INTRODUCTION

Mental illness is not a new word in the world of disability. Mental illness conditions that affect
think, feel, act or other peoples surroundings. A person who suffering mental illness he/ she
doesn’t know their daily routine or their own lifestyles. To overcome this condition psycho
social rehabilitation is good with the medicine. Psycho social rehabilitation restore social
functioning, well being of a person. Mental illness is also known as psychosocial disability.
Two major mental illness are chronic schizophrenia and Bipolar affective disorder.
What is mental illness?
Mental illness is a disorder in a person behaviour or thinking etc. Mental are abnormal
thought perception emotions behaviour and relationship with others. Who introduced
different methods to prevent depression and other mental illness. Mental illness included
depression, bipolar disorder, schizophrenia and other psychosis dementia and developmental
disorders.
 Assessment purposes

• Establishing a diagnosis
• Planning treatment
• Referral to a specialist for further management
• Establish rapport and make the client comfortable
Assessment should include the following steps,
1. History collection
• Review of the presenting complaints
• A detailed biological psychological and social history
2. Attempt founder the patients personality
3. Assessment of current social situation
4. A mental status examination
5. A physical status examination
6. A formulation
7. Making specific diagnosis and differential diagnosis
8. Qualifying the severity of the disorder
9. Identifying any specific risk to the patient or others
10. Organizing any special tests or investigation
1) History taking
History taking has two main aim
I. To details the main complaints
II. To obtain a biographical understanding of the patient as a person

• The presenting complaints

Obtain the brief description of the complaints and the important of the
problem in the individuals own words. Respect and empathy will enhance
trust. And the clinicians specially find out.

❖ The nature of the problems

❖ How has the individual presented at this time
❖ Identify specific symptoms that are present and their duration
❖ Note also any disturbance in mood, appetite, sexual drive and sleep
❖ Obtain information about any treatment given by other doctors or
specialists for this problem, and the individuals response to
treatment.
History Of present illness
This section covers information related to the presenting complaints ;such as

❖ The situation that led to thee current situation

❖ Information about previous episodes
❖ Treatment for previous episodes

o The personal history

The personal history covers many aspects of the individuals life,

from childhood to adulthood obtain information about,

• Infancy
• Childhood and adolescence
• Work history
• Social history
• Marital history
• Children
• Relationship with others

o The family history

Familiar with the person family history, but if not ask about the
individuals close family. Obtain information about.

❖ Age
❖ Health
❖ Occupation
❖ Qualifying relationship with that person
❖ Psychiatric and other illness
❖ Response to treatment
 o Previous psychiatric history

Get information about preview episodes of psychiatric illness

treatment of these and response to treatment

o Drug and alcohol history

Find out the present and previous drug or alcohol used and
abuse and response to each of these drugs.

2.Assessment of personality

An attempt should be made to understand the patient personality. Valuable information

are got from the patients relatives.
Personality defined as a relatively stable and enduring. A person will interact with other in
a reasonably predictable way. Personality changes with Maturity and external demands in a
way that promotes adaptation to the environment.

• Over all mood temperament

• Character traits
• Confidence
• Religious and moral belief
• Ambitious and aspirations
• Social relationship with family, friends, workmates

3.Current social situation

• Social network
• Family relationship
• Home situation
• Occupation -type, security, job satisfaction
• Financial situation
 4. The mental status examination

The mental status component is the essential component is necessary. The MSE
should begin as soon as the patient enters the room – observation will reveal
important information such as grooming, hygiene, behaviour, guilt, level of interest in
and interaction with surroundings etc.
The MSE obtaining ‘free' through obsrvation and discussion from the initial part of
the interview.
‘Free Parameters

• Level of consciousness
• Appearance
• Behaviour
• Cooperation
• Reliability
• Affect
• Thought form

Key components of the MSE are;

• Appearance and Behaviour

Observed and describe the physical appearance of the individuals.
Eg: grooming, hygiene, clothing, including shoes. And observed the individuals present
reaction eg: hostile, friendly, withdrawn, guarded cooperative etc.
• Speech
Speech can be described in terms of rate, volume and quantity of information.
Eg. Slow, rapid, quiet
Characteristics of speech
Mutism. Total absence of speech

Poverty of speech. Restricted amount of speech. Replies togetherness are brief.

Pressured speech: speech is extremely rapid, difficult to interrupt, loud and hard.
Mood and affect: mood is internal feeling and affect external emotional response, may both
provide useful diagnostic information.
Characteristics of affect

Normal affect: variation in facial expression, voice use of hands, body movement

Restricted affect: Decrease in intensity and range of handles, body movement

Restricted affect: Decrease in intensity and range of emotional expression.
Blunted affect: severe decrease in intensity and range of emotional expression’s.
Flat affect: Total absence of emotional expression face, voice monotonous

• Disorder of thinking
Disorder thought include disorders dream of thought possession of
thought, content of thought and form of thought.

• Cognition
Cognition is a general sense, refers to information processing. Cognitive
functions are thinking and memory

Characteristics
Orientation
Time
Place
Person
Attention and concentration

• Memory
Memory can be classified into 3

Immediate memory
The capacity to immediate recall of new learning. It last few seconds
Short term memory

Temporary
Lasting few seconds

Long term memory

Long term memory has no demonstrable limits of storage and provides the
fund of knowledge for the patient.

Long term memory has two types

 Long term memory

Declarative
Procedural

Episodic semantic

skill conditions

Judgement and insight

Judgement involves weighing and comparing the

relative values of different aspects of an issue. Insight refers to the individuals awareness
of his / her situations and illness. There are varying degree of insight.
5. Physical examination
Physical examination is an important elements of the client. If the counsellor has not
received medical training, them she or he can refers the client to a general physicians for
physical examination.
6. The formulation
Information collected on history, mental status examinations and physical examination
must be brought together into a summary, from which flows the diagnostic and differential
diagnosis and treatment plan.

7. Diagnosis and differential diagnosis

A useful way of acknowledging the relevance and potential interaction of biological,
psychological, sociocultural and spiritual factors is use of the multiaxial approach to diagnosis.
Axis I. Mental disorder
Axis. II. Personality traits /disorder
Axis. III. Medical conditions
9. Assessment of risk

Consideration of risk should in compares a range of areas are

Self harm risk
Suicide risk
Dangerous to others

Likelihood of substances abuse

Vulnerability to exploitation by others
Homelessness
Risk of self neglect
10.Investigations and special tests
Once the differential diagnosis has been made further tests may be needed to excluded
or confirm the presence of suspected organic factors.

CT, MRI, Functional imaging, ECG etc. MRI from the psychiatric examination, especially
where organic cerebral pathology is suspected.

Conclusion

Each person experience with mental health and illness is unique and is based upon the
countries growing ethnic and cultural diversity. Mental health are disturbed in a person
thinking, feeling, or behaviour that reflect a problem in mental function. They disability in
social, work, or family activities. Mental illness are affect peoples mood, thinking, and
behaviour. Examples mental illness including depression, anxiety, disorder’s, schizophrenia,
eating disorders and addictive behaviours. Mental illness are mainly affected in persons
thinking behaviour etc.
Reference

Mental health and disorder

Dr Amiteshwar Rator
Assistant professor
Stride Lucknow New Delhi

Epgpathshala