PCP Mental Health REFLECTION

Clinical Concern

Higher functions of a patient’s brain can be examined using simple observation, testing and
questions involved in a mental state examination (Fuller, 2019).

John has come in complaining of memory loss. A mental status exam is indicated to uncover
the underlying cause of his memory problems. There are eight domains to a mental status
examination.

SKILLS/GREATER ISSUE

An effective mental status examination requires a certain level of trust, cooperation and
openness between the patient and practitioner. If I was to do the mental status exam, I may
need a close friend or relative of John’s to be present so he feels comfortable.

If the cause of John’s memory loss is sinister such as a brain disease or early onset
Alzheimer’s or other dementia, I may have to refer John to see a specialist in these fields. I
may also refer to a GP to test John’s vitamin B-12 levels and thyroid level as vitamin B-12
deficiency and hypothyroidism are possible causes of reversible memory loss. However, I
would do my best to help in any way I could by encouraging him to stay active, drinking
enough water, eating health foods, I would do some research into any medication he might
be on that is causing the memory loss.

SEEKING HELP
As the concept of a mental status exam is new to me, I have conducted research into
various published journal articles which explain the 8 domains.

The first component of the mental status exam is appearance. John’s is an elderly man
approximately in his 60’s. He is in a white polo shirt and appears to be clean and well kept.

During the exam, John’s behaviour is good.

A further component is speech and language. John openly tries to answer the questions as
much as he could and even includes little jokes such as, “It’s cold, it must be winter,” when
answering the examiner’s season question.

Mood looks at the patient’s current spirits (Fuller, 2019). John appears to be a little worried
at the beginning of the examination as he was told he needed to come in but he couldn’t
remember why. John doesn’t appear to have any abnormal thought content or thinking
perceptions such as delusions or visual or auditory hallucinations

John did struggle during the cognitive assessment part of the exam in regards to orientation,
attention/concentration and immediate recall. In terms of the geography of the country he
answered reasonably confidently when asked, “What country are we in…What state…What
city or town?” he replied, “Western Australia…New South… Newcastle.” He was unable to
remember the two or the three words that examiner asked him and he was unable to spell
world backwards.

Finally, in terms of insight, the John did acknowledge that he had been having memory
problems. Judgement wasn’t assessed in this example.

TEAM APPROACH

To detect psychiatric signs and symptoms, diagnose a mental illness, identify possible
underlying medical conditions and address the patient’s disposition and severity level, a
mental status examination is key.

An Interprofessional team of primary care physicians, nurses, social works, pharmacists who
have direct patient interactions should be training in monitoring a patient’s condition. In
routine mental status examinations that can observe and monitor any worsening, stability
or improvement throughout a treatment. Different perspectives can point the team in the
right direction for improving both patient care and outcome.

OUTCOMES

John likely has either focal or diffuse neurological deficit. Disorders of reversible memory
impairment such as Alzheimer’s are important to diagnose early to help manage symptoms,
education yourself and family members about the disease, and properly plan for the future
(Mayo Clinic, 2019).

Additionally, a mental state examination can also identify patients with primary or
secondary psychiatric illnesses and must be considered when managing low back pain.
Psychiatric illnesses may slow the recovery of a patient with acute pain and increase the
likelihood of acute pain becoming chronic with functional incapacity. LBP is related to social
and daily activity difficulty and deficits which negatively impact the patient’ quality of life.
Studies have shown that fear/avoidance, depression and increased pain intensity predict a
poorer recovery. The patient’s return to work timeline and objective improvement directly
related to the individual and cognitive factors such as perception and expectation about
pain and disability (Roios, 2017).

REDEPLOYMENT

In follow up appointments, comparing the mental status examination to previous ones will
help the practitioner determine if a patient’s symptoms are improving, stable or worsening
throughout their treatment (Voss & Das 2020).

Going forward as a healthcare profession, I will keep in mind the need to assess patient’s
mental status and consider potential multidisciplinary interventions that combined physical
and psychological approaches to patient conditions in order to optimize treatment.
References

Elsevier Australia. (2017, May 11). Examination 7: Mental State Examination OSCE – Talley +
O’Connor’s Clinical Examination [Video file]. Retrieved from
https://www.youtube.com/watch?v=gVS9PCZ83eE

Fuller, G. (2019). Neurological Examination Made Easy E-Book. (6th ed., Made Easy Ser).

Mayo Clinic. (2019). Memory Loss: When to seek Help. Retrieved from:
https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/memory-
loss/art-20046326

Roios, E., Paredes, A., Alves, A., & Pereira, M. (2017). Cognitive representations in low back
pain in patients receiving chiropractic versus physiotherapy treatment. Journal of Health
Psychology, 22(8), 1012-1024.

Voss R &, Das J. (2020). Mental Status Examination. StatPearls Publishing. Retrieved from:
https://www.ncbi.nlm.nih.gov/books/NBK546682/#article-24998.s3