Mental State Examination
Any health practitioner who is desirous of helping a person in difficulty or treating a sickness can not deny the fact that most important task is to assess or diagnose the condition. And this diagnosis must be characterized by following:
Complete but quick
The assessment must be complete. It must take into account all factors which could have led to present status as well as complete assessment of person’s psychological status. At the same time it should not be hasty but reasonably quick so that the main purpose of assessment should not get lost in the long process.
Everyone will agree that assessment must be correct and no mental health professional would like to make an incorrect assessment. But this occurs due to many factors like haste in assessment, preconceived ideas about condition, lack of knowledge, lack of effort, even lack of desire to go deep into complexities of condition. Needless to say that incorrect assessment can only lead to incorrect treatment.or management.
Not just to give name of sickness
It should not be the approach on part of mental health professional to somehow fix a name to the condition. There are cases where one may not be able to reach any conclusion. It would be much better on part of the mental health professional to seek second opinion.
Meaningful for suitable effective remedial action
Mental health assessment is not meant to fill pages for records. It should be meaningful assessment which could prove useful towards correct management and treatment of the condition.
Psychological Complaints people suffer from can be divided into following types:
- Difficulties or disorder in perception like delusions, illusions or hallucinations.
- Difficulties or disorder in cognitive functions like thinking pattern, concentration, memory, calculation, reading, writing, learning etc
- Difficulties or disorder in emotions like mood disorders, anger, sadness, fear, grief etc.
- Difficulties or disorder in behavior including behavior towards self and behavior towards others.
Management or treatment of psychological complaints requires a comprehensive approach. Therapist can use following techniques depending on their suitability and applicability in a certain case.
- Homeopathic Psychiatry
- Lifestyle management
- Life Management
Mental Disorders in today’s world
Mental disorders are fast becoming very common. The common causes, apart from biological causes, are setbacks in life, grief, poor coping skills, faulty upbringing, high pace & high demands of modern life, complex social structure, rapidly changing human values, lack of role models, poor support system, influence of media etc. The psychological disorders affect people’s ability to think, feel, act and relate in effective manner. They affect the happiness and progress in life. Their early detection and treatment is crucial to save person from long term suffering. (Also see Counseling for early intervention).
It is possible and helpful to recognize the changes early. Look for the following changes / symptoms in yourself or your loved ones.
- Changes in personality
- Problems of behavior
- Inability to function effectively.
- Persistent stress & inability to cope
- Extremes of mood and mood swings
- Unwanted strange / troublesome ideas / thoughts
- Inability to relate and have satisfactory relationships
- Persistent distressing feelings like sadness, anxiety etc
- Marked non specific changes in body functions like sleep or appetite
- Addictions and substance abuse like alcohol / drugs / sex / gambling etc
- Non specific physical complaints like weakness, bodyache, headache etc.
Mental Health Assessment
One must be careful while doing mental state examination. The information gathered is indicative of disorder. Always it is the completeness, the totality which will decide the remedy. In this examination the specific psychiatric terms have been omitted. Focus has been kept on what can be observed to identify what is characteristic of the disorder.
There are certain points given by appearance.
- Others : Altered pupil size could be possible drug abuse. Arcus senilis, palmar erythema and spider angioma indicates alcohol abuse. Skin damage may suggest compulsive washing. Tattoos & body piercing may suggest personality disorders.
- Gait & Posture : This reveals how the person carries himself / herself. It has psychological component along with physical component.
- Physical Status : Note physical states like body built and physical handicap. How patient is dealing with his limitations?
- Grooming : How the patient is dressed & groomed. This can reflect disturbed mental state or ability / attitude for self care. It also reflects how patient relates to self. Note extra bright dressing or extra dull dressing. It could be both, an attempt to conceal or reveal inner self. Dressing may reveal status of gender identity.
- Apparent Age : The apparent age may differ from actual age. Condition of body structure, skin, hair etc contributes to apparent age. Older looking appearance could be because of physical illness, poor socioeconomic status or psychological distress.
This includes in-clinic behavior and general behavior. In-clinic behavior starts the moment patient enters observation field and continues till departure. Observe body language. Observe how patient relates with others and with doctor. Observe activity level. Study the pattern of conscious & unconscious movements. Note the difference between desire for activity and being industrious. Look for indicators of restlessness like frequent shifting, hand wringing, leg movements etc. Look for facial expressions. Do they align with general behavior? Are there some automatic behaviors? What is the level of cooperation? How patient responds to instructions?
Note the patient’s behavior in real life situation. How he responds to responsibility and changes in life? Note the difference between lascivious, coquettish, adulterous and excessive sexual desire. Any substance abuse? See such behaviors in context with prevalent norms and cultural patterns. How is the social behavior, prefers company or aloofness? Is he timid, awkward or arrogant when in company? Is he too cautious, impulsive or reckless? Any capriciousness or fastidiousness? Is he charlatan, deceitful or liar? Is there any compulsive behavior like checking, praying, counting or washing? Is the behavior appropriate for age?
Two components of speech are to be observed. One is language and other is thought content. Observe the ability of patient to express self. How is the articulation? Watch for the accent & dialect. Observe the pressure, rhythm and modulation of speech. The problem could be in speech apparatus, speech centre or in psychological state. Also observe the thought content. How is the organization of thoughts? How is the direction and flow of thoughts? Is there appropriate control? If loquacity is there then about what? Are the thoughts meaningful in self and with context & surroundings? Is he abrupt?
Note the emotional status of patient. Is it in congruence with the life situation? Is it stable or changeable? Observe the range and intensity of emotional state. How he expresses his emotions? Does he torments self in anger, curse & laments others, gets abusive, violent or taciturn? How consolation or contradiction affects him? Is he irritable or averse to be disturbed? How he responds to real life situations? Let him come up with his anxieties and anticipations. Is he fearful of anything or situation? Is he serious, in grief or sad with some reason? Note the difference between apathy, ennui, loathing life and suicidal disposition. Does he craves love, is jealous, feels forsaken or is indifferent to it? Is he affectionate or benevolent? Is he cheerful, vivacious or euphoric?
Note how patient perceives self and surroundings and how is his relationship with surroundings. Is the patient in touch with reality? How he takes the impact of environmental stimuli and surroundings? How is the state of self identity? Note the distortions like delusions, illusions or hallucinations. Observe the kind of insight patient has and his ego status. Is the judgment in order? How are the judgments of time and space? Note the belief system.
Note the cognitive functions of the patient. Observe the level of consciousness, alertness & attention. Note the abilities of concentration, memory, calculation, reading, writing, learning etc. Is he absentminded or forgetful or has difficulty in concentration? Is the memory active, he dwells onto past occurrences, fancies or there is abundance of thoughts? Any tendency of theorizing? Note the state of will power and self confidence. Is there any state of confusion, dullness or delirium?
Once the information is gathered, the next task is to see what is characteristic of the disorder. A mere collection of symptoms is not helpful. Classical Homeopathy requires individualization. Remedy selection and doses including the follow-up must be in accordance with the principles of classical homeopathy. Homeopathy will not let you down if you conform to its principles.
Homeopathy brings about subtle changes in person’s psychological being. It can change the thinking pattern of a person from negative to positive. It erases past emotional trauma and enables to ‘look forward’. It improves cognitive functions and can help one to achieve a positive mental health.