elements in a structured but client-sensitive manner supports that goal. In this Assignment, you take on the role of a social worker conducting an MSE. To prepare: Watch the video describing an MSE. Then watch the Sommers-Flanagan (2014) “Mental Status Exam” video clip. Make sure to take notes on the nine domains of the interview. Review the Morrison (2014) reading on the elements of a diagnostic interview. Review the 9 Areas to evaluate for a Mental Status Exam and example diagnostic summary write-up provided in this Week’s resources. Review the case example of a diagnostic summary write-up provided in this Week’s resources. Write up a Diagnostic Summary including the Mental Status Exam for Carl based upon his interview with Dr. Sommers-Flanagan. By Day 7 Submit  a 2- to 3-page case presentation paper in which you complete both parts outlined below:     Part I: Diagnostic Summary and MSE Provide a diagnostic summary of the client, Carl. Within this summary include: Identifying Data/Client demographics Chief complaint/Presenting Problem Present illness Past psychiatric illness Substance use history Past medical history Family history Mental Status Exam (Be professional and concise for all nine areas) Appearance Behavior or psychomotor activity Attitudes toward the interviewer or examiner Affect and mood Speech and thought Perceptual disturbances Orientation and consciousness Memory and intelligence Reliability, judgment, and insight Part II: Analysis of MSE After completing Part I of the Assignment, provide an analysis and demonstrate critical thought (supported by references) in your response to the following: Identify any areas in your MSE that require follow-up data collection. Explain how using the cross-cutting measure would add to the information gathered. Do Carl’s answers add to your ability to diagnose him in any specific way? Why or why not? Would you discuss a possible diagnosis with Carl at time point in time? Why? Support Part II with citations/references. The DSM 5 and case study  do not  need to be cited.  Utilize the o.

1. Before moving through diagnostic decision making, a social
worker needs to conduct an interview that builds on a
biopsychosocial assessment. New parts are added that clarify
the timing, nature, and sequence of symptoms in the diagnostic
interview. The Mental Status Exam (MSE) is a part of that
process.
The MSE is designed to systematically help diagnosticians
recognize patterns or syndromes of a person’s cognitive
functioning. It includes very particular, direct observations
about affect and other signs of which the client might not be
directly aware.
When the diagnostic interview is complete, the diagnostician
has far more detail about the fluctuations and history of
symptoms the patient self-reports, along with the direct
observations of the MSE. This combination greatly improves the
chances of accurate diagnosis. Conducting the MSE and other
special diagnostic elements in a structured but client-sensitive
manner supports that goal. In this Assignment, you take on the
role of a social worker conducting an MSE.
To prepare:
Watch the video describing an MSE. Then watch the Sommers-
Flanagan (2014) “Mental Status Exam” video clip. Make sure to
take notes on the nine domains of the interview.
Review the Morrison (2014) reading on the elements of a
diagnostic interview.
Review the 9 Areas to evaluate for a Mental Status Exam and

2. example diagnostic summary write-up provided in this Week’s
resources.
Review the case example of a diagnostic summary write-up
provided in this Week’s resources.
Write up a Diagnostic Summary including the Mental Status
Exam for Carl based upon his interview with Dr. Sommers-
Flanagan.
By Day 7
Submit
a 2- to 3-page case presentation paper in which you complete
both parts outlined below:
Part I: Diagnostic Summary and MSE
Provide a diagnostic summary of the client, Carl. Within this
summary include:
Identifying Data/Client demographics
Chief complaint/Presenting Problem
Present illness
Past psychiatric illness
Substance use history
Past medical history

3. Family history
Mental Status Exam (Be professional and concise for all nine
areas)
Appearance
Behavior or psychomotor activity
Attitudes toward the interviewer or examiner
Affect and mood
Speech and thought
Perceptual disturbances
Orientation and consciousness
Memory and intelligence
Reliability, judgment, and insight
Part II: Analysis of MSE
After completing Part I of the Assignment, provide an analysis
and demonstrate critical thought (supported by references) in
your response to the following:
Identify any areas in your MSE that require follow-up data
collection.

4. Explain how using the cross-cutting measure would add to the
information gathered.
Do Carl’s answers add to your ability to diagnose him in any
specific way? Why or why not?
Would you discuss a possible diagnosis with Carl at time point
in time? Why?
Support Part II with citations/references. The DSM 5 and case
study
do not
need to be cited. Utilize the other course readings to support
your response.
The Diagnostic Interview: The Mental Status Exam, Risk and
Safety Assessments The Diagnostic Interview: The Mental
Status Exam, Risk and Safety Assessments Program Transcript
[INTRO MUSIC PLAYING] DIANE RANES: As you will
quickly realize, professional diagnosis is far more than just
linking a person with a diagnostic label. In fact, linking an
individual to a diagnostic label without a complete professional
process is directly in violation of many social work ethical
codes. Professional diagnosis is a broad and a continuous
process that is actually closer to developing a working
hypothesis than to labeling. Professionals form their initial
diagnostic hypothesis, and they continue to refine it using
evidence-based tools or validating it over time in the treatment
process. The professional diagnostic process starts with very
good data gathering, including a number of different kinds of
elements that you might not be familiar with. Diagnosis starts
with a particular type of interview called a diagnostic or
psychiatric interview. And that interview uses many elements
from a biopsychosocial assessment. But it also includes some

5. unique parts like the mental status exam, which is a structured
way of assessing mental functions such as memory, speech,
thought processes, affect, and orientation. The psychiatric
interview also includes details of symptom occurrence and any
other psychiatric or family histories of psychiatric issues.
Gathering complete information is followed by a careful
analysis, which is called a differential diagnosis. That aspect of
diagnostic thinking is about carefully considering each of the
many possible conditions that a client might have in weighing
the most likely possibilities. Especially in diagnosis, you are
searching for patterns of symptoms and other distinguishing
features which best explain an illness. So the logical process of
decision making that you use to narrow down choices is this
decision tree, which is simply a way of step-by-step considering
alternative diagnoses that might have similar symptoms.
Sometimes the decision trees are based on preexisting models
done by psychiatric experts. These are especially helpful when
you're new to the process. So within a decision tree process,
you're simply comparing and contrasting the symptoms and the
observations from your mental status exam to the DSM V's
knowledge base, criteria by criteria. And often you're looking at
several possibilities. A decision tree simply helps you not miss
any important steps by going through the options one at a time.
The logical process of analysis with or without a decision tree
helps the diagnostician avoid error, especially familiarity bias
and to generally keep an open mind. That is especially
important when you have an early idea about a diagnosis that
you think might be accurate. Not jumping to conclusions too ©
2018 Laureate Education, Inc. 1 The
Diagnostic Interview: The Mental Status Exam, Risk and Safety
Assessments quickly guards against making mistaken diagnoses,
which can be very harmful. And these are called false positives.
Remember too, that diagnosis is continuous. While a
professional diagnosis starts at a particular moment in time,
when the client comes to you for help, it's not a static process.
That initial moment is like taking a photograph. It represents

6. only a small sample of an individual's total functioning. In
diagnosis, we look in depth at the last 12 months of a person's
functioning. But the story does not end there. Past information
can help to confirm a diagnosis, as in a bipolar disorder where a
person sometimes has 10 years of mistaken diagnosis before a
correct one is made. Current and ongoing functioning is even
more reliable than past history in validating a diagnosis. If a
person responds well to the treatment plan, more confirmatory
information should emerge. If not, the entire process should be
reviewed. If we believe that individuals change and that they
are impacted by everything around them, then it's easy to
recognize that many initial diagnoses might need regular
reevaluation. That matters even when an illness has more
enduring features as in schizophrenia, which is a lifelong
disorder. Even here, the person may be reaching a phase of
partial remission. And we'll need that milestone added to the
diagnosis to understand the cycles. Even in the short-term
conditions such as an adjustment disorder, the DSM will have
guideline information as to what might occur in treatment
response. In adjustment disorder, a person should be
substantially recovered within six months' time. Viewing
diagnosis in this continuous, ongoing and integrated way will
avoid error. You'll find that quality treatment requires tracking
progress. And treatment plans often need adjusting for all kinds
of unforeseen events. Diagnosis can be changed when new
information comes into the picture. A diagnostic interview also
uses evidence-based tools to ask about risk situations, whether
those are caused by violence, general safety, or the risk of death
by suicide. You probably already know that the World Health
Organization has identified depression as the leading mental
health problem worldwide. Nearly one in 10 people worldwide
has a mental disorder. And within those who are ill, the World
Health Organization considers clinical depression and suicide
risk as the top priorities worldwide. Here in the United States,
the National Institute of Mental Health tell us that the classic
form of depression, which is major depressive disorder, impacts

7. about 16 million adults aged 18 or older in one year alone--
only one year, and that is only one of the unipolar depressive
illnesses, and only one cause of suicide. Suicide risk is on the
rise in the United States overall and within many special ©
2018 Laureate Education, Inc. 2 The Diagnostic
Interview: The Mental Status Exam, Risk and Safety
Assessments populations. While most nonprofessionals think of
suicide as an inherent part of a mood disorder, suicidality is
very common in many other types of mental disorders. Suicide
attempts are common in borderline disorders, in bipolar
disorders, in PTSD, in schizophrenia, and in many other
conditions and situations. And risk escalates even further in all
situations if substance use is involved. Some individuals will
also develop the desire to kill themselves as part of receiving an
intractable physical illness diagnosis. Suicide risk is obviously
on a wide continuum, ranging from recurrent vague wishes to be
dead to direct plans and very overt suicidal behaviors. Even
chronic self-harm without suicide intention can easily escalate
to a direct attempt to die. We also know that the risk of suicide
is very high in the six months after a person has seen a medical
provider, and even after they have been admitted to suicidal
ideation treatments. Suicide risk remains very high after
discharge from hospital stays and from other forms of active
treatment. Sadly, few states and few mental health professionals
have been adequately trained in suicide prevention in response
Required Readings
Morrison, J. (2014).
Diagnosis made easier: Principles and techniques for mental
health clinicians
(2nd ed.). New York, NY: Guilford Press.

8. Chapter 10, “Diagnosis and the Mental Status Exam” (pp. 119–
126)
Chapter 17, “Beyond Diagnosis: Compliance, Suicide,
Violence” (pp. 271–280)
American Psychiatric Association. (2013s). Use of the manual.
In Diagnostic and statistical manual of mental disorders (5th
ed.). Arlington, VA: Author.
doi:10.1176/appi.books.9780890425596.UseofDSM5
American Psychiatric Association. (2013b). Assessment
measures. In Diagnostic and statistical manual of mental
disorders (5th ed.). Arlington, VA: Author.
doi:10.1176/appi.books.9780890425596.AssessmentMeasures
Focus on the “Cross-Cutting Symptom Measures” section.
Chu, J., Floyd, R., Diep, H., Pardo, S., Goldblum, P., & Bongar,
B. (2013). A tool for the culturally competent assessment of
suicide: The Cultural Assessment of Risk for Suicide (CARS)
measure. Psychological Assessment, 25(2), 424–434.
doi:10.1037/a0031264
Osteen, P. J., Jacobson, J. M., & Sharpe, T. L. (2014). Suicide
prevention in social work education: How prepared are social
work students?. Journal of Social Work Education, 50(2), 349-
364.
Blackboard. (2018). Collaborate Ultra help for moderators.
Retrieved from
https://help.blackboard.com/Collaborate/Ultra/Moderator

9. Note:
Beginning in Week 4, you will be using a feature in your online
classroom called Collaborate Ultra. Your Instructor will assign
you a partner and then give you moderator access to a
Collaborate Ultra meeting room. This link provides an overview
and help features for use in the moderator role.
Document:
Case Collaboration Meeting Guidelines (Word document)
Document:
Collaborating With Your Partner (PDF)
Document:
Diagnostic Summary Example (Word document)
Note:
This is an example of a diagnostic summary that can be used as
a template for Part I of the Assignment.
Required Media
Accessible player --Downloads--Download Video
w/CCDownload AudioDownload TranscriptLaureate Education
(Producer). (2018b).
Psychopathology and diagnosis for social work practice
podcast: The diagnostic interview, the mental status exam, risk
and safety assessments
[Audio podcast]. Baltimore, MD: Author.
MedLecturesMadeEasy. (2017, May 29).
Mental status exam
[Video file]. Retrieved from https://youtu.be/RdmG739KFF8

10. Sommers-Flanagan, J., & Sommers-Flanagan, R. (Producers).
(2014). Clinical interviewing: Intake, assessment and
therapeutic alliance [Video file].
Note:
You will access this e-book from the Walden Library
databases.
Watch the “Suicide Assessment Interview” segment by clicking
the applicable link under the chapters tab. This is the interview
with Tommi, which will be used for the Discussion.
Watch the “Mental Status Examination” segment by clicking the
applicable link under the chapters tab. This is the case of Carl,
which will be used for the Application.
Optional Resources
First, M. B. (2014). Handbook of differential diagnosis.
Washington, DC: American Psychiatric Association
Chapter 1, “Differential Diagnosis Step by Step” (pp. 14–24)