Mental Status Exam

Question 1

List the major categories of the mental status examination.

Answer 1

1. General Description
   2. Speech
   3. Mood and Affect
   4. Thought Process
   5. Thought Content
   6. Cognition
   7. Insight/Judgment

Question 2

What are the components of the General Description? What criteria are used to characterize each?

Answer 2

APPEARANCE
→Clothing; hygiene; grooming; apparent physical health; notable physical characteristics; overall appropriateness of appearance.
• Mania: dramatic change in attire
• Hygiene: malodorous, black teeth, coffee stains on shirt, excessive cologne (think about cultural norms)

→Apparent physical health

→Notable physical characteristics: lot of co-morbidities
• Single palmar crease- Down’s Syndrome
• Missing philtrum- fetal alcohol syndrome
• Large protruding ears -Fragile X

→Overall appropriateness of appearance

BEHAVIOR

(1) Facial expressions (or absence of), eye contact
• Yawning and sniffling- opiate withdrawal

(2) Psychomotor Activity

–> Psychomotor Agitation = Motor restlessness: agitation may be the external, motoric manifestation of emotional state; e.g. anxiety, psychosis.
→ schizophrenia, anxiety ,mania

–>Psychomotor Retardation = body is slowed down; e.g. depression, schizophrenia

(3) Abnormal, bizarre movements
• Skin-picking: drugs

–> Mannerisms and tics = repeated, purposeless movements (e.g., grimacing; orofacial dyskinesias, etc.

–> Catatonia = hypoactive to immobile; often with abnormal posturing.

(4) Attitude toward examiner
e. g., cooperative, hostile, uncooperative, argumentative

(5) Akathisia: restless leg syndrome, but entire body

Question 3

What criteria are used to characterize speech?

Answer 3

A. Rate. e.g., pressured speech, long response latency

B. Volume

C. Idiosyncrasies of speech

Question 4

What are the components of the Mood and Affect? What criteria are used to characterize each?

Answer 4

MOOD = overall feeling tone, primarily subjectively experienced, often in patient’s own words. may be described as depressed, anxious, angry, neutral (euthymic), elated, etc.

Present supporting statements from patient, if possible.

AFFECT= objectively observed. How the examiner perceived the patient to be feeling. May be described as:

[Emotion]

• -> Bizarre
• -> Suspicious
• -> Flat = absent expression of feeling
• -> Blunted = severely reduced expression of feeling
• -> Labile = unstable, rapidly fluctuating
• -> Full = displaying normal range of emotions.
• -> Inappropriate = e.g., laughing while describing sad events
• -> Congruent = depressed person appears depressed

Question 5

What are the components of the Thought Process? What criteria are used to characterize each?

Answer 5

Structure of thoughts/Association between words, phrases, ideas
Findings:

–>Goal-directed = logical, coherent, easy to follow (normal).

–>Loosening of Associations = disconnections between thoughts

–>Flight of Ideas = Patient moves quickly from one thought to another

–>Circumstantiality = Patient strays from the point but eventually returns

–>Tangentiality = Patient gets derailed from the topic, never to return.

–>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.

Question 6

What are the components of the Thought Content? What criteria are used to characterize each?

Answer 6

SUICIDAL IDEATION; intent, plan?

HOMOCIDAL IDEATION; intent, plan, intended victim?
Tarasoff ruling – duty to inform.

DELUSIONS; fixed, false beliefs which are not those generally held by society or subculture
Look for themes,
–>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”

PERCEPTUAL DISTURBANCES

1. Hallucinations;
   - ->sensory perceptions in the absence of any external sensory stimulus: Auditory, Visual, Tactile, Gustatory, Olfactory
2. Illusions
   - ->perceptions based on the misperception of a benign or irrelevant sensory impulse
3. Depersonalization
   - ->Feeling of having lost one’s sense of personal identity; feeling strange or unreal.
4. Derealization
   - -> Feeling that the environment around one is strange or unreal

Question 7

What are the components of Cognition? What criteria are used to characterize each?

Answer 7

A. Orientation:

• To time, place and person.
• Time orientation most sensitive to impairment; then place; finally personal identity.
• Disorientation common in delirium, moderate to severe dementia.

B. Attention and Concentration:

• Attention: The ability to focus and direct cognitive processes. If attention severely impaired, remainder of testing is unreliable or perhaps even impossible.
• Concentration: ability to SUSTAIN ATTENTION over a period of time. Can be impaired in a variety of conditions with intact attention (e.g., early Alzheimer’s disease; depression; anxiety, etc.) Also impaired with poor effort, uncooperativeness, etc.

Standard tests of concentration:

			- serial seven's	
			- spell WORLD backwards

C. Memory:

==> 1. Registration: The capacity for immediate recall of new learning, last only a few seconds
Standard test of registration:
Immediate recall of information (3 words)

==>2. Short-Term Memory:
Temporary; lasts few seconds to minutes. Also called “working memory”.

Standard test of short-term memory:
recall of 3 words after 1 to 5 minutes

==>3.Long –Term Memory:

Semantic: general fund of knowledge, e.g., name the last 4 presidents

Episodic: memorable events in the person’s life generally the best preserved

D. Constructional Ability:

==>Ability to draw, construct, or manipulate shapes and figures in two and three dimensions; Involves visuospatial and visuomotor functions

Standard tests: Figure drawing, clock drawing

E. Abstraction:

Standard tests of abstraction:
–> Similarities, “How are a ruler and a watch alike?”

–>Proverb interpretation, “The grass is always greener on the other side”

Question 8

What are Insight and Judgement?

Answer 8

Insight/Judgment:

Insight = knowledge involved in decision or process, e.g. insight into one’s illness

Judgment = opinion or conclusion arrived at

Question 9

What is alexathymia?

Answer 9

inability to describe one’s feelings– it’s a pattern

Question 10

What is the mental status examination?

Answer 10

the (relatively) objective description of the patient’s current state.

–>Objective = no interpretations or inferences drawn, just collecting data presented by the patient; give specific examples whenever possible to support your descriptions.

–>Current = not historical; only those signs and symptoms present now.
• not just a cognitive exam, A&O- alert and oriented

Analogous to physical examination in general medicine.