4. Mental Status Exam

Question 1

What is Mental Status? what is it analogous to?

Answer 1

objective description of the patient’s current state. akin to the physical exam. NOT a history.

Question 2

what are the 7 categories covered in the mental status exam?

Answer 2

general description
speech
mood and affect
thought process
thought content
cognition
insight/judgment

Question 3

what is involved in the General Description?

Answer 3

• appearance (clothing, hygeine, grooming, physical health, appropriateness of appearance)
• behavior (facial expressions, psychomotor agitation or retardation
• movements (mannerisms and tics, catatonia)
• attitude toward examiner (cooperative, hostile, paranoid)

Question 4

what could be the cause of psychomotor agitation?

Answer 4

mania, ADD, drug use

Question 5

what could be the cause of psychomotor retardation?

Answer 5

schizophrenia, depression, drug use

Question 6

what could be the cause of abnl, bizarre movements?

Answer 6

side effects, hallucinations

Question 7

what are the things we pay attention to with speech?

Answer 7

rate, volume, idiosyncrasies

Question 8

what is Mood?

Answer 8

overall feeling, as experienced by the pt. use pt’s own words if possible.

Question 9

what is Affect?

Answer 9

the objective observation of how the patient is feeling. may be described as flat, blunted, labile, full, inappropriate, congruent

Question 10

what does labile mean?

Answer 10

unstable/fluctuating affect

Question 11

what does an inappropriate affect mean?

Answer 11

inappropriate response to circumstance ie laughing while describing sad events

Question 12

what does a congruent affect mean?

Answer 12

appropriate to the stated mood, ie a depressed person appears depressed

Question 13

what are the different types of Thought Processes we may find?

Answer 13

1. Goal-directed
2. circumstantial
3. tangential
4. flight of ideas
5. loosened associations

Question 14

what does a circumstantial thought process look like?

Answer 14

straying from the point but eventually returning

Question 15

what does a tangential thought process look like?

Answer 15

gets derailed from the topic, never to return.

Question 16

what does a ‘flight of ideas’ thought process look like?

Answer 16

moving quickly from one idea to another, with some connection between the thoughts

Question 17

what does a ‘loosened associations’ thought process look like?

Answer 17

jumping from thought to thought without connections between them

Question 18

what are some Thought Contents we pay attention to?

Answer 18

• suicidal ideation/intent/plan
• homocidal ideation/intent/plan/victim
• delusions
• perceptual disturbances

Question 19

what are a few types of delusions?

Answer 19

FIXED false beliefs which are not generally held.

• paranoid (FBI out to get me)
• grandiose (i am the president)
• referential (the TV is sending me messages)
• somatic (my liver is sick)
• thought broadcasting (my thoughts are being announced)
• thought insertion (someone is controlling my thoughts)

Question 20

what are a few types of perceptual disturbances?

Answer 20

hallucinations, illusions

Question 21

how do we test cognition?

Answer 21

use specific tools or questions, very directed

Question 22

how do we test orientation?

Answer 22

questions about time, place, person.

Question 23

how do we test attention?

Answer 23

use a digit span (say 3 digits and have pt repeat)

Question 24

how do we test concentration?

Answer 24

ability to sustain attention. can use subtracting sevens from 100, spell WORLD backwards, days of week backwards

Question 25

what are the 5 types of memory we test for?

Answer 25

• registration (immediate recall)
• short term (seconds to minutes)
• long term (recent, like cramming, or remote, very long term)
• constructional ability
• abstraction

Question 26

how would we test registration?

Answer 26

immediate recall of 3 words

Question 27

how would we test short term memory?

Answer 27

recall of 3 words 5 min after hearing them

Question 28

how would we test long term memory?

Answer 28

semantic: general knowledge. name the last 4 presidents

episodic (more tightly held/personal): facts from a person’s life

Question 29

how would we test constructional ability?

Answer 29

involves visuospatial and visuomotor skills. have them draw an analog clock at 2:30.

Question 30

how would we test for abstraction ability?

Answer 30

ask how is a dog similar to a tree? (they are both alive)

ask them to interpret a proverb (what do we mean by ‘dont cry over spilled milk’?

Question 31

how do we test for insight/judgment?

Answer 31

reasoning capabilities: what would you do if….

Question 32

what is good about the MOCA?

Answer 32

widely used, good inter-rater reliability

Question 33

what is bad about the MOCA?

Answer 33

only tells you that there is a problem, not what it is. somewhat depends on a person’s education level