What are the 8 points of a mental status exam?
A Snake Moves Toward Prey Silently In Jungles
- Appearance, Attitude & Behavior
- Speech
- Mood & Affect
- Thought Form/Process & Content
- Perception
- Sensorium/Cognition
- Insight
- Judgment
Appearance, Attitude & Behavior
- Describe overall appearance, emphasizing abnormalities
- Describe attitude toward examiner
- Describe physical behavior
Speech
- Describe speech (not content of speech, but distinctive qualities of speech: rate, tone, rhythm, volume), emphasizing abnormalities
- Normal: “fluent, w/ normal rate, rhythm & volume”
Mood vs. Affect
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Mood – describes patient’s subjective, internal state of feeling
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Affect – describes patient’s objective, external appearance of feeling
- Normally, affect is an accurate reflection of mood
Describing the mood & affect of patients
- Mood & affect are normally congruent, but may be incongruent in some psychiatric syndromes
- Many terms can be used to describe mood & affect
- Euphoric, elated, depressed, hopeless, irritable, anxious, frightened, etc.
- Affect is appropriate when it “fits” w/ the patient’s situation & feelings
- Patients w/ psychotic disorders often have inappropriate affect
- Comment on range, intensity & appropriateness
- A normal state of mood & affect: “euthymic, appropriate, congruent”
- Euphoric, elated, depressed, hopeless, irritable, anxious, frightened, etc.
Thought Form/Process
- Thought form (process) describes how the patient is thinking
- Normal thought form: “logical, linear, goal-oriented”
What are the abnormalities of thought form? (9)
- Thought blocking
- Poverty of thought
- Circumstantiality
- Tangentiality
- Loose associations (derailment)
- Clang associations
- Neologisms
- Perseveration
- Flight of ideas
mind frequently goes blank
Thought blocking
very little thought occuring
Poverty of thought
takes a long time to get to the point
Circumstantiality
logical, but never gets to the point
Tangentiality
logical connections btwn thoughts break down
Loose associations (derailment)
thoughts are expressed through sounds rather than meaning
Clang associations
new words/phrases invented
Neologisms
being stuck on a single thought
Perseveration
rapid jumping from thought to thought (mania)
Flight of ideas
Thought content
Definition
Abnormalities (9)
- Thought content refers to what the patient is thinking
- Abnormal thought content needs to be explored & documented
- Delusions
- Ideas of reference
- Ideas of influence
- Obsessions
- Compulsions
- Phobias
- Hypochondriacal symptoms
- Thoughts of suicide
- Thoughts of violence
- Delusions
- Ideas of reference
- Ideas of influence
- Obsessions
- Compulsions
- Phobias
- Hypochondriacal symptoms
- Thoughts of suicide
- Thoughts of violence
fixed, false beliefs impervious to disproof or argument; many types
(grandeur, persecution, somatic, paranoid, etc)
Delusions
belief that TV, radio, etc. are talking to or about patient
Ideas of reference
belief that another person or force is controlling some aspect of patients thoughts or behavior
Ideas of influence
upsetting, unstoppable thoughts
Obsessions
irresistible urge to act on obsessional thoughts
Compulsions
irrational, troublesome fears
Phobias
consuming bodily concerns w/o medical cause, but not delusional
Hypochondriacal Symptoms
always inquire & document in careful detail, intervene if necessary
Thoughts of suicide
Thoughts of violence
What are the two most common perceptual disturbances?
Hallucinations
Illusions
What is a hallucination?
- Most common type of perceptual disturbance (Schizophrenia)
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Sensory perceptions in any modality (auditory, visual, tactile, olfactory, gustatory) that are internally generated
- To patients, they are as real as the externally generated perceptions everyone experiences
What is an illusion?
Misinterpretations of externally generated perceptions
Often vague
What is sensorium?
patient’s state of awareness & cognitive abilities
What are some examples of sensorium? (11)
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Alertness – somnolent, obtunded, clouded, fluctuating
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Orientation – to person, place, time, situation
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Concentration – serial 7s or 3s, reverse spellings
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Memory – immediate (retention & recall), recent, long-term
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Calculation – everyday money questions work well
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Fund of knowledge – geography, current events
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Abstract reasoning – interpretation of proverbs, similarities
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Reading – doctor writes “close your eyes”, then patient reads & does it
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Writing – patient is asked to write a complete sentence
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Visuospatial ability – patient is asked to draw a clock face, interlocking pentagons, or a cube
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Estimated intelligence – “above/below/about average”
Insight
Definition
When is it lacking
- Broad term that can describe a patient’s capacity for self-reflection, awareness of illness, understanding of his/her present situation
- Often lacking in patients w/ chronic psychotic disorders (schizophrenia), delirium or severe personality disorders
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Lack of insight makes treatment more difficult & prognosis worse in chronic disorders
- Deficits in insight often become obvious during a psychiatric interview, but may be less so in chronic patients
Judgment
Definition
Impairment
- Refers to a patient’s capacity to make reasonable decisions
- Judgment can be temporarily impaired (intoxication) or chronically impaired (dementia)
- Questions to assess judgment can be asked in the MSE
- But judgment or lack thereof is often evident in the patient’s recent behavior
What is the Folstein Mini-Mental Status Exam?