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?
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appearance
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behavior
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cooperation
What are the terms in the STAMP portion of ABC STAMP LOCKER?
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speech
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thought
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affect
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mood
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perception
What are the terms in the LOCKER portion of ABC STAMP LOCKER?
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level of consciousness
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orientation
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cognitive functioning
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knowledge
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endings
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reliability
Appearance
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grooming: well or poor
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dress: neat, sloppy, disheveled
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hygeine: clean, dirty, malodorous
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posture: stiff, rigid, imposing
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physical characteristics: scars, overweight/underweight, rashes
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age appropriateness: appears stated age
Behavior
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psychomotor activity: psychomotor retardation (slowed movements), agitation (fidgeting)
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nonverbal behavior: gaits, tics, eye contact
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physical behavior: catatonic (immobile), catalepsy (muscular rigidity), waxy flexibility (like gumby), echopraxia (involuntary physical imitation)
Cooperation
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level of cooperation: open, cooperative, compliant/noncompliant, responsiveness to questions
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attitude: friendly, upbeat, hostile, guarded, suspicious
Speech
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rate: normal, pressured (consistant w/bipolar disorder), rapid, slow, latency
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rhythm: normal, dysprosody (musical, sing-song), slurred
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tone/volume: normal, monotone, accent, loud, soft
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quantity: productive, impoverished
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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
ex: rhyming
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?
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form
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content
Thought (form)
Thought process, discerned from speech:
- linear/nonlinear
- concrete
- logical/illogical
- latency
- poverty of thought
- redirectability
- organization
- 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.
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circumstantial thought
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tangential thought
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flight of ideas
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loose associations
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
Thought content
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worries
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paranoia
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preoccupations
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ruminations
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obsessions
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delusions (bizarre or non-bizarre)
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ideas of reference
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grandiosity
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other psychotic content
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anything noteworthy (like self-criticism)
Affect
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
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
Perception
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Perceptual disturbances: hallucinations, illusions (errors in perception)
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depersonalization
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derealization
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:
- comatose
- dazed
- in a stupor
- drowsiness
- alertness
- hypervigilance
Orientation
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?
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judgment
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insight
Cognitive functioning (judgment)
decision-making ability
Are goals reasonable, appropriate, good, poor?
