Tag Archives: mental status

Psychic Communications . . . and Cultural Differences in Mental Status

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

 

Another Sample Mental Status Examination Report

Mental Status Examination (MSE) reports can be more or less detailed. More detailed reports are necessary when patients or clients exhibit a complex array of psychiatric symptoms, affect, and behavior. Less detailed reports are more common when the situation is less complex and the patient or client displays affect and behaviors that are generally within what might be considered a broad range of normal.

In most cases MSEs are imbedded within a clinical or psychiatric interview. As a consequence, as an evaluator, sometimes you may obtain more information about certain areas of functioning than others. This may or may not be intentional and it may or may not be reflected in your report. For example, in the example below, the purpose of the interview was to screen an individual for advanced placement in a Job Corps setting. Because Job Corps is a social and vocational setting, you may notice the MSE report writer emphasizes social functioning. You may also notice that the writer is EXPLICITLY clearly giving the client a “clean” mental status.

Keep in mind that like all MSE reports, this report is designed as a relatively objective appraisal of mental functioning. Nevertheless, subjective judgment and inference is always a part of MSEs and MSE reports.

MSE Sample Report: Example of Positive Functioning

Lucia Rodriguez, a 24-year-old Latino female, was open, pleasant, and cooperative during our meeting. She was well-groomed and looked somewhat younger than her stated age. She was fully oriented and alert. Her speech was clear, coherent, and of normal rate and volume. Her affect was euthymic and stable. She rated her mood as an “8” on a 0-10 scale, with 0 being completely down and depressed and 10 being as happy as possible. She further indicated that she is typically in a “positive mood.” Lucia has no current obsessional thoughts or psychotic symptoms. She has no significant mental health history. Her intellectual ability is probably at least in the above average range. She completed serial sevens and other concentration tasks without difficulty. Her cognitive skills, including memory and abstract thinking were intact. Her responses to questions pertaining to social judgment were positive and well-developed. Overall she appeared forthright and reliable. Her insight and judgment were good.

The WACES Conference in Portland — Presentation I — The Mental Status Exam and Suicide Assessment

This post includes the powerpoint slides from my presentation on Teaching the Mental Status Examination and Suicide Assessment at the Western Association of Counselor Educators and Supervisors. It was a very nice conference organized and attended by some awesome Counselor Educators. WACES MSE

Two Sample Mental Status Examination Reports

JSF Dance Party

This is a photo of me checking my mental status.

Generally, mental status examinations (MSEs) can have a more neurological focus or a more psychiatric focus. The following two fictional reports are samples of psychiatric-oriented MSEs. These sample reports can be helpful if you’re learning to conduct Mental Status Examinations and write MSE reports. They’re excerpted from the text, Clinical Interviewing (6th edition; 2017, John Wiley & Sons). Clinical Interviewing has a chapter devoted to the MSE, as well as chapters on suicide assessment interviewing and diagnostic interviewing (and many others chapter on other important topics). You can take a look at the book (and some darn good reviews) on Amazon: https://www.amazon.com/gp/product/1119215587/ref=dbs_a_def_rwt_bibl_vppi_i0

If you’d like to see a short video-clip MSE example, you can go to: http://www.youtube.com/watch?v=1lu50uciF5Y

Sample Mental Status Examination Reports

A good report is brief, clear, concise, and addresses the areas below:

1.  Appearance

2.  Behavior/psychomotor activity

3.  Attitude toward examiner (interviewer)

4.  Affect and mood

5.  Speech and thought

6.  Perceptual disturbances

7.  Orientation and consciousness

8.  Memory and intelligence

9.  Reliability, judgment, and insight

The following reports are provided as samples.

Mental Status Report 1

Gary Sparrow, a 48-year-old white male, was disheveled and unkempt on presentation to the hospital emergency room. He was wearing dirty khaki pants, an unbuttoned golf shirt, and white shoes and appeared slightly younger than his stated age. During the interview, he was agitated and restless, frequently changing seats. He was impatient and sometimes rude in his interactions with this examiner. Mr. Sparrow reported that today was the best day of his life, because he had decided to join the professional golf circuit. His affect was labile, but appropriate to the content of his speech (i.e., he became tearful when reporting he had “bogeyed number 15”). His speech was loud, pressured, and overelaborative. He exhibited loosening of associations and flight of ideas; he intermittently and unpredictably shifted the topic of conversation from golf, to the mating habits of geese, to the likelihood of extraterrestrial life. Mr. Sparrow described grandiose delusions regarding his sexual and athletic performance. He reported auditory hallucinations (God had told him to quit his job and become a professional golfer) and was preoccupied with his athletic and sexual accomplishments. He was oriented to time and place, but claimed he was the illegitimate son of Jack Nicklaus. He denied suicidal and homicidal ideation. He refused to participate in intellectual- or memory-related portions of the examination. Mr. Sparrow was unreliable and exhibited poor judgment. Insight was absent.

Mental Status Report 2

Ms. Rosa Jackson, a 67-year-old African American female, was evaluated during routine rounds at the Cedar Springs Nursing Home. She was about 5’ tall, wore a floral print summer dress, held tight to a matching purse, and appeared approximately her stated age. Her grooming was adequate and she was cooperative with the examination. She reported her mood as “desperate” because she had recently misplaced her glasses. Her affect was characterized by intermittent anxiety, generally associated with having misplaced items or with difficulty answering the examiner’s questions. Her speech was slow, halting, and soft. She repeatedly became concerned with her personal items, clothing, and general appearance, wondering where her scarf “ran off to” and occasionally inquiring as to whether her appearance was acceptable (e.g., “Do I look okay? You know, I have lots of visitors coming by later.”). Ms. Jackson was oriented to person and place, but indicated the date as January 9, 1981 (today is July 8, 2009). She was unable to calculate serial sevens and after recalling zero of three items, became briefly anxious and concerned, stating “Oh my, I guess you pulled another one over me, didn’t you, sonny?” She quickly recovered her pleasant style, stating “And you’re such a gem for coming to visit me again.” Her proverb interpretations were concrete. Judgment, reliability, and insight were significantly impaired.

 

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