10-15 Mental Status Exam Flashcards
Skeleton of the Mental Status Exam
Objective description of patient’s CURRENT state:
- Appearance
- Behavior/Speech
- Mood/Affect
4a. Though Process
4b. Thought Content - Perception
- Cognition (MoCA/MMSE)
Assessing [1] Appearance
clothing; hygiene; grooming; apparent physical health; notable physical characteristics; overall appropriateness of appearance.
Assessing [2] Behavior/Speech
Facial expression?
Psychomotor activity? (agitated depressed)
Bizarre mov’t? (Mannerisms, tics, catatonic?)
Attitude toward examiner?
Speech (pressured, long response latency), volume, idiosyncrasies of speech (i.e. NOT content)
Assessing [3] Mood/Affect
Mood: How does pt feel? (subjective) Note congruence
—possibilities: euthymic, sad, happy, angry, alexothymic (unable to describe mood)
Affect: How does patient appear to feel? (more objective) Again note congruence/appropriateness
—possibilities: blunted, flat, full (=normal), labile
Assessing [4a] Thought process (define all possible observations)
—Goal-directed = logical coherent, easy to follow (normal).[straight line]
—Circumstantially = Patient strays from the point but eventually returns [arc]
—Tangentiality = Patient gets derailed from the topic, never to return. [straight line to wrong end]
—Flight of Ideas = Patient moves quickly from one thought to another (rapid ideas, but thin thread of direction) [disorganized; ∆ prompted by distracting stimulus; thread connecting thoughts still]
—Loosening of Associations = disconnections between thoughts (usually unrelated thoughts; the more you ask, the worse the loosening
—Thought blocking = Interruption in the train of thought before an idea is finished.
—Perseveration = Persistent repetition of words, phrases, or sentences in a relatively meaningless way.
Assessing [4b] Thought content (define possible responses)
PREOCCUPATIONS: obsessions, phobias, suicidal/homicidal ideation, ruminations
DELUSIONS = fixed, false beliefs:
±Paranoid (persecutory): “The F.B.I. is after me”
±Grandiose: “I am the President”
±Referential: “The television is sending me messages”
±Somatic: “My heart is gone”
±Thought Broadcasting: “My thoughts are being announced over the paging system”
±Thought Insertion: “Someone is making me think about hurting my mother”
Assessing [5] Perceptions
—Define types and common causes thereof
HALLUCINATIONS = sensory perceptions in the absence of any external sensory stimulus. Hearing —voices = schizophrenia
—tactile = drug/neuro-related
—olfactory/gustatory usually neuro/I.D.-related
ILLUSIONS = perceptions based on the misperception of a benign or irrelevant sensory impulse.
DEPERSONALIZATION: feeling of having lost one’s sense of personal identity; feeling strange or unreal
DEREALIZATION: feeling that the environment around one is strange or unreal
Assessing [6] Cognition: skeleton + tools?
a) orientation
b) attention/concentration
c) memory
d) visuospatial ability
e) abstraction
f) insight/judgement
**Can use MoCA or MMSE
Assessing [6a] Cognition -> orientation
Time? Place? Person? Situation?
Assessing [6b] Cognition -> attention/concentration
- Attention: The ability to focus and direct cognitive processes: Digit Span test
- Concentration: Ability to sustain attention. Tests: serial 7’s; spell WORLD backwards
Assessing [6c] Cognition -> memory
- Registration = immediate storage/recall (recall 3 words)
- Short-Term: temporary (sec-mins) (recall words after 2-5 mins)
- Long-Term:
—recent (hours-days)
—remote (months-yrs)
—semantic (general knowledge)
—episodic (personal events)
Assessing [6d] Cognition -> visuospatial ability
clock test; connect letters/numbers
Assessing [6e] Cognition -> abstraction
similarity test, proverb interpretation
Assessing [6f] Cognition -> insight/judgement
Insight = knowledge involved in decision or process
—e.g. does pt have insight into their illness?
Judgment = opinion or conclusion arrived at
—”What would you do if…?”
MoCA Score concerning?
<26/30 → further evaluation
