Mental Status Exam

Question 1

What is a mental status exam?

Answer 1

A mental status exam is the objective description of the patient’s current state.

Question 2

What are the 7 parts of the mental status exam?

Answer 2

1) General description
2) Speech
3) Mood and affect
4) Thought Process/structure of thoughts
5) Thought Content
6) Cognition
7) Insight/judgement

Question 3

What descriptors/notes should be made regarding a patient’s “General Description”?

Answer 3

Include the patient’s general appearance AND behavior:

• Hygiene
• Expressions
• Psychomotor agitation/retardation
• Mannerisms/Tics
• Catatonia
• Attitude toward examiner

Question 4

What aspects of speech should be noted in a mental status exam?

Answer 4

Note these aspects of speech:

• Pressured?
• Long/latent in response
• Volume
• Idiosyncrasies of speech

Question 5

How are mood and affect observed?

Answer 5

• Mood is the overall feeling tone => subjectively experienced
• Affect is how the patient expresses their feelings => objectively observed

Question 6

What are variations in affect?

Answer 6

• Blunted
• Flat
• Labile
• Inappropriate
• Mood congruent

Question 7

What is a goal directed thought process?

Answer 7

A goal directed thought process is interpreted as “normal”

• logical
• coherent
• easy to follow

Question 8

What is a loosening of associations (in regards to thought process)?

Answer 8

A loosening of associations represents a disconnection between thoughts. It usually represents unrelated thoughts

Question 9

What is considered a flight of ideas?

Answer 9

When a patient exhibits a flight of ideas, they move quickly from one thought to another.
- The ideas are rapid but also thinly spread in direction

Question 10

In regards to thought process, what is “circumstantial” thinking?

Answer 10

When a patient speaks circumstantially they stray from a point but eventually return to the original point

Question 11

What is considered tangential thinking?

Answer 11

The patient gets derailed from the topic and never returns to the original question

Question 12

In regards to thought process, what occurs in “thought blocking”?

Answer 12

During thought blocking, a train of thought is interrupted before an idea is finished

Question 13

In terms of thought process, what is “preservation”?

Answer 13

Preservation is the habit of persistently repeting words, phrases, or sentences in a relatively meaningless manner

Question 14

What is a delusion?

Answer 14

Delusions are fixed, false beliefs which are not those generally held by society or subculture

Question 15

What are various forms of delusion?

Answer 15

• Paranoid
• Grandiose
• Referential
• Somatic
• Thought Broadcasting
• Thought Insertion

Question 16

What is an example of a paranoid delusion?

Answer 16

“The FBI is after me”

Question 17

What is an example of a grandiose delusion?

Answer 17

” I am the president”

Question 18

What is an example of a referential delusion?

Answer 18

‘The television is sending me messages”

Question 19

What is an example of a somatic delusion?

Answer 19

“My heart is gone”

Question 20

What is an example of a thought broadcasting delusion?

Answer 20

“My thoughts are being announced over the paging system”

Question 21

What is an example of a thought insertion delusion?

Answer 21

“Someone is making me think about hurting my mother.”

Question 22

Define “hallucination”.

Answer 22

A hallucination is sensory perception in the absence of any external sensory stimulus

• Auditory, Visual, Tactile, Gustatory, Olfactory
• Hearing voices is the most common hallucination among people with schizophrenia

Question 23

Define “illusion”.

Answer 23

An illusion is a perception based on the misperception of a benign or irrelevant sensory impulse

Question 24

Define depersonalization.

Answer 24

Depersonalization is the feeling of having lost one’s sense of personal identity
- Feeling strange or unreal

Question 25

Define derealization.

Answer 25

Derealization is the feeling that the environment around oneself is strange or unreal

Question 26

What is the purpose of the MOCA or MMSE?

Answer 26

The MOCA, MMSE, or other similar exams test cognition => only one part of the mental status exam

• MOCA score <26 requires further evaluation

Question 27

What do cognition exams test?

Answer 27

• Orientation (time, place, person)
• Attention and concentration
• Memory

Question 28

How can attention be tested?

Answer 28

Digit span test => give the patient a progressively elongating list of numbers to recite

Question 29

How can concentration be tested?

Answer 29

• Serial sevens

- Spell WORLD backwards

Question 30

How is short term memory tested?

Answer 30

Recall words after 1-5 minutes

Question 31

How is constructional ability (visualspatial/visuomotor functions) tested?

Answer 31

• Figure drawing

- Clock test

Question 32

How is the ability for abstraction tested?

Answer 32

• Similarity test

- Proverb interpretation

Question 33

Define insight.

Answer 33

Insight is considered knowledge involved in a decision/process
- ie Insight into one’s own illness

Question 34

Define judgement.

Answer 34

Judgement is an opinion or conclusion the patient arrives at

Question 35

Define psychomotor agitation

Answer 35

Motor restlessness: agitation may be the external, motoric manifestation of emotional state
- e.g. anxiety, psychosis.

Question 36

Define psychomotor retardation.

Answer 36

Body is slowed down

- Possibly due to e.g. depression

Question 37

What major points should be noted when observing a patient’s thought content?

Answer 37

• Suicidal Ideation
• Homicidal ideation
• ## Delusions

Question 38

How is long term memory tested?

Answer 38

Long term memory is tested by asking about “general” knowledge.
- Ie Name the last 4 presidents