• What are the functions of the components of mental status and an interview in determining the competence of clients? Explain with examples and rationales.
• For which types of psycholegal evaluations (competency, risk of dangerousness, and insanity), if any, might an MSE provide useful information? State reasons for your answers.
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Introduction
Appearance & Behavior
From the moment the interviewer first greets the patient, he or she will be aware of the patient’s appearance. The interviewer should try to describe it in detail before drawing inferences from it. What is the patient’s physique and habitus? Is there evidence of weight loss or gain? Does the patient have any conspicuous marks or disfigurement? The interviewer should describe the patient’s face and hair. Does the patient look ill? What is the expression of the eyes and mouth? Does the patient appear to be in touch with the surroundings? Is the patient clean and neat, or does he or she exhibit deficiencies in personal hygiene revealed by poor grooming of the skin, hair, or nails? How is the patient dressed? Is the patient’s clothing neat? Is it appropriate or peculiar? After the interviewer describes these characteristics, he or she determines whether an inference may be made about the kind of “statement” the patient is attempting to make with his or her attire.
The interviewer notes general overactivity or underactivity; abnormalities of posture; gross incoordination; or impairment of large muscle function. What is the patient’s gait like and how does he or she sit? The interviewer notes any abnormalities of finer movement and posture, such as tremor, tics, or fidgeting.
Stereotypies are organized, repetitive movements or speech or perseverative postures. They are usually associated with schizophrenia, particularly the catatonic type. A striking variant of postural stereotypy is waxy flexibility, in which the patient will remain indefinitely in a position into which the interviewer places him or her (eg, standing on one leg). Other disorders of movement associated with catatonia include a stiff expressionless face; facial grimacing or contortions; stiff, awkward, o………
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