PIPRAMS
LESSON PLAN ON
TOPIC: MENTAL STATUS EXAMINATION
SUBJECT: MENTAL HEALTH NURSING
Submitted To: Miss. Garima Pant(Asst. Professor)
Submitted By: Miss. Babita Kumari (Bsc NSG.3rd year)
Submitted On: 6/01/2023
IDENTIFICATION DATA:
NAME OF THE TEACHER: Babita kumari
NAME OF THE SUBJECT: Mental Health Nursing
NAME OF THE TOPIC: Mental status examination
GROUP OF THE STUDENTS: Bsc NSG 3rd year
SIZE OF THE GROUP: 45
DATE AND TIME OF PRESENTATION:
VENUE/PLACE OF PRESENTATION: Class room
DURATION OF TEACHING: 45 min.
AV AIDS: flashcard, chartpaper, blackboard
PREVIOUS KNOWLEDGE ABOUT THE TOPIC: Yes
GENERAL OBJECTIVES:
At the end of seminar the student will gain knowledge ‘Mental Status Examination’
improve the knowledge.
SPECIFIC OBJECTIVES:
1. To define the MSE.
2. To explain the techniques of MSE.
3. To enlist the level of consciousness of MSE.
4. To describe the Basic of Science of MSE.
5. Summary
6. Conclusion
7. Bibliography.
S NO TIME SPECIFIC CONTENT TEACHING LEARNING ACTIVITY/ EVALUATION
OBJECTIVE AV AIDs
1. 5 min. To define the DEFINITION Lecture cum Discussion with What is MSE?
MSE. Mental status examination is a Blackboard.
structured assessment of the
patient's behavioral and
cognitive functioning. It
includes descriptions 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, the
reaction evoked 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.
.
In his Treatise on Insanity,
published in 1801, Pinel, one of
the fathers of modern
psychiatry, gave some advice to
his contemporary colleagues.
To seize the true character of
mental derangement in a given
case, and to pronounce an
infallible prognosis of the
event, is often a task of
particular delicacy, and
requires the united exertion of
great discernment, of extensive
knowledge and of incorruptible
integrity.
Techniques.
One could scarcely improve on
2. 8min. To explain the this advice in the present-day
techniques of approach to mental status
MSE. evaluation. The knowledge that
the modern physician can bring
to bear on this task is certainly
much more extensive than in
1801. Nevertheless, the
observational skills and subtle
discriminations that constitute
"great discernment," and the
traits of professional and
scientific integrity that are
likewise required, must be
cultivated afresh in each
generation of physicians.
The level of consciousness
refers to the state of
wakefulness of the patient and
depends both on brainstem
and cortical components.
Levels are operationally
defined by the strength of
stimuli needed to elicit
responses, and the scheme of
Plum and Posner (1980) is
widely accepted.
LEVEL OF
CONSCIOUSNESS
A normal level of consciousness
is one in which the patient is What is the
3. 15min. To enlist the able to respond to stimuli at Lecture cum Discussion with level of
level of the same lower level of Flashcards. consciousness
consciousness strength as most people who of MSE?
of MSE. are functioning without
neurologic abnormality.
Clouded consciousness is a
state of reduced awareness
whose main deficit is one of
inattention. Stimuli may be
perceived at a conscious level
but are easily ignored or
misinterpreted. Delirium is an
acute or subacute (hours to
days) onset of a grossly
abnormal mental state often
exhibiting fluctuating
consciousness, disorientation,
heightened irritability, and
hallucinations. It is often
associated with toxic,
infectious, or metabolic
disorders of the central
nervous system. Obtundation
refers to moderate reduction in
the patient's level of awareness
such that stimuli of mild to
moderate intensity fail to
arouse; when arousal does
occur, the patient is slow to
respond. Stupor may be
defined as unresponsiveness to
all but the most vigorous of
stimuli. The patient quickly
drifts back into a deep sleep-
like state on cessation of the
stimulation. Coma is
unarousable unresponsiveness.
The most vigorous of noxious
stimuli may or may not elicit
reflex motor responses.
When examining patients with
reduced levels of
consciousness, noting the type
of stimulus needed to arouse
the patient and the degree to
which the patient can respond
when aroused is a useful way
of recording this information.
1. APEARANCE AND
GENERAL BEHAVIOUR.
These variables give the
examiner an overall impression
of the patient. The patient's
physical appearance (apparent
vs. stated age), grooming
(immaculate/unkempt), dress
(subdued/riotous), posture
(erect/kyphotic), and eye
contact (direct/furtive) are all
pertinent observations. Certain
specific syndromes such as
unilateral spatial neglect and
the disinhibited behavior of the
frontal lobe syndrome are
readily appreciated through
observation of behavior.
2.SPEECH AND MOTOR
ACTIVITY.
Listening to spontaneous
speech as the patient relates
answers to open-ended
questions yields much useful
information. One might discern
problems in output or
articulation such as the
hypophonia of Parkinson's
disease, the halting speech of
the patient with word-finding
difficulties, or the rapid and
pressured speech of the manic
or amphetamine-intoxicated
patient. Overall motor activity
should also be noted, including
any tics or unusual
mannerisms. Slowness and loss
of spontaneity in movement
may characterize a subcortical
dementia or depression, while
akathisia (motor restlessness)
may be the harbinger of an
extrapyramidal syndrome
secondary to phenothiazine
use.
Affect is the patient's
immediate expression of
emotion; mood refers to the
more sustained emotional
makeup of the patient's
personality. Patients display a
range of affect that may be
described as broad, restricted,
labile, or flat. Affect is
inappropriate when there is no
consonance between what the
patient is experiencing or
describing and the emotion he
is showing at the same time
(e.g., laughing when relating
the recent death of a loved
one). Both affect and mood can
be described as dysphoric
(depression, anxiety, guilt),
euthymic (normal), or euphoric
(implying a pathologically
elevated sense of well-being).
3.MOOD AND AFFECT.
Affect must be judged in the
context of the setting and those
observations that have gone
before. For example, the
startled-looking patient with
eyes wide open and
perspiration beading out on the
forehead is soon recognized as
someone suffering from
Parkinson's disease, when the
paucity of motion and
diminished eye blink are noted
and the beads of perspiration
turn out to be seborrhea.
4.THOUGHT AND
PERCEPTION.The inability to
process information correctly is
part of the definition of
psychotic thinking. How the
patient perceives and responds
to stimuli is therefore a critical
psychiatric assessment. Does
the patient harbor realistic
concerns, or are these concerns
elevated to the level of
irrational fear? Is the patient
responding in exaggerated
fashion to actual events, or is
there no discernible basis in
reality for the patient's beliefs
or behavior?
Patients may exhibit marked
tendencies toward
somatization or may be
troubled with intrusive
thoughts and obsessive ideas.
The more seriously ill patient
may exhibit overtly delusional
thinking (a fixed, false belief
not held by his cultural peers
and persisting in the face of
objective contradictory
evidence), hallucinations (false
sensory perceptions without
real stimuli), or illusions
(misperceptions of real stimuli).
Because patients often conceal
these experiences, it is well to
ask leading questions, such as,
"Have you ever seen or heard
things that other people could
not see or hear? Have you ever
seen or heard things that later
turned out not to be there?"
Likewise, it is necessary to
interpret affirmative responses
conservatively, as mistakenly
hearing one's name being
called, or experiencing
hypnagogic hallucinations in
the peri-sleep period, is within
the realm of normal
experience.
Of all portions of the mental
status examination, the
evaluation of a potential
thought disorder is one of the
most difficult and requires
considerable experience. The
primary-care physician will
frequently desire formal
psychiatric consultation in
patients exhibiting such
disorders.
5.COGNITIVE FUNCTION.
The preceding sections of the
mental status examination
provide a Gestalt view of the
patient and his illness. A
structured examination of
specific cognitive abilities is a
more reductionistic approach
to the patient and pays careful
attention to neuroanatomic
correlates. Such testing
logically follows a hierarchic
ordering of cortical function
with attention and memory
being the most basic functions
on which higher-ordered
abilities of language,
constructional ability, and
abstract thinking are layered.
Mental disorders causally
related to brain disease have
been known since antiquity, as
evidenced in the works of the
compilers of the Hippocratic
tradition. Pinel's influential
Treatise on Insanity helped
disseminate the idea that some
mental illnesses have a
psychologic causation, while
others are secondary to
physical illnesses.
BASIC SCIENCE
Mental status testing stands as
unique in the examination of
the patient in that it attempts
to examine that organ about
which we understand the least.
While the fundamental
structural units of other organs
(e.g., the nephron, the islet cell,
the myofibril) have been
understood at the molecular
level, the human engram
remains unelucidated. Until
there is a quantum leap in
understanding within the
neurosciences, the brain must
continue to be treated largely
as a "black box" as the clinician
attempts to observe, test, and
codify its output—human
behavior.
The past several decades have
4. 5min. To describe the seen the development of a Lecture cum Discussion with What is Basic
Basic of Science large body of literature dealing chartpaper. Science of MSE?
of the MSE. with neuropsychologic testing.
It is beyond the scope of this
chapter to consider this broad
topic; however, some recent
efforts to simplify and
systematize the cognitive
portion of mental status testing
will be of interest and use to
the primary-care physician.
SUMMARY
Write down the
patient's words and the
order in which they are
expressed verbatim.
This should avoid
misinterpretation. Take
into account the
patient's age, culture,
ethnicity, language and
level of premorbid
functioning.
Sensory Modality
involved:
1. Auditory.
2. Visual.
3. Olfactory.
4. Gustatory.
5. Somatic.
CONCLUSION
MSE is used to check
how close estimates or
forecasts are to actual
values. Lower the MSE,
the closer is forecast to
actual. This is used as a
model evaluation
measure for regression
models and the lower
value indicates a better
fit.
BIBLIOGRAPHY.
1. K P Neeraja, “Essentials of
Mental Health and Psychiatric
Nursing”, Vol-1, Jaypee
Brothers Medical Publishers (P)
Ltd, pg no: 304 – 314
2. Shebeer P Basheer, S Yaseen
Khan, “A concise Text Book of
Advanced Nursing Practise”,
Emmess Medical Publisher, pg
no: 632 – 638
