PPT 3: COMPREHENSIVE MENTAL ➢ Comment on any suspiciousness,

HEALTH ASSESSMENT hostility, or inappropriate chumminess.

3. Speech
KEY COMPONENTS OF A COMPREHENSIVE ➢ Is speech spontaneous or labored.
ASSESSMENT INCLUDE: ➢ Are responses made in sentences or are
they monosyllabic.
• History 4. Mood
• Psychosocial ➢ Elevated, euthymic, depressed, labile,
angry, irritable, flattened, euphoric,
• Mental state
incongruent, or anxious.
• Cognitive assessment
5. Thought
• Substance use
➢ Stream/form, or content.
• Medical/biological risk 6. Perception
➢ Any abnormalities in the way in which
the patient perceives the world is
COMPREHENSIVE ASSESSMENT recorded.
➢ The psychiatric interview is an important tool ➢ An alteration of perception can occur in
in assessing and evaluating a clients’ condition. any of the sensory modalities: vision,
The core features are: hearing, touch, smell, or taste.
• Conversation and observation 7. Cognition
• Signs and symptoms ➢ A basic cognitive test involves
• Establish therapeutic alliance establishing whether the patient is
orientated in time, person, and place.
8. Insight
INTRODUCTION TO CLIENT ➢ Does the client think they are ill?
➢ Establish rapport with the client ➢ Just because someone refuses
➢ Collect basic demographics and state purpose treatment does not mean they lack
of interview insight.
➢ Provide a safe environment

MINI MENTAL STATE EXAMINATION (MMSE)

HISTORY ➢ By: Lenore Kurlowicz and Meredith Wallace
➢ History of present illness ➢ MMSE is a tool that can be used to
➢ Psychiatric history and medical history systematically and thoroughly assess mental
➢ AOD status.
➢ Psychosocial/Developmental history (Personal ➢ The MMSE is effective as a screening tool for
History) cognitive impairment with older, community
➢ Social history dwelling, hospitalized, and institutionalized
➢ Family history adults.

MENTAL STATUS EXAMINATION PRINCIPLES OF RISK ASSESSMENT

Is recorded under the following headings: ➢ Assessing and managing clinical risk is an
1. Appearance and behavior integral part of service delivery.
➢ Should provide a detailed description ➢ It is ideally located within the overall provision
of the patient, which evokes a clear of care to individuals.
image in the mind of someone who ➢ Good risk assessment results in:
subsequently reads the notes. • Detection of high-risk situations
➢ What is the patient’s response to the • Optimal service wide response/s
strange situation of the interview? • Optimal allocation of resources
2. Rapport
• Evaluation of management
➢ This is a measure of the quality of the
interaction between the patient and
examiner.

THRISIA G. IRINCO BSN 3 – C

 TYPES OF RISK ➢ Thought content - thoughts of fantasies
➢ Suicide/deliberate self-harm of deliberate self-harm or harm to
➢ Harmful/hazardous drug use others
➢ Compromised physical health and self-care ➢ Perceptions - command hallucinations
➢ Neglect of mental health needs ➢ Cognition - temporary or permanent
➢ Financial/sexual/social/occupational cognitive impairment
vulnerability 2. Current situational factors
➢ Risk of violence to people or property ➢ Biological - presence or absence of
➢ Risk from the treatment itself physical illness
➢ Psychological - losses or shame
➢ Social/cultural - arrest or criminal
APPROACHES TO RISK ASSESSMENT charges
Specifically with regard to assessing and managing 3. Historical/predisposing factors
violence risk, a number of different approaches have ➢ Biological & Psychological - history of
been identified: mental disorder /risk behaviors, and
• Clinician’s assessment – weakness of this features of past crises.
method, unstructured and variable between
clinicians.
• Actuarial approaches – using risk assessment ANAMNESTIC ASSESSMENT
tools as a predictor of potential for violence. ➢ Can be regarded as a detailed examination of
• Anamnestic approach – the clinician identifies past history/incidence of risk
violence risk factors through a retrospective ➢ Includes any cues or early warning signs that
examination of past episodes would assist the service and the client on the
prevention of future episodes.
This approach has face validity in providing a ➢ This is termed a “risk profile” which informs
framework for thinking about risk more generally any current risk assessment. It includes the
within the clinical context. It involves: following sections:
• Clinicians’ familiarity with the various • Mental state at the time
domains of risk, and the clinical factors that • Treatment compliance at the time
are associated with that risk, • Substance use at the time
• A comprehensive structured clinical • Social context at the time
assessment informed by their familiarity rather
• (Retrospective) subjective early
than completion of an actuarial tool
warning signs
• Clinical use of an anamnestic analysis of
• (Retrospective) objective early
previous risk
warning signs

TIMING OF RISK ASSESSMENT

While risk assessment is an aspect of every clinical
encounter, it is of particular importance at times of:
• Entry and exit from the service.
• Transition between parts of the service.
• Changes affecting the individual emanating
from within or without

THE GENERIC/STRUCTURED CLINICAL

APPROACH
1. Current state of mind/mental state
➢ Behavior - dangerous or threatening
actions
➢ Individual’s attitude/rapport - refusal to
cooperate
➢ Affect - arousal, anger, hostility.

THRISIA G. IRINCO BSN 3 – C