In a therapeutic intervention it is essential that the psychologist collects as much information as possible from the patient: family environment, social, economic, work or educational conditions and clinical history. In order to make the most accurate diagnosis possible, it is important to take into account the above and add all the observations and the information gathered in the mental examination .
This is done during the therapy sessions; it is made up of both observations and inferences by the psychologist and what the patient says and expresses.
The health professional will have to clarify and update diagnostic aspects and therapeutic decisions according to the changes observed during the interviews.
How to perform a mental test
These are the 15 elements to analyze for a mental test:
1. Physical appearance
Pay attention to posture, grooming, dress and body composition. If the patient has already been treated for some time, it is important to note any changes observed since the last session , as these are usually related to the evolution of the mental state.
Ensure that it covers all 3 dimensions: personal, temporal and spatial. Basic questions of what is your name, date of birth, date of session , place where the interview is conducted.
3. Speech and Language
To evaluate the speed of speech, voice volume, word articulation, coherence and spontaneity.
4. Motor activity
Emphasis on standing, wandering, posture, facial gestures, tics, abnormal movements (tremors, automatisms) and general body movement Watching for exaggerated movements may be a sign of a manic phase, or slow movements, which could be a sign of a depressive phase or schizophrenic disorder . It is important that in later sessions, changes are observed in response to drugs and therapy.
It is the emotional state expressed by the patient throughout the interview. Inconsistencies can be observed and the affection is inappropriate in relation to the facts that count , as well as the absence of an affective response or instability.
It cannot be observed, rather it is inferred by the psychologist and a comparison has to be made between what he observes and what the patient says . This describes his mood in the last days or weeks.
7. Expression of thought
To value the form of expression, speed of thought and quality of ideational flow. If it is logical, if it has a purpose, if it is tangential, if there are ideational leaks or failure in associations . Alterations in this element may represent disorders in thinking, a manic phase of Bipolar Disorder, intoxication by substances.
8. Content of Thought
What it contains: if delusional thinking is present , common in schizophrenic and thinking disorders; obsessive, primarily in obsessive-compulsive disorder, but may also appear in eating and impulse control disorders; or overrated ideas.
9. Perceptual alterations
It is necessary to ask directly if the patient sees, hears, smells or feels things that are not based on any sensory or sensory stimulus, that he knows others do not feel or perceive. The therapist should also be attentive to the patient’s reactions to the questions, if in answering the questions he or she first turns away or talks to someone else. The disturbances are related to hallucinations, schizophrenic and psychotic disorders, or substance intoxication.
10. Suicidal and/or homicidal ideation
It is extremely important to address in patients who have a history of violent acts, problems with the law, personal history of attempted self-harm, or family history. If it emerges in the interview that you plan to commit suicide or kill someone, you should change the focus immediately, it becomes urgent to address this element. You should be directed to hospital care in the case of suicidal ideation or notify the police, in the case of homicidal ideation.
11. Attention, concentration and memory
It can be evaluated without the need for specific questions, but only by analyzing behaviors and responses during the session. If you do not have enough information, you can ask the patient to spell words backwards and forwards, make them remember series of numbers or letters. It is important that this section takes into account the cultural and educational level of the patient.
If a cognitive deficit is suspected, it is recommended to apply the Mini-Cognitive Examination .
12. Abstract thinking
The easiest way to evaluate this element is to ask the patient to explain the meaning of a saying or proverb. The concrete thought can be presented as an alteration or as a symptom of some mental disorder such as schizophrenia.
It is the level of understanding of the current mental situation, whether you have a disorder or not. The degree of compliance with therapy may serve as an indicator for this step.
14. Ability to judge
It is advisable to ask questions about how you react to specific situations that have a high probability of occurring and that are related to the patient’s daily life.
15. Neurovegetative, sexual and appetite
These elements are evaluated with specific questions: sleep cycle, how much you sleep, sleep quality, and frequency. Whether there have been changes in your sexual motivation and practices with your partner (if any) or if there has been any change in your eating habits or appetite.
Its use in psychotherapy
The mental test is not a one-time evaluation, but rather a constant one, throughout the therapeutic treatment , the psychologist should be analyzing and evaluating these aspects to have a broader view of the individual’s evolution. It is important that all the changes that are observed are noted in order to find possible causes and infer consequences. In this way, the therapy can be shaped according to the needs of the patient.