Transcript
Jun Ostrea, M.D.University of Santo Tomas
HospitalDepartment of Neurology &
Psychiatry
Mental Status Examination
Describes the sum total of the examiner’s
observations and impressions of the
psychiatric patient at the time of the interview
Sections of Mental Status Examination
1. General Description2. Mood and Affect3. Speech Characteristics4. Perception5. Thought Content and Mental Trends6. Sensorium and Cognition7. Impulsivity8. Judgment and Insight9. Reliability
General Description
Appearance- overall physical impression Gait, dress, grooming, posture, gestures,
facial expression, etc. Overt Behavior and Psychomotor
Activity Agitation, retardation, tremors, posture, eye
contact, scanning attitude, etc. Attitude Toward Examiner- level of
rapport established Irritable, aggressive, seductive, guarded,
defensive, apathetic, cooperative, etc
Mood and Affect
Mood Pervasive and sustained emotion that colors
the person’s perception of the world. Steady or sustained emotional state.
Gloomy, tense, hopeless, elated, depressed, fearful, suicidal, grandiose, etc.
Affect Present emotional responsiveness, inferred
from facial expression. Labile, blunt, flat, inappropriate,
Speech Characteristics
Quantity Rate of production Quality.
Slow, fast, pressured, spontaneous, stammering, staccato, aphasia, coprolalia, echolalia, incoherent, mute,
Perception
Disturbances: Hallucinations Illusions Depersonalization Derealization Formication
• Sensory system involved and content must be described
Thought Content and Mental Trends
Process/Form: way in which a person puts ideas and associations, the form in which a person thinks.
Content: what the person is actually thinking about (ideas, beliefs, preoccupations, obsessions, delusions)
Thought Content and Mental Trends Thought Process
Loosening of associations or derailment Flight of ideas Racing thoughts Tangentiality Circumstantiality Word salad or incoherence Neologisms Clang associations Thought blocking Vague thought
Thought Content and Mental Trends Content of Thought
Delusions Paranoia Preoccupations Obsessions and compulsions Phobias Suicidal or homicidal ideas Ideas of reference and influence Poverty of content
Sensorium and Cognition
Assesses brain function including intelligence, capacity for abstract
thought, and level of insight and judgment
Sensorium and Cognition
Mini-Mental State Examination Brief instrument to grossly
assess orientaion, memory, calculations, reading and writing capacity, visuospatial ability, and language
Quantitative Perfect score is 30
Sensorium and Cognition
Consciousness Orientation and Memory Concentration and Attention Reading and Writing Visuospatial Ability Abstract Thought Information and Intelligence
Sensorium and Cognition
Consciousness Disturbance usually indicate
organic brain impairment Clouding Of Consciousness:
overall reduced awareness of the environment
Altered state of consciousness
Sensorium and Cognition
Orientation According to time, place, and
person What is your name? Who am I? What place is this?
Sensorium and Cognition
Memory Immediate: digit span Recent: past few days Recent Past: past few months Remote: childhood, personal
matters
Sensorium and Cognition
Concentration Subtracting serial 7s or 3s from 100
Attention- Calculations- Spell backward- Naming five things that start with a particular letter
Sensorium and Cognition
Reading and Writing Ask to read a sentence and do what the sentence says
Ask to write simple but complete sentence
Sensorium and Cognition
Visuospatial Ability Ask to copy a figure
Sensorium and Cognition
Abstract Thought Ability to deal with concepts Are meanings of simple proverbs
understood? Ask to explain similarities between an
apple and a pear.
Sensorium and Cognition
Information and Intelligence Vocabulary Fund of knowledge Educational level and socioeconomic
status must be taken into account Handling difficult concepts can reflect
intelligence , even in the absence of formal education or extensive fund of information
Impulsivity
Is the patient capable of controlling sexual, aggressive, and other impulses
Critical in ascertaining the patient’s awareness of socially appropriate behavior
Measure of the patient’s potential danger to self and others
Judgment and Insight
Judgment Does the patient understand the likely
outcome of his or her behavior?
Is he or she influenced by this understanding?
Can the patient predict what he or she would do in imaginary situations?
Judgment and Insight
Insight Degree of awareness and
understanding about being ill
Judgment and Insight
Six Levels of Insight
1. Complete denial of illness2. Slight awareness of being sick
and needing help but denying it at the same time
3. Awareness of being sick but blaming it on others, external factors, or organic factors
Judgment and Insight
4. Awareness that illness is due to something unknown in the patient
5. Intellectual Insight: admission that the patient is ill and that symptoms or failures in social adjustment are due to patient’s own irrational feelings without applying this knowledge to future experiences
Judgment and Insight
6. True Emotional Insight: emotional awareness of motives and feelings within the patient and the important persons in his or her life, which can lead to basic changes in behavior
Reliability
Includes an estimate of the psychiatrist’s impression of the patient’s truthfulness or veracity
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