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.
- 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
- 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:
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
- 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:
- Compulsions – repetitive acts that the patient feels driven to do
- Obsessions – recurre t, uncontrollable thoughts
- Ruminations – repetitive or continuous thinking or speculations, often about everyday decisions
- Doubting and indecision – excessive time-consuming uncertainties about everyday decisions
- Phobias – irrational fears
- Free-floating anxieties – sense of ill-defined or impending doom
Bates, Barbara. 1974. A Guide to Physical Examination. J.B. Lippincott Company, Toronto.