Mental status examination in clinical psychological assessment

Mental status examination involves an evaluation of the client's self-presentation, manner with others, orientation towards the world, general level of alertness, thought processes, and his or her mood. The therapist conducts an observation and evaluation of external and internal aspects of the client's functioning, such as the client's hygiene and the ability to rationally speak to the interviewer, as well tests the client's recall and memory, and the ability to use expressive language (Niolin 2000).

The mental status examination is not superficial: it is important to note the client's ability to engage in basic social functioning. Someone who cannot engage in basic self-care or answer simple questions about him or herself will raise a diagnostic red flag, although it is important that the therapist does not arrive at over-hasty diagnosis.

General appearance and behavior

The therapist should note observable aspects of the client's appearance, including basic demographic data such as sex, weight, age, basic hygiene, if the client is wearing weather-appropriate attire, and if the client exhibits normal motor coordination. Deficits in these areas can indicate mood disorders, eating disorders, or other complications. Behavioral attitudes such as speech, receptiveness to treatment, and other modes of self-presentation should also be evaluated.

General appearance and behavior can provide clues about the client's problem, given the prevalence of certain mental illnesses in specific population groups, and must also influence the therapist's approach to the client. A resistant adolescent with depression may manifest the illness differently (with irritability rather than lethargy) than a depressed adult and require different intervention strategies.

Perception

Aspects of the client's presentation to consider when evaluating his or her perception may include orientation (knowing where he or she is), alertness, coherence and ability to concentrate. Recall can be tested by asking questions about the date, who is president, etcetera; concentration can be tested by using a Digit Span test -- asking the client to count backwards from 100 to 50 by 7s or 3s (Niolin 2000). Noting the presence of delusions or hallucinations, gaining a rough estimate of the client's intellectual ability, thought processes, and judgment (ability to understand why he or she is being assessed), and assessing his or her ability to engage in abstraction (such as understanding proverbs) must be part of evaluation (Niolin 2000).

This assessment must be culturally specific: someone from another country might have difficulty understanding the U.S. mental health system or abstraction, and may be more difficult to assess for intellectual ability because of language barriers.

Interpreting interview data

It must be kept in mind that such interview data is merely preliminary, and merely intended to guide the initial approach. The interpretation of the results must be carried out by a qualified individual, particularly if projective, neurological or multiple choice tests are used.

Assessments may involve simply meeting with the client or encompass a battery of tests designed to determine the client's level of functioning. Setting and previous knowledge of the client will influence the types of assessment that are used, but past history should not be allowed to over-influence the interpretation of the results of a new assessment.

Reference

Niolin. (2000). The mental status examination. Psych Page. Retrieved January 20, 2010 at http://www.psychpage.com/learning/library/assess/mse.htm