What acronym can be used to remember the components of the mental status exam?
ABC STAMP LOCKER
What are the terms in the ABC portion of ABC STAMP LOCKER?
What are the terms in the STAMP portion of ABC STAMP LOCKER?
What are the terms in the LOCKER portion of ABC STAMP LOCKER?
level of consciousness
grooming: well or poor
dress: neat, sloppy, disheveled
hygeine: clean, dirty, malodorous
posture: stiff, rigid, imposing
physical characteristics: scars, overweight/underweight, rashes
age appropriateness: appears stated age
psychomotor activity: psychomotor retardation (slowed movements), agitation (fidgeting)
nonverbal behavior: gaits, tics, eye contact
physical behavior: catatonic (immobile), catalepsy (muscular rigidity), waxy flexibility (like gumby), echopraxia (involuntary physical imitation)
level of cooperation: open, cooperative, compliant/noncompliant, responsiveness to questions
attitude: friendly, upbeat, hostile, guarded, suspicious
rate: normal, pressured (consistant w/bipolar disorder), rapid, slow, latency
rhythm: normal, dysprosody (musical, sing-song), slurred
tone/volume: normal, monotone, accent, loud, soft
quantity: productive, impoverished
quality: grammar, syntax, non-interruptable (consistent w/manic state), neologisms, word salad, clanging, echolalia, perseveration
What are neologisms?
made up words, idiosyncrasies in word choice
ex: "I'm feeling very American today."
What is "word salad"?
nonsensical, random speech
What is "clanging"?
sound associations that dictate speech
What is echolalia?
repetition of someone else's words (copycat)
What is perseveration?
repetition of one's own words
What are the two components of thought considered in a mental status exam?
Thought process, discerned from speech:
- poverty of thought
- circumstantial, tangential, flight of ideas, loose associations
From least to greatest, rank the severity of the following: tangential thought, loose associations, flight of ideas, circumstantial thought.
flight of ideas
Describe circumstantial thought.
more detail than needed, goes off on tangents but ultimately returns to the topic being discussed
Describe tangential thought.
worse than circumstantial, doesn't return to the original issue at all
Describe "flight of ideas."
severe, irrational rapid topic jumping
Describe "loose associations."
thought stream is illogical
delusions (bizarre or non-bizarre)
ideas of reference
other psychotic content
anything noteworthy (like self-criticism)
Affect is the emotional "weather"
- expression of emotions during interview
- range: full range, constricted
- intensity: blunted, flat, expansive
- change pattern: labile (rapid shift, like crying, then laughing, then crying again)
- appropriateness: congruency with mood
Mood is the emotional "climate"
- Patient's predominant emotional state: self reported (sad/angry, etc)
- clinical observation inferred from behavior: patient appeared angry, etc.
- eurithmic: fine, ok
- elevated or elated: high, over-inflated, manic
- depressed or dysphoric: low, sad, down
Perceptual disturbances: hallucinations, illusions (errors in perception)
What is depersonalization?
When a patient feels as if he is outside the self, watching, out of body, dream-like.
How does derealization differ from depersonalization?
Derealization occurs when the patient feels that the external world is not real. Depersonalization affects the perception of self.
Levels of consciousness
levels of awareness of external stimuli:
- in a stupor
spheres of orientation: person, place, time
Do they know who they are, where they are, when it is?
What are the two parts of considering cognitive functioning?
Cognitive functioning (judgment)
Are goals reasonable, appropriate, good, poor?
Cognitive functioning (insight)
Is the patient self-aware and aware of their condition?
Anosognosia and La Belle Indifference are part of insight.
What is anosognosia?
unawareness or denial of one's disorder
What is La Belle Indifference?
lack of concern about one's own disorder
intellectual ability (inferred by clinician, not directly tested)
accuracy of patient self-report
Is the patient a reliable or poor historian?
What are the features/purposes of the mental status exam?
clinical tool for diagnosis
part of a larger exam
used to assess and describe behavior (reported and observed)
used for THAT MOMENT ONLY
used to rate severity of signs and symptoms
to know if signs and symptoms are deviant
Can you diagnose a patient from the mental status exam?