You may or may not have noticed that I haven’t posted anything on this blog in the past 10 days or so. This is because I’ve been experimenting with my telepathic (psychic) communication abilities. As it turns out, my telepathy skills aren’t as refined as I wish they were and so instead of any specific communications from me, receivers have only experienced warm and fuzzy positive sensations. And so if you experienced anything positive like that over the past ten days, it probably means I was thinking of you and trying to psychically send you some pleasant holiday wishes.
Below please find another installment in my intermittent Mental Status Examination series. This posting includes an activity you can use yourself or with a class to facilitate a discussion (with yourself or among class members) about cultural differences in mental status.
Happy New Year! and Happy Mental Statusing!!
Cultural Differences in Mental Status
Part One: Cultural norms must be considered when evaluating mental status. In the following Table, read through the MSE category, the MSE observation, and then contemplate the “invalid conclusion” along with the “explanation.” The purpose of this activity is to illustrate how cultural background and context can affect the meaning of specific client symptoms.
| Category | Observation | Invalid Conclusion | Explanation |
| Appearance | Numerous tattoos and piercings | Antisocial tendencies | Comes from region or area or subculture where tattoos and piercings are the norm |
| Behavior/psychomotor activity | Eyes downcast | Depressive symptom | Culturally appropriate eye-contact |
| Attitude toward examiner | Uncooperative and hostile | Oppositional-defiant or personality disorder | Has had abusive experiences from dominant culture |
| Affect and mood | No affect linked to son’s death | Inappropriately constricted affect | Expression of emotion about death is unaccepted in client’s culture |
| Speech and thought | Fragmented and nearly incoherent speech | Possible psychosis | Speaks English as third language and is under extreme stress |
| Perceptual disturbances | Reports visions | Psychotic symptom | Visions are consistent with Native culture |
| Orientation and consciousness | Inability to recall three objects or do serial sevens | Attention deficit or intoxication | Misunderstands questions due to language problem |
| Memory and intelligence | Cannot recall past presidents | Memory impairment | Immigrant status |
| Reliability, judgment, and insight | Lies about personal history | Poor reliability | Does not trust White interviewer from dominant culture |
Part Two: For each category addressed in a traditional MSE, try to think of cultures that would behave very differently but still be within “normal” parameters for their cultural or racial group. Examples include differences in cultural manifestations of grief, stress, humiliation, or trauma. In addition, persons from minority cultures who have recently been displaced may display confusion, fear, distrust, or resistance that is entirely appropriate to their situation.
Work with a partner to generate possible MSE observations, in addition to those listed in Part One of this Multicultural Highlight and using the Table below, that might lead you to an inappropriate and invalid conclusion regarding client mental status.
| Category | Observation | Invalid Conclusion | Explanation |
This Table is adapted from the text, Clinical Interviewing, by John and Rita Sommers-Flanagan: http://www.amazon.com/Clinical-Interviewing-2012-2013-John-Sommers-Flanagan/dp/1118390113/ref=la_B0030LK6NM_1_1?ie=UTF8&qid=1357167677&sr=1-1
John Sommers-Flanagan 
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