Program name: B.A Hons.

Applied Psychology
Semester: IV
Title of paper: Health Psychology
Name of student: Darpan Mehandiratta
College roll number: 19/0062
University roll number: 19075505010
 MENTAL STATUS EXAMINATION

AIM: To study the cognitive and behavioural functioning of a client diagnosed with chronic
illness using mental status examination (MSE)

BASIC CONCEPT:

Introduction to health

The World Health Organization (1948) defined health as “a complete state of physical, mental,
and social well-being and not merely the absence of disease or infirmity.” Health comprises the
diagnosis of an illness, predisposition to a disease, and any unexpected injury. Healthcare exists
to help people maintain this optimal state of health. It is a resource to support an individual’s
function in wider society, rather than an end in itself. A healthful lifestyle provides the means to
lead a full life with meaning and purpose. Apart from Mental and Physical health, Spiritual,
emotional, and financial health also contribute to overall health. The continuous state of
enhanced well being or wellness promotes active awareness of and participating in measures that
preserve health, both as an individual and in the community.

Health psychology is an exciting and relatively new field devoted to understanding psychological
influences on how people stay healthy, why they become ill, and how they respond when they do
get ill. It includes psychology’s contributions to the enhancement of health, the prevention and
treatment of disease, the identification of health risk factors, the improvement of the healthcare
system, and the shaping of public opinion with regard to health.

Physical illness

1. Acute illness

Acute illnesses are short-term illnesses caused by a virus or bacterial infection that can normally
be healed. It may or may not be fatal, meaning that if the disease is left untreated for a long time,
it may become fatal. Acute diseases, such as tuberculosis, pneumonia, and other infectious
diseases, are medical conditions that develop unexpectedly and last for a brief period of time.
The prevalence of acute infectious disorders, such as tuberculosis, influenza, measles, and
poliomyelitis, has declined because of treatment betterment, scientific innovations and changes
in public health standards, such as improvements in waste control and sewage. In earlier times
acute illness was more common because of less technological advancement and ongoing process
of discoveries and experiments.

2. Chronic illness

These diseases develop slowly and last for a longer period of time. It can become fatal at times.
A number of factors play a role in causing a chronic illness, in the present time stress, less
exercising or overeating or incorrect eating could lead to these diseases. These include heart
disease, cancer, and respiratory diseases—are the main contributors to disability and death,
particularly in industrialized countries. Chronic illnesses are slowly developing diseases with
which people live for many years and that typically cannot be cured but rather are man- aged by
patient and health care providers. In contemporary times the chronic illness is more common
since the stress is more, lifestyle has become more lethargic and the clock of the body has
changed drastically. The sleeping pattern, the stress levels, the high aggressive behaviour are
some of the factors that are present in every individual’s life in present times.

Methods of assessment

Tests and assessments are two separate but related components of a psychological evaluation.
Psychologists use both types of tools to help them arrive at a diagnosis and a treatment plan.
Psychological assessment is a process of testing that uses a combination of techniques to help
arrive at some hypotheses about a person and their behavior, personality and capabilities. It is
also referred to as psychological testing, or performing a psychological battery on a person.
Psychological testing is nearly always performed by a licensed psychologist, or a psychology
trainee. A part of a thorough assessment of an individual is that they also undergo a full medical
examination, to rule out the possibilities of a medical, disease or organic cause for the
individual’s symptoms.
Primary purposes of psychological assessment in clinical settings are:
1. To identify, operationally define, and measure a client’s adaptive and maladaptive behaviors
and treatment goals.
2. To identify, operationally define, and measure factors that influence a client’s adaptive and
maladaptive behaviors and attainment of treatment goals.
3. To integrate assessment information in order to design and evaluate interventions that can
improve a client’s quality of life.

Components of Psychological Assessment:

1. Norm-Referenced Tests- A standardized psychological test is a task or set of tasks given

under standard, set conditions. It is designed to assess some aspect of a person’s
knowledge, skill or personality. A psychological test provides a scale of measurement for
consistent individual differences regarding some psychological concept and serves to line
up people according to that concept. Norm-referenced psychological tests are
standardized on a clearly defined group, termed the norm group, and scaled so that each
individual score reflects a rank within the norm group. Norm-referenced tests have been
developed to assess many areas, including intelligence; reading, arithmetic, and spelling
abilities; visual-motor skills; gross and fine motor skills; and adaptive behavior.
Psychologists have a choice of many well-standardized and psychometrically sound tests
with which to evaluate an individual. Norm-referenced tests have several benefits over
non-norm-referenced tests. They provide valuable information about a person’s level of
functioning in the areas covered by the tests. They take relatively little time to administer,
permitting a sampling of behavior within a few hours. Each appraisal can provide a
wealth of information that would be unavailable to even the most skilled observer who
did not use testing. Finally, norm-referenced tests also provide an index for evaluating
change in many different aspects of the child’s physical and social world.

2. Interviews- Valuable information is gained through interviewing. Interviews are more

open and less structured than formal testing and give those being interviewed an
opportunity to convey information in their own words. A formal clinical interview is
often conducted with the individual before the start of any psychological assessment or
 testing. This interview can last anywhere from 30 to 60 minutes, and includes questions
about the individual’s personal and childhood history, recent life experiences, work and
school history, and family background.There are many types of clinical interviews that
can be used at different times and with different people. The 2 most common clinical
interviews are the intake interview and the mental status exam. The intake interview
happens the first time a person comes to see a psychologist. The focus is on their mental
and physical health history. A mental status exam is a clinical interview that looks at
more than just the answers to questions. The focus is on the patient's behaviors,
appearance, attitude and movements, as well as their answers to the psychologist’s
questions.

3. Observations- Observations of the person being referred in their natural setting can
provide additional valuable assessment information. The researcher observes and
systematically records the measurement of a person's behavior. It can also help the
professional conducting the assessment better formulate treatment recommendations.In
general, observations are relatively cheap to carry out and few resources are needed by
the researcher. However, they can often be very time consuming and longitudinal. There
are 2 types of observation: Controlled observations, usually a structured observation are
likely to be carried out in a psychology laboratory. The researcher decides where the
observation will take place, at what time, with which participants, in what circumstances
and uses a standardized procedure. Participants are randomly allocated to each
independent variable group. Naturalistic observation involves studying the spontaneous
behavior of participants in natural surroundings. The researcher simply records what they
see in whatever way they can. In unstructured observations, the researcher records all
relevant behavior without a system. Behavior intrusion is minimized or limited as it is
recorded in the natural setting.

4. Informal Assessment- Standardized norm-referenced tests may at times need to be

supplemented with more informal assessment procedures, such as projective tests or even
career-testing or teacher-made tests. For example, in the case of a child, it may be
valuable to obtain language samples from the child, test the child’s ability to profit from
systematic cues, and evaluate the child’s reading skills under various conditions. The
 realm of informal assessment is vast, but informal testing must be used more cautiously
since the scientific validity of the assessment is less known.

Psychologists seek to take the information gathered from psychological assessment and weave it
into a comprehensive and complete picture of the person being tested. Recommendations are
based on all the assessment results and from discussion with peers, family, and others who may
shed light on the person’s behavior in different settings. For instance, in children, information
must be obtained from parents and teachers in order for psychological assessment to be
considered complete and relevant to the child. Major discrepancies among the findings must be
resolved before any diagnostic decisions or recommendations for treatment are made.
Psychological assessment is never focused on a single test score or number. Every person has a
range of competencies that can be evaluated through a number of methods. A psychologist is
there to evaluate the competencies as well as the limitations of the person, and report on them in
an objective but helpful manner. A psychological assessment report will not only note
weaknesses found in testing, but also the individual’s strengths.

Physical Examination is the process of evaluating objective anatomic findings through the use
of inspection, palpation, percussion, and auscultation. The information obtained must be
thoughtfully integrated with the patient's history and pathophysiology. Moreover, it is a unique
situation in which both patient and physician understand that the interaction is intended to be
diagnostic and therapeutic. The physical examination, thoughtfully performed, should yield 20%
of the data necessary for patient diagnosis and management.

1. Inspection- Performed first, inspection is the most repeated of the four physical
examination methods. Inspection can be emphasized by using sight and smell to check
specific areas for normal color, shape, and consistency.
2. Palpation- Palpation is the act of touching a patient to feel for abnormalities anywhere in
the body. There are two different types: light and deep palpation. Light palpation is soft
and gentle. Nurses may find information on skin texture and moisture, masses, fluid,
muscle guarding, and superficial tenderness by using light palpation. Deep palpation
explores the body’s internal structures to a depth of 4-5 centimeters. This technique can
 inform nurses about the position of organs and masses, as well as their size, shape,
mobility, consistency, and areas of discomfort.
3. Percussion- It includes tapping one’s hands on a patient’s body to produce sound
vibrations. The sounds made can confirm the presence of air, fluid, and solids, along with
organ size, shape, and position. Percussion can be practiced almost anywhere to analyze
the intensity, duration, pitch, frequency, quality, and location of sound.
4. Auscultation- It means listening to the heart, lungs, neck, or abdomen to gather
information. There are two types of auscultation: direct and indirect. Direct Auscultation
is listening with the unaided ear. This may include listening to the patient from a distance
or right on the patient’s skin. Indirect Auscultation is using amplification or a mechanical
device, such as a stethoscope.

The physical examination is a key part of a continuum that extends from the history of the
present illness to the therapeutic outcome. If the history and physical examination are linked
properly by the physician's reasoning capabilities, laboratory tests should in large measure be
confirmatory. The physical examination, however, can be the weak link in this chain if it is
performed in a perfunctory and superficial manner.

Selected illness

Diabetes is a condition that impairs the body’s ability to process blood glucose, otherwise
known as blood sugar. It is a serious chronic condition. According to the American Diabetes
Association (ADA), the condition is the seventh leading cause of death in the U.S. Three major
diabetes types that can develop are:

Type I diabetes: This type occurs when the body fails to produce insulin. It is also known as
juvenile diabetes. People with type I diabetes are insulin-dependent, which means they must take
artificial insulin daily to stay alive.

Type 2 diabetes: Type 2 diabetes affects the way the body uses insulin. While the body still
makes insulin, unlike in type I, the cells in the body do not respond to it as effectively as they
once did. This is the most common type of diabetes, according to the National Institute of
Diabetes and Digestive and Kidney Diseases, and it has strong links with obesity.

Gestational diabetes: This type occurs in women during pregnancy when the body can become
less sensitive to insulin. It does not occur in all women and usually resolves after giving birth.

Some of the signs and symptoms of type 1 diabetes and type 2 diabetes are Increased thirst,
Frequent urination, Extreme hunger, Unexplained weight loss, Presence of ketones in the urine
(ketones are a byproduct of the breakdown of muscle and fat that happens when there's not
enough available insulin), Fatigue, Irritability, Blurred vision, Slow-healing sores, Frequent
infections, such as gums or skin infections and vaginal infections. Type 1 diabetes can develop at
any age, though it often appears during childhood or adolescence. Type 2 diabetes, the more
common type, can develop at any age, though it's more common in people older than 40.

Causes:

Type 1 diabetes:

The immune system which normally fights harmful bacteria or viruses attacks and destroys the
insulin-producing cells in the pancreas. This leaves one with little or no insulin. Instead of being
transported into our cells, sugar builds up in the bloodstream. Type 1 is thought to be caused by a
combination of genetic susceptibility and environmental factors, though exactly what those
factors are is still unclear. Weight is not believed to be a factor in type 1 diabetes.

Prediabetes and type 2 diabetes:

Here, the cells become resistant to the action of insulin, and our pancreas is unable to make
enough insulin to overcome this resistance. Instead of moving into the cells where it's needed for
energy, sugar builds up in the bloodstream. It is not sure why this happens, although it's believed
that genetic and environmental factors play a role in the development of type 2 diabetes too.
Being overweight is strongly linked to the development of type 2 diabetes, but not everyone with
type 2 is overweight.

Gestational diabetes:

During pregnancy, the placenta produces hormones to sustain the pregnancy. These hormones
make one’s cells more resistant to insulin. Normally, our pancreas responds by producing
enough extra insulin to overcome this resistance. But when it can’t keep it up, too little glucose
gets into our cells and too much stays in our blood, resulting in gestational diabetes.

Diagnosis:

Tests for type 1 and type 2 diabetes and prediabetes:

1. Glycated hemoglobin (A1C) test- This blood test doesn't require fasting and indicates a
person’s average blood sugar level for the past two to three months. It measures the
percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red
blood cells. The higher are the blood sugar levels, the more hemoglobin one will have
with sugar attached. An A1C level of 6.5% or higher on two separate tests indicates that a
person has diabetes. An A1C between 5.7 and 6.4 % indicates prediabetes. Below 5.7 is
considered normal.

If the A1C test results aren't consistent or not available, or a person has conditions that can make
the A1C test inaccurate (pregnant or having an uncommon form of hemoglobin), the following
tests are suggested to diagnose diabetes:

● Random blood sugar test- A blood sample is taken at a random time regardless of
when one last ate. A blood sugar level of 200 milligrams per deciliter (mg/dL) —
11.1 millimoles per liter (mmol/L) or higher suggests diabetes.
● Fasting blood sugar test. A blood sample is taken after an overnight fast. A fasting
blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood
sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If
it's 126 mg/dL (7 mmol/L) or higher on two separate tests suggests diabetes.
 ● Oral glucose tolerance test. For this test, one has to fast overnight, and the fasting
blood sugar level is measured. Then one drinks a sugary liquid, and blood sugar
levels are tested periodically for the next two hours. A blood sugar level less than
140 mg/dL (7.8 mmol/L) is normal. A reading of more than 200 mg/dL (11.1
mmol/L) after two hours indicates diabetes. A reading between 140 and 199 mg/dL
(7.8 mmol/L and 11.0 mmol/L) indicates prediabetes.

If type 1 diabetes is suspected, urine is tested to look for the presence of a byproduct produced
when muscle and fat tissue are used for energy because the body doesn't have enough insulin to
use the available glucose (ketones).

Tests for gestational diabetes:

● Initial glucose challenge test- An individual begins a glucose challenge test by

drinking a syrupy glucose solution. One hour later, a blood test is taken to measure
your blood sugar level. A blood sugar level below 140 mg/dL (7.8 mmol/L) is
usually considered normal on a glucose challenge test, although this may vary at
specific clinics or labs.
If the blood sugar level is higher than normal, it only means that an individual has
higher risk of gestational diabetes. The doctor then orders a follow-up test to
determine if a person has gestational diabetes.
● Follow-up glucose tolerance testing- For the follow-up test, one is required to fast
overnight and then have fasting blood sugar level measured. Then one drinks
another sweet solution containing a higher concentration of glucose and the blood
sugar level is checked every hour for a period of three hours. If at least two of the
blood sugar readings are higher than the normal values established for each of the
three hours of the test, one is diagnosed with gestational diabetes.

Treatment:

Common treatment:

An important part of managing diabetes as well as overall health is maintaining a healthy weight
through a healthy diet and exercise plan:
 ● Healthy eating: Contrary to popular perception, there's no specific diabetes diet.
However, the focus should be on having more fruits, vegetables, lean proteins and
whole grains, overall the food that is high in nutrition and fiber and low in fat and
calories and cut down on saturated fats, refined carbohydrates and sweets. A
registered dietitian can help to create a meal plan that fits health goals, food
preferences and lifestyle.
● Physical activity: Exercise lowers blood sugar level by moving sugar into the cells,
where it's used for energy. Exercise also increases the sensitivity to insulin, which
means our body needs less insulin to transport sugar to the cells. Physical activities
like walking, swimming or biking can help an individual.

Treatments for type 1 and type 2 diabetes:

Treatment for type 1 diabetes involves insulin injections or the use of an insulin pump, frequent
blood sugar checks, and carbohydrate counting. Treatment of type 2 diabetes primarily involves
lifestyle changes, monitoring of your blood sugar, along with diabetes medications, insulin or
both.

● Monitoring your blood sugar: Careful monitoring is the only way to make sure that
blood sugar level remains within our target range. People with type 2 diabetes who
aren't taking insulin generally check their blood sugar much less frequently.
People who receive insulin therapy also may choose to monitor their blood sugar
levels with a continuous glucose monitor. Even with careful management, blood
sugar levels can sometimes change unpredictably. In addition to daily blood sugar
monitoring, doctors recommend regular A1C testing to measure average blood
sugar level for the past two to three months. Compared with repeated daily blood
sugar tests, A1C testing better indicates how well our diabetes treatment plan is
working overall.
● Insulin: People with type 1 diabetes need insulin therapy to survive. Many people
with type 2 diabetes or gestational diabetes also need insulin therapy.
Many types of insulin are available, including short-acting (regular insulin), rapid-
acting insulin, long-acting insulin and intermediate options. Insulin can't be taken
orally to lower blood sugar because stomach enzymes interfere with insulin's action.
An insulin pump also may be an option.
 ● Oral or other medications: Sometimes other oral or injected medications are
prescribed as well. Some diabetes medications stimulate the pancreas to produce
and release more insulin. Others inhibit the production and release of glucose from
the liver. Still others block the action of stomach or intestinal enzymes that break
down carbohydrates or make tissues more sensitive to insulin. Metformin
(Glumetza, Fortamet, others) is generally the first medication prescribed for type 2
diabetes. Another class of medication called SGLT2 inhibitors may be used. They
work by preventing the kidneys from reabsorbing sugar into the blood.
● Transplantation: In some people who have type 1 diabetes, a pancreas transplant
may be an option. With a successful pancreas transplant, one would no longer need
insulin therapy. However, it’s quite risky. One needs a lifetime of immune-
suppressing drugs to prevent organ rejection. These drugs can have serious side
effects, which is why transplants are usually reserved for people whose diabetes
can't be controlled or those who also need a kidney transplant.
● Bariatric surgery: Although it is not specifically considered a treatment for type 2
diabetes, people with type 2 diabetes who are obese and have a body mass index
higher than 35 may benefit from this type of surgery. People who've undergone
gastric bypass have seen significant improvements in their blood sugar levels.
However, this procedure's long-term risks and benefits for type 2 diabetes aren't yet
known.

Treatment for gestational diabetes:

Controlling your blood sugar level is essential for keeping the baby healthy and avoiding
complications during delivery. In addition to maintaining a healthy diet and exercising, treatment
plans may include monitoring blood sugar and, in some cases, using insulin or oral medications.
If blood sugar rises, the baby may release high levels of insulin which can lead to low blood
sugar right after birth.

MENTAL STATUS EXAMINATION

The mental status examination (MSE) is a component of all medical exams and may be viewed
as the psychological equivalent of the physical exam. The purpose is to evaluate, quantitatively
and qualitatively, a range of mental functions and behaviors at a specific point in time. It is
especially important in neurologic and psychiatric evaluations. The MSE provides important
information for diagnosis and for assessment of the disorder’s course and response to treatment.
Observations noted throughout the interview become part of the MSE, which begins when the
clinician first meets the patient. Information is gathered about the patient’s behaviors, thinking,
and mood.

To assess properly the patient’s mental status, it is important to have some understanding of the
patient’s social, cultural, and educational background. What may be abnormal for someone with
more intellectual ability may be normal for someone with less intellectual ability. Patients for
whom English is a second language may have difficulty understanding various components of
the MSE, such as the proverbs. Age may be a factor. In general, patients over the age of 60 years
tend to do less well on the cognitive elements of the MSE. Often this is related to less education
rather than to aging alone. At an appropriate point in the evaluation the formal MSE is
undertaken to compile specific data about the patient’s cognitive functioning. Earlier informal
observations about mental state are woven together with the results of specific testing. For
example, the interviewer will have considerable information about attention span, memory, and
organization of thought from the process of the interview. Specific questions during the formal
exam clarify more precisely the degree of attention or memory dysfunction.

Culture, native language, level of education, literacy, and social factors such as sleep deprivation,
hunger, or other stressors must be taken into account when interpreting the examination, because
these factors can affect performance. Language skills of the physician and patient are critical; the
patient must be able to understand the questions and communicate his or her answers, and the
physician must be able to interpret the examination results. The mental status examination should
occur when the physician is alone with the patient and again in the presence of the patient’s
friends or family members who can provide more longitudinal insight into problems the patient
may be having. The physician should maintain a nonjudgmental, supportive attitude during the
encounter.

Components of MSE:

Major components of mental status examination are:

Appearance: Age, sex, race, body build, posture, eye contact, dress, grooming, manner,
attentiveness to examiner, distinguishing features, prominent physical abnormalities, emotional
facial expression, alertness

Motor: Retardation, agitation, abnormal movements, gait, catatonia

Speech: Rate, rhythm, volume, amount, articulation, spontaneity

Affect: Stability, range, appropriateness, intensity, affect, mood

Thought content: Suicidal ideation, death wishes, homicidal ideation, depressive cognitions,
obsessions, ruminations, phobias, ideas of reference, paranoid ideation, magical ideation,
delusions, overvalued ideas

Thought process: Associations, coherence, logic, stream, clang associations, perseveration,

neologism, blocking, and attention

Perception: Hallucinations, illusions, depersonalization, derealization, déjà vu, jamais vu

Intellect: Global impression: average, above average, below average

Insight: Awareness of illness

METHODOLOGY

1. Subject details

Name- Naveen
Age- 46 years
Qualification- Higher Secondary School

2. Material required

MSE worksheet, Pencil, Eraser

 3. Method

The participant was welcomed and informed about the objective of the practical. A small
conversation was held for rapport formation. All the doubts were clarified. Some questions about
the illness and activities related to components of MSE were prepared prior to the conduction.
He was then asked questions and activities were conducted and the MSE worksheet was filled.
The participant was then thanked for his time.

RESULTS

The participant selected was a 46 years old male with diabetes. He was quite overweight and had
a lean posture while sitting. His hair was well groomed but he was underdressed. The participant
was using gestures while talking and a slow and loud speech was also observed. He was quite
responsive and talkative. He seemed friendly, cooperative, interested, attentive and frank. His
mood was quite expansive and his affective expression was normal. His behavior seemed
appropriate. He had overvalued ideas and thoughts about certain things and his thought form was
abstract. The participant’s speech was voluble. He was able to pay selective attention but he did
show a recent past memory deficit. His judgement seemed quite critical when asked objective
questions. He had an intellectual insight about his disease.

DISCUSSION

The aim of this practical was to study the cognitive and behavioral functioning of a client
diagnosed with chronic illness using mental status examination (MSE). The mental status
examination is a useful tool to assist physicians in differentiating between a variety of systemic
conditions, as well as neurologic and psychiatric disorders ranging from delirium and dementia
to bipolar disorder and schizophrenia. The examination comprises a few brief observations made
during a general patient encounter or a more thorough evaluation by the physician. The purpose
is to evaluate, quantitatively and qualitatively, a range of mental functions and behaviors at a
specific point in time.
The examination begins with a general assessment of the patient’s level of consciousness,
appearance, activity, and emotional state. Each of the items may be rapidly assessed by a
physician in the initial moments of the encounter through history taking and general observation.
These findings, combined with a brief memory test is needed to ascertain that no pathology is
present. If the general assessment does reveal areas of concern, further in-depth investigation is
warranted.

General Description- The participant chosen for this practical is a diabetic patient. Diabetes is a
chronic illness that occurs when blood glucose, also known as blood sugar, is too high. Some of
the signs and symptoms of type 1 diabetes and type 2 diabetes are Increased thirst, Frequent
urination, Extreme hunger, Unexplained weight loss, Fatigue, Irritability, Blurred vision, Slow-
healing sores, Frequent infections, etc. The participant weighs 85 kg thus, he is overweight. He
was shaved and his hair was well groomed, however he was quite underdressed as he was
wearing a T-shirt and a trouser. He used gestures with his hand while explaining his illness. It
was observed that his way of speaking was slow and calm and not very loud. During the entire
conversation with him regarding his illness, he was very responsive and talkative. When asked
about the history of his illness, he gave an in-depth insight in which he talked about the
challenges, causes and medications of diabetes. He was very friendly, cooperative and frank as
he shared all the information regarding his illness without being hesitant. He also seemed
interested and attentive while sharing.

Mood and Affect- The participant’s mood seemed quite expansive. As when he was asked about
his daily routine, he emphasized every detail in an interesting way. However, his affective
expression was normal as he expressed his feelings about his family members in a positive
manner focusing on how helpful and supportive they have been during his illness. As he
mentioned their actions like making sure he does not eat much cuisine and giving him a
controlled diet, his mood seemed quite appropriate.

Thought Process- Throughout the conversation, the participant was giving unnecessary and
often irrelevant details before arriving at the main point which shows circumstantiality type of
thought form. It was also observed that he was talking quite fluently which shows a voluble kind
of speech.

Sensorium and Cognition- The participant was well aware of himself and the time and place. In
order to make sure of any memory deficit, some activities were held in the following order: Q1-
How much did you score in your 12th board exams ? Q2- What was your first job ? Q3- What
was the first vehicle you bought? Q4- What did you do last Sunday’s morning? Q5- Did you
watch TV 5 days back? Q6- Can you recall where you went 4 days back? Q7- What did you have
for breakfast today? Q8- What was the first thing you did in the morning today? Q9- Whom at
home did you first talk to today? Q10- What was the question I just asked you ? Q12- What was
the first question that I asked? Through this questioning, it was observed that the participant
couldn’t answer all the questions that showed Recent past memory deficit, i.e, Q4, Q5, Q6. To
check whether the participant could pay selective attention, he was given one page from a book
to read and music was played along and then he was asked to brief about what he understood. It
was seen that the participant was able to pay selective attention and was not at all disturbed by
the music playing.

Thus, through Mental Status Examination (MSE) it was quite clear that the participant’s chronic
illness,i.e, diabetes did not have any kind of serious impact on his cognitive and behavioural
functioning. He was quite well behaved, normal and did not show signs of any kind of delusions,
hallucinations, dissociation, amnesia, phobias.

CONCLUSION

The aim of this practical was to study the cognitive and behavioral functioning of a client
diagnosed with chronic illness using mental status examination (MSE). MSE provides important
information for diagnosis and for assessment of the disorder’s course and response to treatment.
The participant selected was a 46 years old diabetic patient. He was well mannered, calm and
very responsive. With this examination, it was observed that his chronic illness had no major
impact on his cognitive and behavioral functioning. Not all the components of MSE matched the
participant’s illness.
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