Mental Health Assessment – a starting point

 

Dress, Grooming and Personal Hygiene:

  • Include style of dress and its appropriateness to the patient’s age and situation
  • Unkempt appearance in depression, chronic organic brain disease
  • meticulous grooming of the compulsive personality.

 

Facial Expression:

  • observe facial mobility at rest and in interaction with others
  • watch for variations in speech and manner.
  • Depression, anxiety, apathy, anger, facial immobility occurs in Parkinson’s

 

Speech:

  • Quality – loudness, clarity, inflection
  • Quantity – pace, volume
  • Organization – coherence, relevance, circumstantiability
  • Slow monotonous tone of depression, pressure of speech, flight of ideas in manic conditions, incoherent circumstantial speech with neologisms (self-coined speech) in schizophrenia.

 

Manner,Mood and Relation to Person and Things

  • note variations according to the topics under discussion and to other activities or People around him
  • note the patient’s openness and approachability
  • watch for the following:
  1. Uncooperativeness
  2. evasiveness
  3. hostility
  4. anger
  5. resentment
  6. depression
  7. tearfulness
  8. elation
  9. distrustfulness

 

Mood:

Assess the patient’s mood, not only by observation, but through line of questioning

This may be accomplished through the interview by asking:

“How did you feel about that”

of generally “How are your spirits”

If you suspect depression, it is essential that you assess its depth and the associated risk of suicide

A series of questions like the following is useful, proceeding as far as the patient’s positive answers warrant.

  • Do you get pretty discouraged, depressed or blue
  • How low do you feel
  • What do you see for yourself in the future
  • Do you ever feel that life isn’t worth living? Or that you had just as soon be dead?
  • Have you ever thought of doing away with yourself?
  • How did, do you think you would do it?
  • What would happen after you were dead?

 

Thoughts Processes and Perceptions

Coherency and Relevance of Thought Processes

  • observation of the way in which the patient describes his history is most important here
  • incoherent, disorganized thought occurs in schizophrenia

 

Thought Content

  • much information about the patent’s thought content has probably been revealed in the interview.
  • additional inquires may be necessary to ascertain specific symptoms
  • Phrase your questions in the context of the patient’s history, follow leads provided by the patient’s own words
  • “Sometimes when people are upset like this, they can’t keep certain thoughts out of their minds”

 

Thoughts associated with neurotic disorders:

  1. Compulsions – repetitive acts that the patient feels driven to do
  2. Obsessions – recurre t, uncontrollable thoughts
  3. Ruminations – repetitive or continuous thinking or speculations, often about everyday decisions
  4. Doubting and indecision – excessive time-consuming uncertainties about everyday decisions
  5. Phobias – irrational fears
  6. Free-floating anxieties – sense of ill-defined or impending doom

Bates, Barbara. 1974. A Guide to Physical Examination. J.B. Lippincott Company, Toronto.

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