Mental status exam

Question 1

Cognition

Answer 1

o Refers to processes like memory, attention, language comprehension and production, sensory perception, and executive function
o Ex disorders: dementia, delirium

Question 2

Emotion

Answer 2

o Complex feeling states with psychological, somatic, and behavioral components that guide adaptive behavioral responses and decision-making
o Ex disorders: mood disorders (major depressive disorder, bipolar disorder); anxiety disorders (PTSD)

Question 3

Behavior

Answer 3

o Arise from interplay of motivations, cognitive processes and emotional state

Question 4

Explain the biological, psychological, and social contributions to psychiatric illness, as described by the biopsychosocial model.

Answer 4

•	Model postulates that illness arises from complex interplay between 3 factors: 
1) Biological factors:
o	Genetic predisposition 
o	In utero exposure
o	Temperament
o	Head trauma
o	Use of drugs and alcohol
o	Cerebrovascular disease
o	Neurodegeneration 

2) Psychological factors:
o	Childhood development
o	Personality traits
o	Coping style
o	Defense mechanisms
o	Self-image and identity 
o	Psychological trauma 
o	Relationships with others

3) Social and cultural factors
o	Current stressors
o	Support system
o	Spiritual beliefs
o	Cultural influences

Question 5

Mood vs. Affect

Answer 5

Mood = subjective experience of an emotion (what the patient describes to you)
o “Sad, mad, glad, scared”
o Alexithymia = difficulty describing mood

Affect = outward manifestation of an emotion (what you see)
o Content: euthymic (normal, non-depressed mood), dysphoric (feeling unwell or unhappy), anxious, irritable, angry, elated, euphoric
o Congruent or incongruent = does affect match the stated mood?
o Range: full, restricted, flat
o Intensity: blunted or intense
o Consistent: labile or not

Question 6

Thought processes vs content

Answer 6

Thought processes
o Normally = logical, linear, goal-directed
o Tangential
o Circumstantiality (indirect and delayed responses in reaching goal)
o Loosening of associations:
= Flight of ideas = loosened associations with pressured speech
= Thought blocking or derailment = sudden disruption of thought process
o Preservation = repeats phrases or questions
o Thought poverty = little or no spontaneous speech

Thought content

Suicidal ideation:

1. No Passive suicidal ideation (SI)
2. Passive SI
3. Active SI, with intent to harm self
4. Active SI, with intent and plan to harm self
5. Active SI, with intent, plan, and means to harm self

Homicidal ideation 
Hallucinations 
•	Auditory (including command AH)
•	Visual 
•	Tactile, olfactory, gustatory 
Delusions
•	Persecutory or paranoid
•	Grandiose
•	Religious 
•	Somatic (belief that body is diseased or abnormal)

Question 7

Recognize specific abnormalities of the mental status examination and their associated psychiatric diagnoses = Appearance

Answer 7

o Track marks on arms = IV drug use
o Pinpoint pupils = opiate use
o Spider angiomata = hepatic disease due to chronic alchohol use
o Masked facies = parkinsonism
o Evidence of self-harm
o Poor grooming = depressive disorder, psychotic disorder, dementia
o Provocative clothing, make-up = hypomania, mania
o Odd or inappropriate clothing = schizophrenia
o Older than stated age = chronic mental illness, long-standing substance abuse, chronic medical illness

Question 8

Recognize specific abnormalities of the mental status examination and their associated psychiatric diagnoses = Behavior

Answer 8

o Abnormal involuntary movements = neurological disorder (Parkinson’s disease), medication side effects (antipsychotic medications, tremor due to lithium) or severe psychiatric states
• Includes: tremor, tic, dyskinesia (slower movements), rigidity, waxy flexibility (patient is awake, not normally responsive, and maintains postures into which they’ve been placed), posturing (assuming bizarre posture), stereotypy (purposeless, repetitive movement)
o Psychomotor retardation, poor eye contact, tearful = depressive disorder
o Psychomotor agitation, intense eye contact = hypomania or mania
o Restlessness, panicky, startled, shifting eye movements = anxiety disorder
o Rigid, waxy flexibility, posturing = catatonia (severe manifestation of mood or psychotic disorder)

Question 9

Recognize specific abnormalities of the mental status examination and their associated psychiatric diagnoses = Speech

Answer 9

o	Slow, monotonous, soft, latent = depression 
o	Pressured (rapid and difficult to interrupt) = mania
o	Dysarthic, halting = neurological disorder

Question 10

Recognize specific abnormalities of the mental status examination and their associated psychiatric diagnoses = thought processes

Answer 10

o Thought disorganization = schizophrenia
o Flight of ideas = mania
o Thought blocking = psychosis
o Preservation = dementia, psychosis
o Thought poverty = severe depression, psychosis, dementia

Question 11

Recognize specific abnormalities of the mental status examination and their associated psychiatric diagnoses = Thought content

Answer 11

o SI: major depressive disorder, bipolar disorder, psychotic disorders, personality disorders, substance use disorders
o Auditory hallucinations = schizophrenia, psychotic disorders, mood disorders
o Visual hallucinations = dementia, delirium, substance intoxication or withdrawal; also in psychotic disorders and mood disorders
o Tactile hallucinations = “bugs crawling” in alcohol withdrawal syndrome
o Olfactory hallucinations = smell of burning in temporal lobe epilepsy
o Persecutory and paranoid delusions = schizophrenia, other psychotic disorders; also in major depressive disorders, dementia
o Grandiose delusions = schizophrenia, manic

Question 12

Recognize specific abnormalities of the mental status examination and their associated psychiatric diagnoses = Insight and judgment

Answer 12

o Lack of insight = psychotic disorders, dementia, delirium, severe mood disorders

Question 13

Define psychotherapy.

Answer 13

Way to treat people by helping them understand mental disorder and teach strategies and tools to manage disorder

Considered to have 2 parts:
o Technical: focuses on behavioral “problem solving”
o Relationship: focuses on healing = Provides context for change (makes problem solving possible) and direct mechanism of change (corrective experience)

Question 14

List the major types of psychotherapies

Answer 14

• Cognitive behavioral therapy (CBT)
• Dialectical behavior therapy
• Interpersonal therapy
• Family-focused therapy

Question 15

Cognitive behavioral therapy (CBT)

Answer 15

o CT = Focuses on thoughts and beliefs and how influences a person’s mood and actions; aims to change person’s thinking to be more adaptive
o BT = focuses on person’s actions; aims to change unhealthy behavior patterns
o Overall: patient learns to identify unhelpful thinking patterns, recognize & change inaccurate beliefs, better relate to others, and change behaviors

Uses: many mental disorders
• Depression
• Anxiety disorders (may involve exposure therapy)
• Bipolar disorder (in combo with mood stabilizer)
• Eating disorders = reduce relapse
• Schizophrenia (in combo with medication to help cope)

Question 16

Dialectical behavior therapy

Answer 16

o Multidimensional: mindfulness, interpersonal effectiveness, emotional regulation, and distress tolerance
o Two opposing views are discussed until logical blending or balance is found
o Emphasizes patient-therapist relationship
o Used: borderline personality disorder

Question 17

Interpersonal therapy

Answer 17

o Helps identify how patient interacts with others and helps guide patient to change problem-causing behavior
o Patient identifies troubling emotions and triggers, then learns to express emotions in healthy way
o Used: depression or dysthymia

Variation: interpersonal and social rhythm therapy
• Treat bipolar disorder
• Combines interpersonal therapy with behavioral psychoeducation
• Helps patients adopt regular schedules/routines, stick with medications, and improve relationships

Question 18

Family-focused therapy

Answer 18

o Assumption = relationship with family is vital to success of illness management
o Includes family in therapy sessions to improve relationships and help find better ways to resolve conflicts/difficulties → supports better treatment results
o Helps educate and support family members
o Used: bipolar disorder