Beh Med - Mental Status Examination

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