Saturday, July 16, 2016

Mental Status Exam

The questions in the mental status exam include all the basic of social work assessment. While the MSE's lack of full exploration into the biopsychosocialspiritual components of client experience makes it an imperfect tool for social work, it's still a good start. That's why you'll see the MSE used in many clinical settings and why you shouldn't be surprised to see a question about the MSE on the social work licensing exam (e.g., "A social workers asks a client to spell a word backwards. What is the social worker assessing for?")

The general elements covered in the MSE are as follows:
  • General Appearance
  •  Psychomotor Behavior
  • Mood and affect
  • Speech
  • Cognition
  • Thought Patterns
  •  Level of Consciousness
There's too much detail in the exam to recount here, but click through to the further reading to get more comfortable with the details of the exam. 

Further reading: "How to Do a Mental Status Exam," and Mental Status Examination at Wikipedia.

Tuesday, July 12, 2016

Into the DSM - Bipolar I Disorder

To meet criteria for bipolar I disorder, a manic episode is required--it may be followed by a hypomanic or major depressive episode. (For bipolar II, a hypomanic episode + a current or past major depressive episode are required.) Here are the criteria for a manic episode:

A. Distinct period of abnormally and persistently elevated, expansive, or irritable mood with increased goal-directed activity or energy, lasting at least 1 week.

B. Three or more of the following during the mood disturbance:
  1. Inflated self-esteem or grandiosity
  2. Decreased need for sleep
  3. Increased talkativeness
  4. Racing thoughts or flight of ideas
  5. Distractibility
  6. Increased goal-directed activity or psychomotor agitation
  7. Excessive risk-taking
C. Mood disturbance severe enough to cause impairment.

D. Episode is not attributable to effects of a substance or another medical condition.

Hypomanic episodes include many of the same symptoms, but are not severe enough to cause marked impairment in social or occupational functioning or to require hospitalization.

Specifiers for bipolar I disorder include:
  • With anxious distress
  • With mixed features
  • With rapid cycling
  • With melancholic features
  • With atypical features
  • With mood-congruent psychotic features
  • With mood-incongruent psychotic features
  • With catatonia
  • With peripartum onset
  • With seasonal pattern
Risk factors include:
  • Having a first-degree relative (e.g., parent or sibling) with the disorder.
  • Substance abuse
  • High stress
  • Major life changes (e.g., death of loved one)
For further study: Bipolar I Disorder at

Wednesday, July 06, 2016

Into the DSM-5 - Schizoaffective Disorder

If you've encountered schizoaffective disorder in your work  with clients, questions about the diagnosis on the licensing exam shouldn't give you much trouble. For everyone else, here's a quick primer. The essential formula to remember with schizoaffective disorder is psychotic symptoms + mood symptoms which are independent of the psychotic symptoms. Common rule-outs: schizophrenia, bipolar disorder, MDD with psychotic features.

There are two essential criteria:
  • Major mood episode concurrent with symptoms of schizophrenia
  • Delusions or hallucinations in the absence of mood symptoms at some point
 Specifiers include:
  • Bipolar type
  • Depressive type
  • With catatonia
Risk factors: Having a blood relative with schizophrenia, schizoaffective disorder, or bipolar disorder; stress; drug use.

For further study: Schizoaffective disorder at