03: The Mental Status Exam

Question 1

List the five components of the Mental Status Examination.

Answer 1

1. Appearance, behavior, speech & attitude
2. Mood and affect
3. Thought process, content & perception
4. Cognitive
5. Insight and judgement

Question 2

Describe the components of appearance, behavior, speech & attitude.

Answer 2

• Clothing and grooming
• Motor behavior (agitation or retardation)
• Speech rate, volume, modulation (inflection) - “slow, quiet, mumbled, forceful”
• Interactions with the interviewer (cooperativeness, eye contact)

Question 3

Describe the types of psychomotor behavior.

Answer 3

• Psychomotor agitation: noticeable and marked increase in body movements (hand wringing, pacing)
• Psychomotor retardation: significant slowing of speech and body movements, lack of usual fidgetiness

Question 4

What is the difference between mood and affect?

Answer 4

• Mood: subjective feeling state sustained over much of the interview (must be asked)
• Affect: objective feeling state (as observed by physician)

Question 5

List the various mood descriptors.

Answer 5

• Normal: Euthymic (non-depressed, reasonably positive)
• Abnormal:
  
  • Depressed/dysthymic
  • Sad
  • Irritable
  • Expansive (enthusiastic)
  • Euphoric (feeling great, as if just won lottery)
  • Nervous
  • Angry

NB: In your note, quote the patient directly, then add your own translation of how they are feeling.

Question 6

List the various affect discriptors.

Answer 6

• Normal: full range
• Abnormal:
  
  • Constricted: normal amplitude, restricted range (i.e., stuck in one emotional state)
  • Blunted: decreased amplitude
  • Flat: virtually complete absence of affective expression
  • Inappropriate: emotions expressed are not congruent with content (sustained over entire interview)
  • Labile: unpredictable shifts

Question 7

Describe the components of thought process, thought content and perception.

Answer 7

• Thought process: overall pattern and organization; “normal” = coherent and goal-directed
• Thought content: specific signs/symptoms/themes of psychopathology (e.g., delusion, obsession, etc.)
• Perception: assessment of perceptual symptoms (e.g., illusions, hallucinations)

Question 8

List the various thought process descriptors.

Answer 8

• Organized
  
  • Tangential: occasional lapses in organization (change subject, never return to original point).
  • Circumstantial: organized but overly-inclusive (eventually gets to point, but in painstakingly slow manner).
  • Flight of ideas: Flow of thoughts extremely rapid, but connections intact.
• Disorganized (“formal thought disorder”)
  
  • Loosening of associations: frequent lapse between thoughts; disorganized.
  • Word salad: incomprehesible due to lapses in connections even within single sentence; incoherent, “tossed salad” of ideas.
  • Blocking: losing train of thought (must confirm patient’s subjective experience).
  • Neologism: created word with idiosyncratic meaning (patient does not acknowledge as made up).

Question 9

List the various thought content descriptors.

Answer 9

• Delusion: belief held with strong conviction despite superior evidence to the contrary; fixed (reality testing not in tact = patient cannot consider possibility that thought is false), false, not shared by members of patient’s culture
  
  • Grandiose: exaggerated view of one’s importance
  • Paranoid: suspiciousness of others’ motives
  • Somatic: relating to one’s body
  • Religious: relating to religion
  • Reference: misinterpret external events as having particular meaning for individual
• Overvalued idea: firmly held, but reality testing in tact; false and not shared by members of patient’s culture (e.g., paranoid ideation, ideas of reference)
• Obsession: intrusive, **egodystonic idea **(thoughts and behaviors in conflict with the needs and goals of the ego) with intact reality testing
• Phobia: specific fear that results in avoidance despite realization that fear is irrational
• Suicidal ideation
• Homicidal ideation
• Paucity of thought: lack of content; patient has very little to say

Question 10

List the various perception descriptors.

Answer 10

• Illusion: misinterpretation of sensory stimulus (any modality)
• Hallucination: perceiving sound/sight/smell/tase/touch in absence of external sensory stimulation; seems indistinguishable from such an experience in reality
• Depersonalization: sense that one is outside oneself
• Derealization: vague sense of unreality in one’s perception of the external world
• Psychosis: defined via formal thought disorder, delusions & hallucinations; NOT a diagnosis; sign of a disorder (analagous to fever)

Question 11

What is the difference between insight and judgement?

Answer 11

• Insight: individual’s understanding of themselves in the context of wanting/needing help
• Judgement: behavior related to illness; impulsivity

NB: Describe in assessment (e.g., “impaired with glimmers of understanding”); explain with examples; normal = intact, excellent; abnormal = fair, impaired.