Conducting A Diagnostic Interview With A Mental Status Exam

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Before moving through diagnostic decision making, a social worker needs to conduct an interview that builds on a biopsychosocial assessment. New parts are added that clarify the timing, nature, and sequence of symptoms in the diagnostic interview. The Mental Status Exam (MSE) is a part of that process.

The MSE is designed to systematically help diagnosticians recognize patterns or syndromes of a person’s cognitive functioning. It includes very particular, direct observations about affect and other signs of which the client might not be directly aware.

When the diagnostic interview is complete, the diagnostician has far more detail about the fluctuations and history of symptoms the patient self-reports, along with the direct observations of the MSE. This combination greatly improves the chances of accurate diagnosis. Conducting the MSE and other special diagnostic elements in a structured but client-sensitive manner supports that goal. In this Assignment, you take on the role of a social worker conducting an MSE.

To prepare:

  • Watch the video describing an MSE. Then watch the Sommers-Flanagan (2014) “Mental Status Exam” video clip. Make sure to take notes on the nine domains of the interview.
  • Review the Morrison (2014) reading on the elements of a diagnostic interview.
  • Review the 9 Areas to evaluate for a Mental Status Exam and example diagnostic summary write-up provided in this Week’s resources.
  • Review the case example of a diagnostic summary write-up provided in this Week’s resources.
  • Write up a Diagnostic Summary including the Mental Status Exam for Carl based upon his interview with Dr. Sommers-Flanagan.

By Day 7

Submit a 2- to 3-page case presentation paper in which you complete both parts outlined below:

Part I: Diagnostic Summary and MSE

Provide a diagnostic summary of the client, Carl. Within this summary include:

  • Identifying Data/Client demographics
  • Chief complaint/Presenting Problem
  • Present illness
  • Past psychiatric illness
  • Substance use history
  • Past medical history
  • Family history
  • Mental Status Exam (Be professional and concise for all nine areas)
    • Appearance
    • Behavior or psychomotor activity
    • Attitudes toward the interviewer or examiner
    • Affect and mood
    • Speech and thought
    • Perceptual disturbances
    • Orientation and consciousness
    • Memory and intelligence
    • Reliability, judgment, and insight

Part II: Analysis of MSE

After completing Part I of the Assignment, provide an analysis and demonstrate critical thought (supported by references) in your response to the following:

  • Identify any areas in your MSE that require follow-up data collection.
  • Explain how using the cross-cutting measure would add to the information gathered.
  • Do Carl’s answers add to your ability to diagnose him in any specific way? Why or why not?
  • Would you discuss a possible diagnosis with Carl at time point in time? Why?

Support Part II with citations/references. The DSM 5 and case study do not need to be cited.  Utilize the other course readings to support your response.

These are the only case I am allowed to chose to write this paper on

Case D Dr. Rullo

CASE PRESENTATION – Darien

 

Intake Date: November 2018

Identifying Information:

 

A 27 year old African-American, male student was referred for a psychiatric consultation after a workup for gastrointestinal distress proved negative. Darien has consulted his family physician after months of feeling bloated and nauseated in anticipation of certain distressing events and circumstances.

History of Present Illness:

Darien described 3 years of “anxiety attacks” accompanied by palpitations, shortness of breath, hot flashes, sweating and parathesias, in addition to abdominal discomfort. Their onset was clearly traced to a blind date arranged by a close friend. On the way with his friend to pick up the girl he suddenly felt extreme nausea and was forced to pull the car off to the side of the road. He got out for a breath of fresh air and promptly vomited. Although his friend forced him to go through with the date, Darien was extremely nervous and preoccupied throughout, took his date home immediately after the movie was over and sped away without even walking her to the door.

Darien has continued to think about this situation and feels down when thinking of what happened in the past. Over the past several months his mood is low and he has had trouble staying asleep at night. Although he had previously been shy around girls, following this incident, Darien panicked at the thought of a date. There were girls to whom he felt attracted, but whenever he brought himself to even consider asking one out, he became symptomatic. The anticipation generalized so that he became anxious going to local basketball games, bars and concerts with friends because he might see girls he was interested in meeting, talking to or dating. He frequently felt like staying home but forced himself with the help of some peer pressure to go out at least “with the boys.” More recently he does not even want to do that. He finds himself staying home more and eating to relax himself.

As he neared completion of his MSW program he had to go for job interviews, these began to cause anticipatory anxiety. He described feeling “trapped” in the interview with “no way out.” He then developed a fear of talking on the phone to people to arrange appointments for interviews or follow-ups. He was hired by a large municipal welfare agency and stayed mostly to himself on the job. His telephone fear extended to conversations with clients. Darien finds himself being more challenged now because he is forgetting things at work and is having difficulty focusing.

 
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