THE MENTAL STATUS EXAMINATION- IN HOMOEOPATHIC PERSPECTIVE - homeopathy360
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THE MENTAL STATUS EXAMINATION- IN HOMOEOPATHIC PERSPECTIVE

Abstract: Present era is an era when every minute counts and each person tries hard to get ahead of the others, be it a student or a professional. A situation of this kind puts constant pressure on our mental faculty leading to various kinds of mental as well as physical disorders, which are very rightly named as psycho-somatic disorders. Pressure at work causes mental disturbances which in-turn affects work efficiency, which again increases the mental stress. And this vicious cycle continues, unless this cycle is broken by                                                                                            anyone (friend, counsellor, etc.) or by anything (medicines).
This paper will deal with how to examine mental status of the patients in a better and systematic way and to understand various terminologies related to psychiatry.
Introduction
WHO defines Health as- “A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”. The definition here clearly mentions that mental health is an integral part of our general health and should be included in examination of each and every patient. Similar concepts Dr. Hahnemann had, as mentioned in the Organon of Medicine where he says, (aphorism 213) – “We shall, therefore, never be able to cure conformably to nature – that is to say, homoeopathically – if we do not, in every case of disease, even in such as are acute, observe, along with the other symptoms, those relating to the changes in the state of the mind and disposition[1].
But what does a normal mental well being means? It is very difficult to define a normal mental health, but some of the parameters can be considered for it, such as[2]
·         Person is free from internal conflicts
·         He is well adjusted, i.e., he is able to get along with others. He accepts criticism and is not easily upset.
·         He searches for identity.
·         He has a strong sense of self- esteem.
·         He knows himself: his needs, problems and goals.
·         He has a good self- control- he balances rationality and emotionality
·         He faces problems and tries to solve them intelligently.
HAHNEMANN’S CONCEPT OF MENTAL DISEASE[3]
He has defined mental diseases in aphorism 210-230 as one sided diseases and Psoric in origin. He has categorised them into 4 types-
1.      Mental diseases appearing with decline of the corporeal disease- somato-psychic type (aph. 216)
2.      Mental diseases appearing suddenly as an acute disease in patient’s ordinary calm state caused by some exciting factor (aph. 221)
3.      Mental diseases of doubtful origin (aph. 224).
4.      Mental diseases arising from prolonged emotional causes- psycho- somatic type ( aph. 225)
THE NEED FOR THE TOPIC-
According to WHO report 2010 – one in four people in the world will be affected by mental or neurological disorders at some point in their lives. Around 450 million people currently suffer from such conditions, placing mental disorders among the leading causes of ill-health and disability worldwide.
Treatments are available, but nearly two-thirds of people with a known mental disorder never seek help from a health professional. Stigma, discrimination and neglect prevent care and treatment from reaching people with mental disorders, says the World Health Organization (WHO). Where there is neglect, there is little or no understanding. Where there is no understanding, there is neglect[4].
Currently, more than 40% of countries have no mental health policy and over 30% have no mental health programme. Around 25% of countries have no mental health legislation[5].
According to WHO Around 20% of the world’s children and adolescents have mental disorders or problems. About half of mental disorders begin before the age of 14. Similar types of disorders are being reported across cultures. Neuropsychiatric disorders are among the leading causes of worldwide disability in young people. Yet, regions of the world with the highest percentage of population under the age of 19 have the poorest level of mental health resources. Most low- and middle-income countries have only one child psychiatrist for every 1 to 4 million people[6].
World Mental Health Day – celebrated on 10 October every year worldwide. It is a day for global mental health education, awareness and advocacy. This year’s World Mental Health Day will focus on “psychological first aid”. Observing mental health day will enable us to contribute to the goal of taking mental health out of the shadows so that people in general feel more confident in tackling the stigma, isolation and discrimination that continues to plague people with mental health conditions, their families and carers.
    THE MENTAL STATUS EXAMINATION
Mental status examination is a standardised format in which the clinician records the psychiatric signs and symptoms present at the time of the interview/ case taking. It is cross- sectional summary of the patient’s behaviour, sensorium and cognitive functions. It serves the same function for psychiatrists as physical examination does for the primary care physicians[7]. The MSE provides important information for diagnosis and for assessment of the disorder’s course and response to treatment. Observations noted throughout the interview become part of the MSE, which begins when the clinician first meets the patient. It was mentioned in ICD- 9 in III vol. Under section 94.09 and 94.11, while in ICD -10 CM it is included under Z00.8 which is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes[8].
Dr. Hahnemann clearly emphasizes on observation towards the mental status of the patient as in aphorism 90- “When the physician has finished writing down these particulars, he then makes a note of what he himself observes in the patient, and ascertains how much of that was peculiar to the patient in his healthy state.
For example, how the patient behaved during the visit – whether he was morose, quarrelsome, hasty, lachrymose, anxious, despairing or sad, or hopeful, calm, etc. Whether he was in a drowsy state or in any way dull of comprehension; whether he spoke hoarsely, or in a low tone, or incoherently, or how otherwise did he talk? What as the colour of his face and eyes, and of his skin generally? What degree of liveliness and power was there in his expression and eyes? Whether he lay with head thrown back, with mouth half or wholly open, with the arms placed above the head on his back, or in what other position? And anything else in him that may strike the physician as being remarkable”.

COMPONENTS

ELEMENTS TO ASSESS

APPEARANCE AND BEHAVIOUR APPEARANCE
ATTITUDE TOWARDS EXAMINER
COMPREHENSION
GAIT AND POSTURE
MOTOR ACTIVITY
SOCIAL MANNERS
RAPPORT
SPEECH
 
RATE AND QUANTITY
VOLUME AND TONE
FLOW AND RHYTHM OF SPEECH
CONTENT OF SPEECH
EMOTIONS
 
MOOD
AFFECT
THOUGHT PROCESS STREAM OF THOUGHT
CONTENT OF THOUGHT
PERCEPTION HALLUCINATIONS
ILLUSIONS
DEPERSONALISATION
DEREALISATION
COGNITION ASSESSMENT CONSCIOUSNESS/ ORIENTATION
ATTENTION/ CONCENTRATION
MEMORY
INTELLIGENCE
ABSTRACT THINKING
INSIGHT  AWARENESS OF ILLNESS
JUDGEMENT CAPACITY TO MAKE APPROPRIATE DECISION

 
APPEARANCE AND BEHAVIOUR-
A.APPEARANCE- it is the record of prominent features of the patient making a portrait which highlights his/ her unique features. It includes factors such as, approximate age as compared to his/ her chronological age, body habitus, dress, hair colour and texture, styling and grooming; hygiene, jewellery, scar formation, tattoos; an estimate of how old patient looks as compared to his / her chronological age.
v  Physique and body habitus-
Sepia– build, very tall, slim, narrow, straight from the shoulders all the way down[9].
Nitric acid– lean persons of rigid fibre, dark, swarthy complexion, black hair and eyes; the brunette rather than blonde.[10]
Sulphur– lean, stoop-shouldered persons who walk and sit stooping; walk stooping like old men.[11]
Lycopodium– upper part of body wasted, lower part semidropsical[12]
v  Grooming, hygiene and self-care-
Sulphur- he has long, uncut hair and a dirty face; his study is un-cleanly, it is untidy; books and leaves of books are piled up indiscriminately; there is no order[13].
Amm.c– can be very untidy, even dirty, looking very like Sulphur. Both have an aversion to bathing. Am-c also has a marked aggravation from washing. The difference between the two is that the dirty appearance of Sulphur is a result of their laziness, whilst in Am-c it is more a form of protest, a sign that they don’t want to belong to this ‘bloody awful world[14]‘.
v  Dressing-
Lachesis– Intolerance of tight bands about neck or waist[15]
Psorinum– Great sensitiveness to cold air or change of weather; wears a fur cap, overcoat or shawl even in hottest summer weather[16]
v  Facies/ Looks-
Aconite: The countenance is expressive of fear[17]
Baptisia– Face flushed, dusky, dark-red, with a stupid, besotted drunken expression[18]
Aethusa– An expression of great anxiety and pain, with a drawn condition and well-marked
linea nasalia[19]
 Sepia establishes a progressing emaciation of the body and the skin becomes wrinkled; the person looks
prematurely old; wrinkles intermingled with sallow spots on the face in one who is 35 years of age,
making him look as if he were fifty[20].
Secale- Face: pale, pinched, ashy, sunken, hippocratic; drawn, with sunken eyes; blue rings around eyes[21].
Phos. acid– Pale sickly complexion, eyes sunken and surrounded by blue margins[22].
B. ATTITUDE TOWARDS EXAMINER- the physician takes notice of not only the general impression but,  also focuses on shift in the attitude of the patient at a particular point of interview.
v  Cooperation/ haughtiness-
Chamomile– Patient cannot endure any one near him; is cross, cannot bear to be spoken to; averse to talking, answers peevishly[23]
Sulphuric acid– Unwilling to answer; says yes or no with difficulty[24].
v  Attentiveness-
Phos– It is a diffusion of awareness which the patient may not be able to control readily. During a thunderstorm, the normal person will hear a clap of thunder and then easily prepare himself for more; the Phosphorus patient, however, tends to become diffuse automatically, and so will be startled with each noise[25].
Mezerium– ideas vanish while talking; unable to repeat what has been learned by heart; looks through window for hours, without being conscious of objects around; knows not what she is about; forgets what she is about to utter[26]
v  Interest/ disinterest-
The Arnica patient is morose, wants to be let alone, does not want to be talked to, does not want to be approached. He does not want to be approached, both because he does not wish to enter into conversation, a mental state[27]
Phos. acid– When questioned he answers slowly or does not speak, but only looks at the questioner. He is too tired to talk or even think. He says: “Don’t talk to me; let me alone.”[28]
Nux moschata– Gives answers which have not the least reference to questions put to him[29].
C. COMPREHENSION-
v  Intact/ impaired-
Abrotanum– Feebleness and dullness of mind. No capacity for thinking, as if all bodily and mental power were gone[30].
Agnus – He finds reading difficult; has to read several things twice[31]
Baryta carb.– Children are late coming into usefulness; or activity; late with their studies; late learning to
talk; late learning to read; late learning to make the combinations that enter into life; late learning to take
in images, and form perceptions; to take on their activities; to do their work[32].
D. GAIT AND POSTURE-
v  Way of sitting
Sepia- Sitting with legs crossed
Rhus tox.- Anxiety: while sitting was obliged to take hold of something because she did not think she could keep up on account of the beating and drawing pains in limbs; and apprehension as if he wished to take his own life[33]
v  Way standing/ walking
  Argentums nit.- Walks and stands unsteadily, especially when he thinks himself
Un-observed[34]
  Kali brom- Nervous, restless; cannot sit still, must move about or keep occupied; hands and fingers in
constant motion; fidgety hands (fidgety feet, Zink.); twitching of fingers[35].
Agaricus– Uncertainty in walking, stumbles over everything in the way[36]
E. MOTOR ACTIVITY- the physician observes the patient’s freedom of movement, noting the strength and firmness of handshake. He also observes any involuntary or abnormal movements such as tremors, tics mannerism, lips smacking or any stereotyped movements.
The speed of the movements is also noticed.
v  Increased/ decreased-
Arsenic– When in bed, unable to sit up, the patient tosses and turns from side to side; if he is able, he climbs out of bed and sits in the chair, keeps moving from one place to another, and, when thoroughly exhausted, he gets back into bed again[37].
Hepar sulph.- He desires a constant change of persons and things and surroundings and each new surrounding or person or thing again displeases and makes him irritated[38].
v  Excitement/ stupor-
Coffea– Unusual activity of mind and body. Full of ideas; quick to act, no sleep on this account[39].
Opium– Sopor: painless, complains of nothing, wants nothing; with delirium; depression of lower jaw; dilated pupils[40]
v  Abnormal involuntary motions / Catatonic signs (mannerism, stereotypes, stupor, etc.)-
Agaricus-Involuntary movements while awake, cease during sleep; chorea, from simple motions and jerks of single muscles to dancing of whole body; trembling of whole body[41]
Zincum met.– Automatic motion of hands and head, or one hand and head[42]
Bryonia – Left arm and hand in a weaving motion up and down; each time uttering a sigh[43].
Amyl nitros.- Constant stretching for hours[44].
Elaps corallines– Must have oscillatory motion[45]
v  Conversion states (possessive states)-
Thuja- Fixed ideas : as if a strange person were at his side; as if soul and body were separated; that body, particularly limbs, are made of glass and will readily break; as if a living animal were in abdomen; talks about being under the influence of a superior power[46]
Anacardium– Feels as though he had two wills, one commanding him to do what the other forbids. When walking, is anxious, as if someone were pursuing him; suspects everything around him[47]
v  Social withdrawal-
Phos. acid– Is listless, apathetic; indifferent to the affairs of life; prostrated and stupefied with grief,  to those things that used to be of most interest, especially if there be debility and emaciation[48].
Coca – Melancholy; bashful, ill at ease in society, irritable, delights in solitude and obscurity[49].
Argentum nit.- Became insensible to all social pleasures and lost all desire for labour[50].
Bufo- Desire for solitude, to practice masturbation[51]
Fluoric acid– Feeling of indifference towards those he loves best, has no objection to their presence but does not care to converse with them, yet it strangers or mere acquaintances come in will enter into animated conversation[52]
v  Compulsive behaviours-
Syphilinum- Always washing the hands[53].  Will not even shake hands with you. Wash hands 50 – 200 times daily. If not able to wash hands will develop sweat, headache. Paranoid fear that if their children touch what they have touched they will be similarly tainted. Know this is ridiculous but do not have strength to stop[54].
Arum triph.- Constant picking at the nose until it bleeds; boring with the finger into the side of the nose. Pick lips until they bleed; corners of mouth sore, cracked, bleeding; bites nails until fingers bleed[55].
v  Reaction time-
Rhus toxicodendron– To all interrogations his answers are slow, reluctant and petulant[56]
F. SOCIAL MANNERS-
v  Inappropriate behaviour-
Hyoscyamus– Lascivious mania: immodesty, will not be covered, kicks off the clothes, exposes the person; sings obscene songs; lies naked in bed and chatters[57].
Verat. Album– Mania with desire to cut and tear everything, especially clothes with lewd, lascivious talk, amorous or religious[58].
Anacardium– Strange temper, she laughs at serious and is grave over ludicrous occurrences[59].
Belladonna– Insanity; they stripped themselves and clad only in their shirts ran out into streets in broad daylight, gesticulating, dancing, laughing and uttering and doing many absurd things[60].
v  Eye contact-
Nat. mur.– mind, looked at, evading the look of other person, spoken to when[61]. He concluded from the look of everyone, that he was pitied on account of his misfortune, and he wept[62]
G. RAPPORT- whether a orking relationship can be established with the patient.
Phosphorus– Right from the first interview, the patient views the prescriber as a friend, shaking his hand warmly, sitting forward on the seat, and perhaps reaching out to touch the prescriber’s hand or wrist when emphasising a point[63].
Phosphorus type will plead for help to the homoeopath, while the Arsenicum type will demand it. no patients in our Materia Medica are so clinging and demanding of relief from their anxiety as are Arsenicum and Nitric acid[64]
SPEECH-
A.RATE AND QUANTITY-
Strammonium– Talks incessantly foolish things which nobody can understand; sits down, rises up, kneels, or takes other queer positions; tears his clothing and breaks chairs with remarkable celerity; gives no answer, and evades carefully looks of other persons[65].
Rhus tox.- Incoherent talking; answers hastily or reluctantly, thought seems difficult; answers correctly but slowly[66]
Mercurius- Hurried and rapid talking[67]
B. VOLUME AND TONE-
Cocculus Indicus.-Great lassitude of the whole body; it requires exertion to stand firmly; feels too weak to talk loudly[68].
Melilotus officinalis – Says she dares not talk loud as it would kill her; she whispers[69].
C. FLOW AND RHYTHM OF SPEECH-
v  Smooth/ hesitant-
Amygdalus communis– Jerking, hesitating speech- “What’s – the mat – matter with me ?”[70]
Pulsatilla– He hesitates in his speech; it vexes him to have to answer[71].
v  Stuttering/ stammering-
Spigelia– Stammering, repeats first syllable three or four times; with abdominal ailments; with helminthiasis[72].
Strammonium– exerts himself for a long time before he could utter a word; makes effort to speak; distorts the face.[73]
v  Stereotypes-
Zincum met.– Child repeats everything said to it[74].
D. CONTENT OF SPEECH- it will be the projection of what patient thinks, it will contain same points as
contents of thought which will mentioned in the coming part.
Bryonia– Irrational talk or prattle of his business[75].
 Argentums nit.– He wept and assured every one that he was lost beyond hope for this world; that no one
could delude him in that respect, and no one could reason him out of it[76].
EMOTIONS-
A.MOOD- it is the sustained feeling tone that prevails over time for a patient. Anxious, panicky, terrified, sad, depressed, angry, euphoric, guilty etc. are some moods frequently described. It can even inferred from observation of patients non- verbal body language.
Aurum met.- Melancholy, disposed to weep; imagines he is unfit for this world, that he never can succeed[77]
Lac caninum- Despondent, hopeless; thinks her disease incurable; has not a friend living; nothing worth living for; could weep at any moment[78].
Phosphoricum acidum- Is listless, apathetic; indifferent to the affairs of life; prostrated and stupefied with grief, to those things that used to be of most interest, especially if there be debility and emaciation[79].
B. AFFECT- When we talk about a person’s affect we’re referring to how people convey their mood by their behaviour.   A “normal’ affect, within reason, would be described as reactive and appropriate – that is, laughs at a joke, or cries when sad.
Baryta carb.- The highest degree of irresoluteness; she proposes a little journey, but as soon as she makes preparation she changes her mind; she wavers between opposite resolutions[80]
Ignatia amara- Mental conditions rapidly, in an almost incredibly short time, change from joy to sorrow, from laughing to weeping; moody[81].
THOUGHT-
A.STREAM AND FORM OF THOUGHT- we have to note the rate and quality of thoughts; see whether there is poverty or flooding of thoughts. There could be flight of ideas. We also have to note whether thoughts are goal- directed and continuity of thoughts is there or not.
B.CONTENT OF THOUGHT-
v  Circumstantiality- in this the patient exhibits lack of goal directedness, inco-operates tedious and unnecessary details, and has difficulty in arriving at an end point.
v  Tangentiality- It describes a thought process in which the patient’s thoughts disagrees from the subject under discussion and introduces thoughts that seem unrelated and irrelevant.
Nux mosc.- Answers irrelevantly[82]. Gives answers which have not the least reference to questions put to him[83]
Opium- gives irrelevant answers[84]
v  Thought- blocking- there is sudden cessation in the middle of a sentence, at which point patient cannot recover what he or she has sad or complete the sentence.
Medorrhinum- In conversation he would occasionally stop, and on resuming make remark that he could not think what word he wanted to use[85]
v  Loosening of association- it is jumping from one topic to another with no apparent connection between the topics.
Lachesis- Most extraordinary loquacity, making speeches in very select phrases, but jumping off to most heterogeneous subjects; at same time proud, full of mistrust[86].
v  Preservation- patient repeating the same reponse to a variety of questions and topics with inability to change his or her response or the topic.
Along with the above varieties, there can be other points to be noted such as- delusion, obsession, compulsion, preoccupation and various phobias.
DELUSION- these are fixed false believes which cannot be corrected by logical explaination.
1.      Delusions of influence (Believe that their thought and actions are controlled by outside force)
2.      Delusions of persecution (Believe that others are trying to harm)
3.      Delusions of reference (Believe that some events in the environment have special meaning to, and directed at the patient)
4.      Grandiose delusions (The patient’s feelings of having special power and knowledge or special relationships with important figures)
5.      Somatic delusions (Feelings that the body has been manipulated by outside forces)
6.      Delusion of love (Belive that he has a special romantic relationship with a public famous figure)
7.      Nihilism (Patient believe that the self world and even time has been lost or destroyed)
Arsenicum- Dissatisfied and angry with himself all day; thinks he has not accomplished enough, and reproaches himself bitterly[87]
Aurum met.- Looks on dark side, weeps, prays, thinks she is not fit for this world, longs for death, strong inclination to commit suicide; desperate, desires to jump from a height. Melancholy disposed to weep; imagines he is unfit for this world, that he never can succeed.[88].
Lachesis- Thinks : she is somebody else and in the hands of a stronger power; she is dead, and preparations are made for funeral, or that she is nearly dead and wishes someone would help her off; herself pursued by enemies, or fears medicine is poison; there are robbers in house and wants to jump out of window; herself under super-human control; visions real; he will die[89]
Platina– Pride and overestimation of one’s self; looking down with haughtiness on others[90].
Rhus tox.- Disgust for life : thoughts of suicide; wants to drown himself; with fear of death; with desire to die, without sadness[91].
Selenium– Lascivious thoughts with impotency[92].
Sulphur- Great dejection, with thoughts of suicide; feels inferior to everybody; can decide nothing; listless, unable to work; can understand nothing she reads; great disgust, amounting to nausea, at odors of her own body[93]
PERCEPTION-
A.HALLUCINATIONS- it is a perception experienced in the absence of an external stimulus.
Types of hallucination are-
·         Visual hallucinations.
·         Tactile hallucinations
·         Auditory hallucination
·         Hallucinations of taste and smell.
Anacardium- Imagines he hears voice of mother or sister, who are far away[94]
Medorrinum- Thinks someone is behind her, hears whispering; sees faces that peer at her from behind bed and furniture[95].
Aethusa -Imagined she saw rats run across room[96].
Anacardium- Has a devil in his ear whispering blasphemous words[97].
Cocainum- sensation as if small foreign bodies or worms were under the skin[98]
Arsenic alb.- He sees all kinds of vermin on his bed, throws handfuls of them away, and tries to escape from them. He imagines that he sees burglars in his room, and listens under the bed; he is bathed in cold sweat[99].
B. ILLUSIONS- it is misinterpretation of a real external stimulus.
Baptisia– He thinks his gouty legs are holding a conversation with each other; He thinks his toe is holding a confab with his gouty thumb[100].
Baryta carb.- Walking in street she imagines men are laughing at her, criticising to disadvantage; this makes her so timid that she dare not look up or at anybody, and she perspires over whole body[101].
C. DEPERSONALISATION- it is unreality of one’s self.
Valeriana– Erroneous ideas; thinks she is someone else, moves to edge of bed to make room; imagines animals lying near her which she fears she may hurt[102].
Verat. Album– Fancies herself pregnant, or that she will be delivered soon; that she is in throes of childbirth[103]
Sabadilla– Imagines himself sick; parts shrunken; that she is pregnant, when she is merely swollen from flatus; that she has some horrible throat disease which will end fatally[104].
Zincum met.- Fanciful illusions when holding head down, as if she had a large goitre which she could not see over[105].
Alumina- “When he says anything he feels as if another person had said it, and when he sees anything, as if another person had seen it, or as if he could transfer himself into another and only then could see.”[106]
D. DEREALISATION- a subjective experience of unreality of the outside world
Platina– Illusions of fantasy on entering the house after walking an hour, as if everything about her were very small and all persons mentally and physically inferior, but she herself physically large and superior; the room seemed gloomy and unpleasant, with apprehensive and fretful mood[107].
Anacardium– Has the fixed idea that her husband is not her husband, her child not her child; now she fondles them and again pushes them away[108]
COGNITION ASSESSMENT
A.CONSCIOUSNESS/ ORIENTATION
Arnica– Unconsciousness; when spoken to answers correctly, but unconsciousness and delirium at once return[109]
Baptisia- Stupor; falls asleep while being spoken to or in the midst of his answer[110]
Badiaga– Mistakes the days[111]
Bryonia– Delirium: talks constantly about his business; desire to get out of bed and go home[112].
Strammonium- Does not seem to notice objects around him. No correct estimation of distance, or size of objects; reaching hands to catch hold of objects across room, and running against persons and things, which they appeared to view as distant[113]
Opium– Thinks he is not in his own house; imagines himself living in a locality three hours distant from his house; detains all passers-by and wishes to take them into his house; will brook no opposition, meets force with force, face flushed; stupor, forgetfulness, he does not at once recognize friends[114]
B. ATTENTION/ CONCENTRATION-
Nat. mur.- absent minded or distracted while talking; does not know what he ought to say; awkward in talking; easily makes mistakes[115]
E. MEMORY-
Syphilinum– Cannot remember names of persons, books or places. Difficulty in making arithmetical calculations[116]
Nux mos.- Vanishing of thoughts while reading, talking or writing; uses wrong words; does not recognize well-known streets[117]
Baryta carb.-Forgets what was just said, just done, or what he was going to do or get[118].
F. INTELLIGENCE-
Nat carb.-Memory gradually failing; inaptitude for meditation or hard work; difficulty of conception or combining ideas when listening or reading; figures and diagrams were void of expression to him and seemed enveloped in mist[119].
Ambra griesia– Memory impaired.  Comprehension slow, has to read everything three or four times, and then does not understand it[120]
G. ABSTRACT THINKING- it reflects the ability to formulate and generalize. Testing of abstract thinking includes testing similarities, differences and the meaning of proverbs. Inability to abstract is called concreteness of responses. Concreteness of responses on formal testing reflects intellectual impoverishment, cultural deprivation and cognitive disorders like dementia whereas bizarre and inappropriate responses to proverbs reflects schizophrenia.
INSIGHT
The capacity of the patient to be aware and to understand what he/ she has problem or illness and be able to arrive at a tenable solution is referred to as insight. This pertains to the ability of the patient to be aware of his/ her problem/ illness. Another element of insight involves the patient’s motivation to change his or her health risk behaviours.
Agnus castus– Absent-minded, reduced power of insight; cannot recollect things[121].
Arnica- Says there is nothing the matter with him. When roused up, he looks at the doctor and says: “I do not want you; I did not send for you; I am not sick; I don’t need a doctor.”He will say this even when he is seriously ill. Yet when in a state of health he was friendly, but now he is irritated at seeing the doctor and insists there is nothing the matter with him[122].
Arsenicum album– Anxious fear of death; thinks it useless to take medicine,  is incurable,  is surely going to die; dread of death,  when alone, or, going to bed[123].
JUDGEMENT
It refers to the patient’s capacity to make appropriate decision and appropriately act on them in social situations. This is assessed by either patient’s history or by asking the patient question requiring a judgemental answer, e.g., puls, caust.
Arsenc alb.– He is unable to decide between two opinions[124].
SOME POINTS TO BE CONSIDERED WHILE DOING MSE
¨      The art of psychiatric interviewing develops with practice and supervision by skilled mentors.
¨      Along with the patient, the family or the attendants mental state has to be assessed because sometimes they may exaggerate or ignore an important observation. The history told by the patient should be coherent and logical.
¨      Patents educational status has to be taken into account as an illiterate person may not be having the same mental level as that of an literate person.
¨     Social and cultural backgrounds has to be considered as there is difference in opinion between various cultures, e.g., In Western cultures eyes are considered to show the central point of a person’s focus while in Middle Eastern Cultures Eye contact is less common, and considered less appropriate than in Western cultures. There are strict gender rules, whereby women should not make too much eye contact with men. In countries such as China and Japan, eye contact is not considered an essential to social interaction, instead it is often considered inappropriate
CONCLUSION
Our materia medica is enriched with myriads of psychiatric symptoms but we can only apply them in our practice when we know the correct interpretation and application of those symptoms. And homoeopathy is indeed a pathy which has the capability of curing those psychosomatic illness and relief the suffering humanity.

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[2] Park K., park’s textbook of preventive and social medicine, 20th edition, bhanot publ.
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