MENTAL HEALTH

ASSESMENT
AURTHOR
1. BYAWELE JAIRUS WANGUSA
2. Masudio Mercy
3. Ayo nelson
 STEP : HISTORY TAKING
• It should be gathered in the standard order.
• This provides structure and logical coherence to
the questioning, both for the doctor and the
patient, and it is less likely that items will be
omitted.
• Information collected includes; name, age, and
marital status, current occupation.
• Colateral history ………..information from a
caregiver of a patient
 1. PRESENTING COMPLAINTS $ THEIR
HISTORY
• Presenting complaints Number and brief description of
presenting complaints. Which is the most troublesome symptom?
• History of presenting complaints For each individual
complaint, record its nature (in the patient’s own words as far as
possible); chronology; severity; associated symptoms and
associated life events occurring at or about the same time.
• What are the aggravating, and relieving factors. Have these or
similar symptoms occurred before? To what does the patient
attribute their symptoms?
 2. PAST PSYCHIATRIC AND MEDICAL
HISTORY

• Previous psychiatric diagnoses.

• Chronological list of episodes of psychiatric inpatient,
day hospital, and outpatient care.
• Current medical conditions. Chronological list of
episodes of medical or surgical illness. Episodes of
symptoms for which no treatment was sought.
 3. DRUG HISTORY

• List names and doses of current medication (have they been

taking it?) Previous psychiatric drug treatments. History of
adverse reactions or drug allergy. Any non-prescribed or
alternative medications
 4. FAMILY HISTORY

• Family tree detailing names, ages, relationships, and illnesses

of first- and second-degree relatives.
• Are there any familial illnesses?
 7. PERSONAL HISTORY

• Note the personality

• Childhood Were there problems during their pregnancy or delivery?
• Did they reach development milestones normally?
• Was their childhood happy?
• In what sort of family were they raised?
• Education Which primary and secondary schools did they attend?
• If more than one of each, why was this? Did they attend mainstream or
specialist schools? Did they enjoy school—if not, why?
• At what age did they leave school and with what qualifications? Type of
further education and qualifications attained.
 PERSONAL HISTORY CONT.
• If they left higher education before completing the course—why
was this?
• Employment: Chronological list of jobs. Which job did they hold
for the longest period? Which job did they enjoy most?
• If the patient has had a series of jobs—why did they leave each?
Account for periods of unemployment in the patient’s history.
• Relationships: Sexual orientation. Chronological account of
major relationships.
• Reasons for relationship breakdown.
 7. FORENSIC HISTORY
• Have they been charged or convicted of any offences? What
sentence did they receive? Do they have outstanding charges
or convictions at the moment?
 8. SOCIAL BACKGROUND
INFORMATION
• Current occupation. Are they working at the moment? If not, how
long have they been off work and why?
• Current family/relationship situation. Alcohol and illicit drug use
• Main recreational activities.
• Premorbid personality :How would they describe themselves
before they became ill? How would others have described them?
 MENTAL STATE EXAMINATION

Appearance and Behaviours

1. Dress, grooming, posture, gait, physical characteristics, apparent
vs. chronological age, physical health,
2. Body habitus---physic, facial expression (e.g. sad, suspicious),
attitude toward examiner (e.g. ability to interact, level of co-
operation),
3. Psychomotor activity (e.g. agitation, retardation), abnormal
movements(e.g. tremors, akathisia, tardive dyskinesia), attention
level, and eye contact
 MSE CONT.
• Speech
❏ rate (e.g. pressured, slowed, muted), rhythm/fluency, volume,
tone, articulation, quantity, spontaneity
• Mood and Affect
❏ mood - subjective emotional state; in patient’s own words
❏ affect - objective emotional state; described in terms of quality
( depressed, elevated, anxious), range (full, restricted), stability
(fixed, labile), appropriateness, intensity (flat, blunted)
 MSE CONT.

• Thought Process Abnormalities

❏ circumstantiality • speech that is indirect and delayed in
reaching its goal; eventually comes back to the point
❏ tangentiality• speech is oblique or irrelevant; does not
come back to the original point
❏ flight of ideas • skipping verbally from one idea to
another where the ideas are more or less connected
 MSE CONT.

loosening of associations • illogical shifting between

unrelated topics
❏others include
• thought blocking (sudden interruption in the flow of thought
or speech)
• neologisms (invention of new words) • clanging (speech
based on sound such as rhyming or punning)
• perseveration (repetition of phrases or words)
 THOUGHT CONTENT ABNORMALITIES
❏ ideas, themes, worries, pre-occupations, ruminations, obsessions,
overvalued ideas, magical thinking, ideas of reference, delusions
❏ suicidal ideation / homicidal ideation
• low - fleeting thoughts, no formulated plan, no intent• intermediate
- more frequent ideation, has formulated plan, no active intent
• high - persistent ideation and profound hopelessness, well
formulated plan and active intent, believes suicide is the only helpful
option available
 THOUGHT CONTENT ABNORMALITIES CONT.
•poor correlation between clinical impression of suicide risk and probability
of attempt
❏ delusion
• a fixed false belief that is out of keeping with a person’s cultural or
religious background and is firmly held despite incontrovertible proof to the
contrary
types of delusions
• persecutory (belief others are trying to cause harm) • delusions of reference
(interpreting events as having direct reference to the patient) • erotomania
(belief another is in love with you)
 THOUGHT CONTENT
ABNORMALITIES CONT.
delusions of control (belief that one’s thoughts/actions are controlled
by some external source)
• somatic (belief one has a physical disorder/defect)
first rank symptoms: thought insertion / withdrawal / broadcasting
❏ obsession
• recurrent and persistent thought, impulse or image which is
intrusive or inappropriate
• cannot be stopped by logic or reason • causes marked anxiety
 PERCEPTUAL DISTURBANCES
❏ hallucination
• sensory perception in the absence of external stimuli that is
similar in quality to a true perception; auditory is most common;
other types include visual, gustatory, olfactory, somatic
❏ illusion • misperception of a real external stimulus
❏ depersonalization • change in self-awareness such that the
person feels unreal, detached from his or her body, and/or unable
to feel emotion
 PERCEPTION DISTURBANCES CONT.

❏ derealisation
• feeling that the world/outer environment is unreal
 COGNITION
❏ level of consciousness (LOC)
❏ orientation: time, place, person
❏ memory: remote, recent, immediate
❏ intellectual functions
• attention, concentration and calculation
• abstraction (proverb interpretation, similarities test)
• intelligence
 INSIGHT AND JUDGEMENT
Insight
❏ patient’s ability to realize that he or she has a physical or
mental illness and understand its implications
Judgment
❏ ability to understand relationships between facts and draw
conclusions that determine one’s action
 SUMMARY
Multiaxial Assessment (Impression)
• Axis I - clinical disorders - DSM IV; differential diagnosis
• Axis II - personality disorders - DSM IV
• - mental retardation
• Axis III - general medical conditions (as they pertain to Axis
I or other Axes)
• Axis IV - psychosocial and environmental problems
• Axis V - global assessment of functioning (GAF)
 FORMULATION

❏ biological, psychological, social factors

❏ predisposing, precipitating, perpetuating, and
protecting factors
 MINI ASSESSMENT TOOLS FOR MDS
• MINI INTERNATIONAL NEUROPSYCHIATRIC INTERVIEW
• This MINI is not designed or intended to be used in the place of a full medical
and psychiatric evaluation by a qualified licensed physician – psychiatrist.
• It is intended only as a tool to facilitate accurate data collection and
processing of symptoms elicited by trained personnel.
• The M.I.N.I. was designed as a brief structured interview for the major Axis I
psychiatric disorders in DSM-IV and ICD-10
• It can be used by clinicians, after a brief training session
 INTERVIEW
• In order to keep the interview as brief as possible, inform the
patient that you will conduct a clinical interview that is more
structured than usual,
• With very precise questions about psychological problems
which require a yes or no answers
 GENERAL FORMAT

• The M.I.N.I. is divided into modules identified by letters, each

corresponding to the diagnostic category
• At the beginning of each diagnostic module(except for psychotic
disorders module), screening question(s) corresponding to the main
criteria of the disorder are present in a grey box
• At the end of each module, diagnostic box (es) permit the clinician to
indicate whether diagnostic criteria are met
 CONVENTIONS
• Sentences written in « normal font » should be read exactly as written
to the patient in order to standardize the assessment of diagnostic
criteria
• Sentences written in « CAPITALS » should not be read to the patient.
They are instructions for the interviewer to assist in the scoring of the
diagnostic algorithms
• Sentences written in « bold » indicate the time frame being
investigated. The interviewer should read them as often as necessary.
Only symptoms occurring during the time frame indicated should be
considered in scoring the responses
 CONVENTIONS CONT.
• Answers with an arrow above them (􀂷) indicate that one of the
criteria necessary for the diagnosis(es) is not met. In this case, the
interviewer should go to the end of the module, circle « NO » in all
the diagnostic boxes and move to the next module
• When terms are separated by a slash (/) the interviewer should read
only those symptoms known to be present in the patient (for
example, question H6).
• Phrases in (parentheses) are clinical examples of the symptom.
These may be read to the patient to clarify the question.
 RATING INSTRUCTIONS
• All questions must be rated. The rating is done at the right of
each question by circling either Yes or No. Clinical judgment
by the rater should be used in coding the responses.
• The rater should ask for examples when necessary, to ensure
accurate coding.
• The patient should be encouraged to ask for clarification on
any question that is not absolutely clear.
 RATING INSTRUCTIONS CONT.

• The clinician should be sure that each dimension of the

question is taken into account by the patient (for example,
time frame, frequency, severity, and/or alternatives).
• Symptoms better accounted for by an organic cause or by the
use of alcohol or drugs should not be coded positive in the
M.I.N.I. The M.I.N.I. Plus has questions that investigate
these issues.
 MINI—MENTAL STATUS EXAM(MMSE)

• a practical method for grading the cognitive state of patients for the
clinician
INTRODUCTION
• EXAMINATION of the mental state is essential in evaluating
psychiatric patients.
• 1 Many investigators have added quantitative assessment of
cognitive performance to the standard examination, and have
documented reliability and validity of the several “clinical tests of
the sensorium”.2*3 The available batteries are lengthy
 MMSE CONT.
• For example, WITHERS and HINTON’S test includes 33
questions and requires about 30 min to administer and score.
• The standard WAIS requires even more time. However,
elderly patients, particularly those with delirium or dementia
syndromes, cooperate well only for short periods.
 MMSE CONT.
• Therefore, we devised a simplified, scored form of the
cognitive mental status examination,
• the “Mini-Mental State” (MMS) which includes eleven
questions, requires only 5-10 min to administer, and is
therefore practical to use serially and routinely.
• It is “mini” because it concentrates only on the cognitive
aspects of mental functions, and excludes questions
concerning mood, abnormal mental experiences and the form
of thinking.
 MMSE CONT.
• Questions are asked in the order listed and scored immediately. The
tester (psychiatric resident, nurse, or volunteer) is instructed first to
• Make the patient comfortable, to establish rapport, to praise successes,
and to avoid pressing on items which the patient finds difficult.
• In this setting most patients cooperate, and catastrophic reactions are
avoided.
• The MMS is divided into two sections, the first of which requires
vocal responses only and covers orientation, memory, and attention;
the maximum score is 21.
 MMSE CONT.

• The second part tests ability to name, follow verbal and written
commands, write a sentence spontaneously,
• and copy a complex polygon similar to a Bender-Gestalt Figure;
the maximum score is nine.
• Because of the reading and writing involved in Part II, patients
with severely impaired vision may have some extra difficulty
that can usually be eased by large writing and allowed for in the
scoring. Maximum total score is 30.
• The test is not timed.
 REFERENCES

• Livesley, W. J., Jang, K. L. & Vernon, P. A. (1998) Phenotypic and

genetic structure of traits delineating personality disorder. Archives of
General Psychiatry, 55, 941−48.
• Loranger, A.W., Susman, V. L., Oldham, J. M., et al (1985) Personality
Disorder Examination (PDE). A Structured Interview for DSM−III−R
and ICD−9 Personality Disorders. WHOI ADAMHA Pilot Version.
White Plains, NY: New York Hospital, Comell Medical Center.