Mental Status Exam-Gardner

Question 1

What is the mental status exam?

Answer 1

The Mental Status Exam (MSE) is the psychological equivalent of a physical exam.

• Describes the mental state and behaviors of the person being seen.
• It includes both objective observations of the clinician and subjective descriptions given by the patient.

Question 2

T/F MSE can provide helpful info for comparison to gauge improvement or worsening.

Answer 2

True.

Question 3

What are some patient hx things needed in an MSE?

Answer 3

education
cultural
social factors
**need to know what is normal for this patient. Ex: fast talking is normal.

Question 4

What are the categories of the MSE?

Answer 4

Observations
Mood
perceptions
thoughts
behaviors
insight
judgment
cognition

Question 5

What do you observe in the MSE?

Answer 5

appearance
speech
eye contact
motor activity
affect

Question 6

What are some appearances you observe?

Answer 6

well groomed
neat
good hygiene
OR
adequate
OR disheveled, inappropriate, poor hygiene

Question 7

What are some speeches things you will observe?

Answer 7

regular rate & rhythm

rate: regular, increased/pressured, decreased
rhythm: articulation, prosody, dysarthria, monotone (autism), slurred (Intoxicated)
volume: loud, soft, mute

Question 8

What do you observe with eye contact?

Answer 8

Normal: good, appropriate,
in b/w: intermittent
Bad: poor (autism), intense (schizophrenia)

Question 9

What do you observe with motor activity?

Answer 9

normal motor activity & gait

psychomotor agitation or retardation, tics, restless, akathesia

Question 10

What is akathesia?

Answer 10

can be a side effect of antipsychotics

pt feels like they can’t stop moving their feet

Question 11

What do you observe with affect?

Answer 11

the clinician judges their emotional state

type: euthymic, dysphoric, euphoric, anxious
range: full (normal); restricted, blunted or flat, labile
congruency: does it match the mood
stability: stable or labile (up & down & all around)

Question 12

What is euthymic, dysphoric, euphoric?

Answer 12

euthymic: normal mood
dysphoric: depressed, irritable, angry
euphoric: elevated, elated

Question 13

When do you see labile stability of affect?

Answer 13

in personality disorders

in bipolar disorder

Question 14

How do you report mood in the MSE?

Answer 14

what the patient reports, not what you think
their statement of their emotional state
use quotes
can use 1/10

Question 15

How do you report perceptions in MSE?

Answer 15

how are they perceiving their reality
normal: no illusions or hallucinations
could be: preoccupations, illusions, ideas of reference (TV talking to me), auditory or visual hallucinations, derealization

Question 16

How do you determine thought content on MSE?

Answer 16

refers to the themes that occupy the patient’s thoughts
suicidal ideation
homicidal ideation
delusions
Normal: no suicidal or homicidal ideation. no delusional thinking.

Question 17

How should you specify suicidal & homicidal ideation?

Answer 17

active (i want to die), passive (i wish sorta that I would die), plan, intent

Question 18

What are examples of delusions?

Answer 18

grandiose
paranoid
religious

Question 19

How do you report thought process in the MSE?

Answer 19

rate of thoughts, how they flow & are connected.
Normal: tight, logical, linear, coherent, goal directed
Abnormal: associations unclear, organized, coherent. Ex: circumstantial, tangential, loose, flight of ideas, word salad, thought blocking

Question 20

What is circumstantial thought process?

Answer 20

round about way of getting to the point.

I will tell you about my whole morning & then tell you what you asked.

Question 21

What is tangential thought process?

Answer 21

you ask them a question. They go off on a tangent & never get to the question.

Question 22

What is loose thought process?

Answer 22

they kinda make sense but don’t really put ideas together

Question 23

What is flight of ideas?

Answer 23

random ideas one after another usually in mania or schizophrenia

Question 24

What is word salad?

Answer 24

put random words together

Question 25

What is thought blocking?

Answer 25

distracted from your question by the voices in their head (internal stimuli). May answer you after a long pause.

Question 26

How do you describe behavior on the MSE?

Answer 26

normal: calm & cooperative
abnormal: guarded, hyperactive, irritable (not motor agitation but attitude). aggressive, hostile, uncooperative, vague.

Question 27

How do you describe insight & judgment on the MSE?

Answer 27

insight: awareness of their illness or a situation
judgment: the ability to anticipate consequences of one’s behavior & make decisions to safeguard their well begin & that of others
Descriptive range: good, fair, poor

Question 28

How do you describe memory & concentration in the MSE?

Answer 28

assess level of consciousness
orientation
memory/attention

Question 29

Orientation?

Answer 29

time, place, person

description: alert & oriented X3

Question 30

Memory/attention?

Answer 30

can be determined by interview
or can ask them to spell world backwards
memory: remember 3 objects
abstractions: proverb interpretation

Question 31

What does the MMSE or Folstein do?

Answer 31

assesses cognition, a small part of the MSE.
30 item screening tool.
documents serial cognitive changes.
score it.

Question 32

What is constricted affect?

Answer 32

no range because so sad.