Mental Status Examination Training: Section 7 - Interpersonal Issues

Introduction

• Presented by Tom Field.
• Focus on interpersonal issues within the mental status examination.
• Part of a larger training series, concluding with an end-of-training test.
• Importance of following along with handouts and using scrap paper for practice.

Key Concepts

1. Intrapersonal Behavior

• Defined as internally driven behavior.
• Three facets: Ego Congruence, Ego Centrism, and Ego Strength.

2. Ego Congruence

• Ego-dystonic: Behavior inconsistent with core personality, leading to remorse.
  • Example: Client expressing regret for past behavior.
• Ego-syntonic: Behavior consistent with core personality, even if problematic.
  • Example: Client justifying long-term drinking habits.

3. Ego Centrism

• Focus on self, often exaggerating personal importance.
  • Conceited: Self-important, arrogant behavior, possibly compensating for inadequacies.
  • Grandiose/Expansive: Inflated ego with unrealistic goals; often linked to manic states.

4. Ego Strength

• Ability to cope with adversity; lack thereof leads to negative behaviors.
  • Intro-punitive: Self-blame for events, linked with depression.
  • Splitting: Dichotomous thinking, associated with borderline personality disorder.
  • Catastrophizing: Predicting worst-case scenarios, linked with faulty logic.

Video Case Studies

• Demonstrations of concepts through client interactions.

Case Study Examples

1. Ego-dystonic vs Ego-syntonic
   • Client's regretful behavior vs client justifying problematic behavior.
2. Conceited Behavior
   • Client displaying overconfidence without studying.
3. Grandiosity
   • Client's ambitious, unrealistic project ideas.
4. Intro-punitive Behavior
   • Client self-blaming for familial issues.
5. Splitting
   • Black-and-white perception of self.
6. Catastrophizing
   • Escalating minor issues to extreme consequences.

Guided Practice

• Students tasked with assessing video case studies for various mental status factors (effect, mood, thought process, memory, motor speech, interpersonal, and intrapersonal issues).

Conclusion

• Section covered ego congruence, centrism, and strength.
• Importance of recognizing these behaviors in mental status examinations.
• Prepares students for the final section and end-of-training test.