Psychiatric Nursing
- Focuses on the care of individuals and families,
requiring clinical treatment, and uses all the
components of the nursing process with
increasing degrees of skill.
- This course allows student nurses to apply the
nursing process to the care of psychiatric patients.
- A specialty within the field of nursing that provides
holistic care to individuals with mental disorders or
behavioral problems, so as to promote their
physical and psychosocial wellbeing.
- It also emphasizes the use of interpersonal
relationships as a therapeutic agent and considers
the environmental factors that influence mental
health.
MENTAL STATUS EXAMINATION
- A structured assessment of a patient’s behavioral
and cognitive function. It includes a description of
the patient’s appearance and general behavior,
level of consciousness and attentiveness, motor
and speech activity, mood and affect, thought and
perception, attitude and insight, and actions
evoke in the examiner and finally higher cognitive
abilities.
- The specific cognitive functions of alertness,
language, memory, constructional ability, and
abstract reasoning are the most clinically relevant.
OBJECTIVES:
- Communicate effectively with culturally diverse
clients with mental health issues.
- Provides important information for diagnosis and
for assessment of the disorder’s course and
response to treatment.
- Utilize the teaching/learning process in providing
safe and effective nursing care for the psychiatric
client across the life cycle.
MENTAL STATUS EXAMINATION
- Is the part of the clinical assessment that describes
the sum total of the examiner’s observations &
impressions of the pt. at the time of the interview.
- It involves observing the patient’s behavior &
describing it in an objective & nonjudgmental
manner. MSE is to psychiatric nursing what the PE
is to general medical nursing.
- A psychiatric tool used to objectively and
descriptively as well as thoroughly report the
patient’s mental state at the time of interview.
- Part of every psychiatric clinical evaluation.
- It is interpreted in conjunction of the patient’s
history, physical exam, and laboratory studies
leading to differential diagnosis.
- Consideration is given to all aspects of mental
functioning.
- Psychological equivalent of the physical exam
- The patient’s MSE can change from day to day, or
hour to hour (do not rely on what was recorded
on the patient’s chart, because that is already part
of the history, have your own interview, don’t copy
from the patient’s chart)
MENTAL STATUS EXAMINATION
i Presentation/Appearance
ii Stream of Talk/ Behavior & Speech
iii Emotional State & Reaction
iv Disturbances in Thinking
v Disturbances in Perception
vi Neurovegative Dysfunction
vii General Sensorium & Intellectual Status
viii Insight/Judgement
1. Presentation
General Appearance – describes the patient’s
appearance & overall physical impression, as reflected
by apparent age, facial expressions, posture, poise,
clothing, & grooming, hair & nails.
- What do you see in the client during the interview?
- Describe the prominent physical appearance of
the client, describe the alertness, somnolence, or
during the interview the client is alert, the attitude
of the patient towards the examiner, is the patient
cooperative.
- Gives the examiner an overall impression.
- Sickly, healthy, ill, at ease, poised, old or young-
looking compared to the age of the client,
disheveled, childlike, demonstrate bizarre
behavior, with signs of anxiety, has moist hands,
perspiring, tense, wide eyes.
- Facial expressions – patient is anxious,
demonstrate pleasure, confidence, blunted, eye-
 to-eye contact, able to build rapport easily,
conscious or drowsy, behavior is overly friendly,
disinhibited or preoccupied, aggressive or normal.
Activity & Behavior
- Level of activity
- Examiner’s description of the amount & type of
motoric behavior:
◼ Mannerisms, tics & gestures
◼ Twitches & stereotyped behavior
◼ Psychomotor agitation & retardation
◼ Echopraxia & catatonia
◼ Automatisms & ataxia
- Note for drinking alcohol/ aware with patient’s
smell
- Stereotyped or repetitive activities such as hand
waving, bed rocking, headbanging, which could
be noted as common among patients with mental
retardation.
- Targeted dyskinesia – is involuntary irregular
movements of the muscles of the head, the limbs,
and trunk, and it is exacerbated by stress, and
relieved during sleep.
- Echopraxia - is imitation or repetition of body
movements, of another person and sometimes
practiced by schizophrenic patients.
- Catatonia - is a state of psychologically induced
disability with muscular rigidity, and at times
interrupted by agitation. Usually manifested as
immobility with extreme muscular rigidity or less
commonly as excessive, impulsive activity of the
patient.
- Automatism - refers to repetitive and undirected
behavior that is consciously controlled.
- Ataxia – is an impaired ability to coordinate
movement caused by a lesion in the spinal cord,
and usually the patient has a staggering gait and
a postural imbalance.
◼ Waxy Flexibility – common with
schizophrenia, maintaining the position for
long periods of time without discomfort.
◼ Catatonic excitement – having agitation,
purposeless motor activity, uninfluenced by
external stimuli.
◼ Catatonic Stupor - slowed motor activity,
and open to the point of immobility, and
seeming unawareness of the surrounding.
◼ Catatonic rigidity’ – voluntary assumption of
a rigid posture and held against all efforts to
be moved.
◼ Catatonic posturing – voluntary assumption
an inappropriate or bizarre posture.
- Attitude towards Examiner –
- how patients relate to the examiner:
◼ irritable, aggressive, seductive, guarded,
defensive, indifferent, apathetic, cooperative,
sarcastic, attentive, angry
2. Stream of Talk
- Is the examiner’s description of the patient’s ability
to articulate thoughts (physical characteristics):
rate (increased or pressured, decreased, or there
is latency in terms of talking), volume (loud or soft),
amount, articulation/characteristic, content,
rhythm.
3. Emotional State & Reaction
-Mood- pervasive & sustained emotion that colors
the person’s perception of the world. Gloomy, tense,
hopeless, ecstatic, sad, exultant, elated, euphoric,
depressed, fearful, or demonstrates suicidal, and
grandiose thoughts or behavior. Ask the patient: how
are you feeling today?
-Affect- the emotional state we observe during the
interview.
◼ Blunt – severe reduction
◼ Flat – absence or near absence
◼ Liability – shifting or expression
◼ Inappropriate – disharmony between stimuli
& emotional reaction.
- Suicidal & Homicidal Ideation-
depersonalization & derealization – strangeness
towards self & environment. Do you have
thoughts of harming others or harming yourself?
4. Disturbances in Thinking
a) Though process – refers to the way in which
a person puts together ideas & associations,
the form in which & person thinks. Logical or
coherent, or otherwise. Ask what the patient
thinks of.
i. Circumstantiality – overinclusion of
details usually irrelevant & eventually
gets back to the original point.
ii. Tangentiality – similar to
circumstantiality but the person never
 answers the original question external stimuli:
iii. Clang association – association of ◼ Illusion – with external stimuli with
words similar in sound but not in misinterpretation or word distortion
meaning; words have no logical ◼ Hallucination – not associated with real
connection, RHYMING. external stimuli.
iv. Flight of Ideas – shifting of the topic ◼ Do you see things? Or hear voices? Do
from one subject to another in a you have strange smell of something?
somewhat related way ◆ Auditory – most common
v. Looseness of Association – shifting of a ◆ Visual
topic from one subject to another in a ◆ Tactile
completely unrelated way. ◆ Gustatory
vi. Word salad – incoherent mixture of ◆ Olfactory
words & phrases.
vii. Perseveration – repetition out of 6. Neurovegative Dysfunction
context of words, phrases or ideas of a Assess:
single response - Sleep – disturbances, difficulty
viii. Thought Blocking – sudden disruption - Appetite
of thought or a break in the flow of ideas. - Diurnal – change in the mood-related to the
ix. Neologism – pathological creation of time of the day. Active in daytime or nighttime.
new words often blends to another word. - Variation
b) Thought Content – refers to what a person - Weight – rapid or drastic increase or
is thinking about: ideas, beliefs, decrease weight changes
preoccupations, obsessions. - Libido – instinctual drive, energy level
Descriptions: 7. General sensorium and Intellectual Status
-delusions a) Seeks to assess brain function, intelligence,
-obsessions & compulsions the capacity of abstract thought, level of
-phobia insight & judgement
-thought broadcasting b) Ability to perform certain mental tasks
Delusion – false fixed beliefs which are inconsistent c) Level of consciousness – awareness to the
with knowledge & culture. environment.
- Persecutory or paranoid i. Alert
- Grandiose ii. Drowsy
- Jealous iii. Lethargy
- Somatic iv. Stupor – unresponsiveness, seems
- Religious unaware of the surrounding
- Ideas of reference v. Coma – state of profound
Persecutory or Paranoia – extremely paranoid unconsciousness
Grandiose Delusion – an individual is convinced that d) Orientation
they have a special power, a talent or an ability, they i. Time: what is today’s date?
are a famous character. ii. Place: what place is this?
- Religious Grandiosity – religious or spiritual iii. Person: Do you know who am I?
content delusion. One is favored by the higher being e) Memory – ability to recall past experiences
or an instrument of the higher being. i. Remote – past historical events or data
that can be verify i.e. address, SSS, DOB
5. Disturbance in Perception ii. Recent – recall of past few days,
- False sensory perception with or without yesterday’s events, meals eaten today
 iii. Intermediate – recall three words at 5 ◼ Recall
min, recall names of people in ◼ Language
immediate environment.
- Indication: it is commonly used in medicine
f) Concentration/Attention & Calculation and allied health to screen for dementia.
- patients’ ability to pay attention during - (Insert picture)
interview & ability to do simple mathematics. Interpretations:
- Subtracting serial 7s from 100 - Any score greater than or equal to 24 points
- Spell WORLD backwards (out of 30) indicates a normal cognition.
- Functional calculation by practical - Below this, scores can indicate
questions - Severe (less than or equal to 9 points)
g) General information - Moderate (10-18 points)
- Estimate of overall fund of knowledge - Mild (19-23 points) cognitive impairment
- Patients educational level & socioeconomic
status must be considered.
h) Abstract Thinking
- ability to deal with concepts, how they
conceptualize & handle ideas
◼ meaning of simple proverbs
◼ similarities between objects in the same
class
◼ ability to discuss emotions & see content
of thought
i) Judgment & Reasoning
- Social Judgment – does patient understand
the likely outcome of personal behavior
- Test Judgment – prediction in imaginary
situations
8. Insight – patient’s degree & awareness &
understanding about being ill
- Any denial or some awareness that they are
ill but place the blame on others
- Good or poor
- What are your plans in the future?
- Describe if client has complete denial of the
illness
- Slight awareness of being sick

MMSE (Mini-Mental State Examination) or Folstein

Test
- Is a 30-point questionnaire that is used
extensively in clinical and research settings to measure
cognitive impairment.
◼ Orientation
◼ Registration
◼ Attention and calculation