Mental Status Exam (JAM BATTS PIC)

Question 1

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Answer 1

Judgment

refers to the patient’s capacity to make sound, reasoned and responsible decisions. One should frame judgement to the functions or domains that are normal vs impaired. (I.e. poor judgement is isolated to petty theft, able to function in relationships, work, academics.)

Question 2

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Answer 2

Attitude:

also known as rapport or cooperation,[17] refers to the patient’s approach to the interview process and the quality of information obtained during the assessment

Question 3

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Answer 3

Mood/affect

Mood is described using the patient’s own words, and can also be described in summary terms such as neutral, euthymic, dysphoric, euphoric, angry, anxious or apathetic. Alexithymic individuals may be unable to describe their subjective mood state. An individual who is unable to experience any pleasure may be suffering from anhedonia.

Affect is described by labelling the apparent emotion conveyed by the person’s nonverbal behavior (anxious, sad etc.), and also by using the parameters of appropriateness, intensity, range, reactivity and mobility. Affect may be described as appropriate or inappropriate to the current situation, and as congruent or incongruent with their thought content.

Question 4

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Answer 4

Behavior

Abnormalities of behavior, also called abnormalities of activity, include observations of specific abnormal movements, as well as more general observations of the patient’s level of activity and arousal, and observations of the patient’s eye contact and gait.

Question 5

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Answer 5

Appearance

including apparent age, height, weight, and manner of dress and grooming. Colorful or bizarre clothing might suggest mania, while unkempt, dirty clothes might suggest schizophrenia or depression. If the patient appears much older than his or her chronological age this can suggest chronic poor self-care or ill-health. Clothing and accessories of a particular subculture, body modifications, or clothing not typical of the patient’s gender, might give clues to personality. Observations of physical appearance might include the physical features of alcoholism or drug abuse, such as signs of malnutrition, nicotine stains, dental erosion, a rash around the mouth from inhalant abuse, or needle track marks from intravenous drug abuse. Observations can also include any odor which might suggest poor personal hygiene due to extreme self-neglect, or alcohol intoxication.[15] Weight loss could also signify a depressive disorder, physical illness, anorexia nervosa or chronic anxiety.

Question 6

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Answer 6

Thought process: quantity, tempo (rate of flow) and form (or logical coherence) of thought.

Note:

normal vs. formal thought disorders (thought blocking, fusion, loosening of associations, tangential thinking, derailment of thought, or knight’s move thinking)

Circumstantial: patient includes a great deal of irrelevant detail and makes frequent diversions, but remains focused on the broad topic

Tempo (flight of ideas, vs. retarded or inhibited thinking)

Poverty of thought.

Thought perseveration (keep coming back to same set of limited ideas)

Question 7

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Answer 7

Thought Content: describes a patient’s suicidal thoughts, depressed cognition, delusions, overvalued ideas, obsessions, phobias and preoccupations. One should separate the thought content into pathological thought, versus non-pathological thought. Importantly one should specify suicidal thoughts as either intrusive, unwanted, and not able to translate in the capacity to act on these thoughts (mens rea), versus suicidal thoughts that may lead to the act of suicide (actus reus).

Question 8

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Answer 8

Speech

noting and commenting on paralinguistic features (volume, pitch, rate of speech, pitch, intonation, etc.

Question 9

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Answer 9

Perception

hallucinations, depersonalization (distortion in sense of self), derealization (distortion in sense of reality)

Question 10

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Answer 10

Insight

The person’s understanding of his or her mental illness is evaluated by exploring his or her explanatory account of the problem, and understanding of the treatment options.

three components: recognition that one has a mental illness, compliance with treatment, and the ability to re-label unusual mental events (such as delusions and hallucinations) as pathological

Question 11

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Answer 11

Cognition: patient’s level of alertness, orientation, attention, memory, visuospatial functioning, language functions and executive functions.