Critical Analysis of Mental Status Examination by Rachel M. Voss and Joe M Das (2019)

The research paper 'Mental Status Examination', proposed by Voss, R M & Das attempts to explain mental status examination to thoroughly capture the objective and subjective aspects of mental illness. It elaborates on each part of the mental status examinations- by classifying them into the broad categories of appearance, behavior, motor activity, speech, mood, affect, thought process, thought content, perceptual disturbances, cognition, insight, and judgment-which is used to identify, diagnose, and monitor signs and symptoms of mental illness. The mental status examination can aid in the diagnosis of a patient when combined with a thorough psychiatric interview including history of present illness, past psychiatric history, substance use history, medical history, review of systems, family history, social history, physical examination, and objective laboratory data such as toxicology screening, thyroid function, blood counts, and metabolic levels, neuroimaging. They explain how the study provides an elaborative description of all important aspects of MSE to measure and judge various attributes, ranging from types such as speech, thought content, to various sub types like recent and long term memory. Though it is essential and used by psychiatrists in evaluating a patient on initial and subsequent encounters, it has many limitations and loopholes- some of which were described, and some missed by the authors of this paper.

Several factors can limit the mental status examination. There are no guidelines for how to interpret and use the findings of an abnormal mental status examination; it is dependent on the practitioner to use their 'best clinical judgment' to combine the information with other subjective and objective findings. Subjective assessment of a patient may vary significantly between practitioners depending on their level of skill in observation and eliciting responses from the patient. To perform an effective mental status examination, a certain level of trust needs to have been built with the patient to be able to have their cooperation and openness. Some patients are agitated to the point of being unable to answer questions or have to be sedated for safety concerns limiting the ability to perform a mental status examination.

One major factor that it yet again misses is the role of family/friends and peers, and their ‘reliable’ observations, and views and opinions on the changes, and potential factors causing change in the behavior of the client.

Apart from addressing controversial incompetence of the clinical/medical support staff, it raises questions over the accountability of practitioners during treatment as it advocates “mental health professional’s duty to warn a person if a patient has made a threat against their life”.

Though M. Voss stressed the importance of and provided actual definitions of different components (as he emphasized on how “description” of each of these is important),it is quite ironic that he himself fails to provide clarity, and overcome subjectivity in his 'description of some factors'. While his meticulous analysis is largely palatable, his omission of the family/friends (his or her core social group, and the society) and ambiguity how to interpret and use the findings do not sit easily. In the entire article, he never mentions about seeking external help from the near and dear ones of the client and by large undermines the role that one’s micro-micro group play in shaping and identification with ones ‘self’, and the impact the intimate group has on one’s life. Whether this was an intentional omission or a sloppy oversight is unclear, but it weakens Voss’s stand as he fails to provide a pre-emptive response to such arguments. Nevertheless, Voss and Das’s work still provides significant ‘descriptions’ about various factors used during psychological assessment as mentioned above and can be of great value to all the future researchers conducting a study in the same area.

Link for Research Article: Voss RM, M Das J. Mental Status Examination. [Updated 2020 Jun 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546682/ https://www.ncbi.nlm.nih.gov/books/NBK546682/

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