Mental Status Exam

Question 1

Why do we do Mental Status Exams?

Answer 1

• Provides information for diagnosis and assessment of disorder and response to tx
• Provides a snap shot at a point in time
• Allows other providers to determine if patient status has changed

Question 2

Components of the MSE?

Answer 2

Appearance
Behavior
Speech
Mood
Affect
Thought process
Thought content
Cognition
Insight/Judgment

Question 3

Appearance

Answer 3

What do you see?
Build, posture, dress, grooming, physical abnormalities
Alertness (somnolent, alert)
Facial expression
Attitude toward examiner (cooperative, uncooperative)

Question 4

Behavior

Answer 4

Eye contact (poor, good, piercing)
Psychomotor activity (retardation, agitation, hand wringing)
Movements (tremor, abnormal movements, gait)

Question 5

Speech

Answer 5

Rate (increased, decreased, pressured, monosyllabic, latency)
Rhythm (articulation, prosody, dysarthria, monotone, slurred)
Volume (loud, soft, mute)
Content (fluent, loquacious, paucity, impoverished)

Question 6

Mood

Answer 6

Prevalent emotional state

Often placed in quotes

Question 7

Affect

Answer 7

Emotional state we observe
Type (euthymic, dysphoric, euphoric, anxious)
Range (full, restricted, blunted, flat, labile)
Congruency (does it match the mood)
Stability (stable, labile)

Question 8

Thought process

Answer 8

Rate of thoughts, how they flow and are connected
Normal: tight, logical and linear, coherent and goal directed
Abnormal: associations are not clear, organized, coherent

Question 9

Circumstantial

Answer 9

Provide unnecessary detail but eventually get to the point

Question 10

Tangential

Answer 10

Move from thought to thought that relate in some way but never get to the point

Question 11

Loose

Answer 11

Illogical shifting between unrelated subjects

Question 12

Flight of ideas

Answer 12

Quickly moving from one ideas to another (seen with mania)

Question 13

Thought blocking

Answer 13

Thoughts are interrupted

Question 14

Perseveration

Answer 14

Repetition of words, phrases, or ideas

Question 15

Word salad

Answer 15

Randomly spoken words

Question 16

Thought content

Answer 16

Themes that occupy patient’s thoughts and perceptual disturbances

Question 17

Preoccupations

Answer 17

Suicidal or homicidal ideation, perseverations, obsessions, or compulsions

Question 18

Illusions

Answer 18

Misinterpretations of environment

Question 19

Ideas of reference

Answer 19

Misinterpretation of incidents and events in the outside world having direct personal reference to the patient

Question 20

Hallucinations

Answer 20

False sensory perceptions e.g. auditory, visual, tactile, olfactory

Question 21

Derealization

Answer 21

Outer environment feels unreal

Question 22

Depersonalization

Answer 22

Sensation of unreality concerning oneself or parts of onseself

Question 23

Delusions

Answer 23

Fixed, false beliefs firmly held in spite of contradictory evidence

Question 24

Types of delusions (6)

Answer 24

• Control: outside forces are controlling actions
• Erotomanic: a person, usually of higher status, is in love with the patient
• Grandiose: inflated sense of self-worth, power, or wealth
• Somatic: patient has a physical defect
• Reference: unrelated events apply to them
• Persecutory: others are trying to cause harm

Question 25

Cognition

Answer 25

Level of consciousness

Includes attention and concentration, memory, abstraction (proverb interpretation), mini-mental state exam

Question 26

Folstein Mini-Mental State Exam

Answer 26

30 item screening tool
Useful for documenting serial cognitive changes and impairment
Document what was missed, not just the total score

Question 27

Insight/Judgment

Answer 27

Insight: awareness of one’s own illness and/or situation
Judgment: the ability to anticipate the consequences of one’s behavior and make decisions to safeguard your well being and that of others