Beh Med - Mental Status Examination

Jun Ostrea, M.D. University of Santo Tomas Hospital Department 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 General Description Mood and Affect Speech Characteristics Perception Thought Content and Mental Trends Sensorium and Cognition Impulsivity Judgment and Insight 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 illness 2. 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