Observing a Mental Status Exam Jennifer Broadwell FPSY 4111: Forensic Interviewing and Investigation Walden University April 2015

Mental Status Examinations are conducted to gain perspective into a person’s cognitive functioning. This information can be important in different situations. The information can be resourceful in a clinical setting, a treatment setting, as well as a criminal investigation setting. When interviewing an individual in reference to a crime it is important to conduct a mental status examination to be able to gauge if the information gained is credible, comprehensive, consistent, and comprehensible. “Mental status tests will examine your appearance, orientation, attention span, memory, language skills, and judgment skills” (Martel, 2012, para. 1). The information gained from the mental status examination can be used to prepare forensic psychologists in working with suspects, witnesses, or victims of crime. Elaine Roffban was a witness to a crime. It is known that she has a diagnosis of dementia. The mental status examination allows insight into just how reliable she would be as a witness to the events. General Appearance: Elaine is an 87 year old overweight Caucasian female whose appearance corresponds with her age and has been diagnosed with dementia. While Elaine’s clothing is clean and properly maintained the style is inappropriate for the season. The clothing is more properly suited for fall or winter. In addition the clothing was ill-fitted or too tight for her size. Elaine appears to be well groomed and proper hygiene is evident. Her hair is clean and styled. Elaine maintained eye contact throughout the interview, breaking eye contact only when she needed to focus. Elaine related well with the interviewer and with questioning. She displayed a desire to help and to answer all questions to the best of her ability. She maintained an open, cooperative, engaging, and relaxed attitude through the interview. Elaine was mildly fidgety throughout the interview with leg movements and hand movements. She shifted her legs quite regularly as well as bouncing them. She also fidgeted with her hands and moved them around, almost as if she wasn’t sure what to do with them at times. Overall, Elaine displayed an open relaxed posture with elbows away from the body, head held level, and legs uncrossed. Mood/Effect: Elaine was cooperative with all questioning. She attempted to answer all questions to the best of her ability and provided as much information as she could. She stated in the beginning of the interview that she would try to answer all the questions, even the difficult ones. Elaine displayed a euthymic mood and remained calm throughout the interview. Elaine would appear nervous with fidgeting and chuckling when she did not know the answers to questions such as the date, her address, and who the vice president is. Overall, she maintained an appearance of “calm, pleasant, friendly, and comfortable” (Polanski & Hinkle, 2000, p.359). Elaine did not vary between a range of emotions but maintained appropriate emotions throughout the interview. She did convey that she used to do things to make life interesting but that she was not doing many things now. Elaine’s affect was not labile and was appropriate to the questioning. Speech/Language: Elaine demonstrated appropriate vocabulary and speech patterns. Her speech was normal in tone, volume, and quality. She spoke at a normal rate and did not experience pressured speech. She did not mumble or slur. She understood the questions, asking for clarification if she did not understand the first time. Elaine understood and expressed that her memory has been affected by her dementia and stated on several occasions that she may get confused or mixed up. She had difficulty relating similar objects together such as apple and orange. She was coherent and understandable, while able to articulate appropriately. Her speech was not broken or slowed. Thought Process: Elaine displays good concentration for a woman diagnosed with dementia. She gets confused at time but maintains her thought process throughout the interview. She was asked to count backwards by 7 starting at 50. She was unable to complete the task correctly but gave a valiant effort. Her inability to perform this task is most likely due to her dementia which can make simple calculations difficult. Her thoughts were goal oriented. She did not readily get off task with her thoughts and answers. Elaine was given five words to repeat and then later asked to remember. She could not repeat all words or relate any of the words together even though two were easily relatable: apple and orange. She did relate two of the words to herself; apple and boat stating that she liked both. This was the one time she went off topic but got back on point very quickly. Elaine experienced difficulty in her orientation to person, place, and time. She was unable to answer who the current vice president of the United States is, stating that she would get “put in a place where I won’t know anything, and then I’ll feel really strange about it”. She continued to think then stated, “That’s something I really should know, I’ll have to think about it”. She was never able to recall the vice president. She could not correctly answer what the date or month is, she stated “these are the things I’m worse at”. She answered that it was the 21st of May, when it is in fact the 11th of June. She also could not recall her address although she did recall her complex. This example of long term memory loss is commonly found in dementia patients. Long term memory loss is usually less severe than short term memory (DSM IV, dementia). Thought Content and Perception: Elaine does not present with any evidence of delusions or hallucinations. However, her dementia is very prevalent. “Though not confused, patients have difficulty with short-term memory and, to a relatively lesser degree, long-term memory. Intellectual abilities are likewise impaired. The ability to think abstractly fails and patients become more and more concrete” (DSM IV, dementia). Elaine shows significant errors in memory and factual data. She cannot correctly recall the events as they actually happened. She states that the victim was inside her vehicle looking in the rearview mirror, while the video shows that the woman was at the rear of the vehicle looking into the open trunk. Elaine also states that the men made some noise when they passed by the woman and she wanted to know what they wanted but they wouldn’t tell her and then they ran off. The video does not support Elaine’s recollection of the events. Elaine does not present with any suicidal ideation. Elaine has scattered awareness of the environment. She can express correct directionality in her recount of where the two suspects ran to. However, she cannot convey the correct placement of the victim in reference to the vehicle. Elaine is asked to describe what she would do if she found an addressed, stamped envelope. Her judgment is questionable in this type of hypothetical questioning. Elaine states that she would pick it up. She then says that she would check inside to see if there was something in it that someone might be missing. She also states that she would be interested to see what was inside. She does not ever mention putting the envelope in the mail to be delivered. Polanski & Hinkle offer the explanation in their “Mental Status Examination” paper that “assessment of insight focuses on whether clients recognize that their problems are deviations from what is normal” (2000, p.361). Elaine states in her interview that “she has been doing things all her life and she is not doing them now”. She also mentions several times that her memory is not what I used to be and that she should remember things that she is unable to remember.
Conclusion:
As is a well known fact, the purpose of an interview is to gain pertinent information related to a specific event or subject. The information gained in an interview is only as credible as the witness that provides the information. To measure credibility, comprehensibility, and consistency of information it is important to include a mental status examination in with the interview. In order to assist with the amount of accurate information gained it may be best to perform the interview as soon as possible after the event and in the same location as the actual event. This allows the witness to remember details in a type of real-world experience. If the interview cannot take place that day, at that location then the location and time should be as similar as possible to the actual event. It is also important to remember that “each witness’s mental record of an event is unique” (Fisher, 2010, p.27). Each interview should be adjusted to the interviewee. With children, appropriate language should be used, with the elderly they should be allowed to take their time to answer, with individuals with mental impairments the questioning should be geared to enhance or compliment their greater abilities and deter from forcing them to use abilities that are no longer sharp. It may become important to have a family member present that the witness trusts or that can make them feel safe but it is also important to make sure that very same person does not inadvertently hinder the interview. It may be beneficial to use the family member or trusted individual in the rapport building portion of the interview and then excuse them for the remainder. Most importantly remember that if the interviewee is not comfortable it will affect the amount of information gained.

REFERENCES
Dementia. DSM-IV. Retreived from http://www.brown.edu/Courses/BI_278/Other/Clerkship/Didactics/Readings/Dementia.pdf
Fisher, R. P. (2010). Interviewing cooperative witnesses. Legal and Criminological Psychology, 15(1), 25– 38. Retrieved from the Walden Library Databases.
Goldberg, C. (2008). A practical guide to clinical medicine: The mental status exam. The Regents of the
University of California. Retrieved from http://meded.ucsd.edu/clinicalmed/mental.htm How to do a mental status exam. Retrieved April 5, 2015, from www.psychpage.com/learning/library/assess/mse.htm Laureate Education Inc. (Executive Producer). (2012). Conducting a mental status exam. Baltimore, MD: Author. Polanski, P. J., & Hinkle, J. S. (2000). The mental status examination: Its use by professional counselors. Journal of Counseling & Development, 78(3), 357–364. Retrieved from the Walden Library Databases.