Mental Status Exam Flashcards
What are the subsections of general description?
Appearance
Behaviour and Motor Activity
Attitude
What is included in the appearance subsection?
a) Patient’s dress and grooming:
* Inconsistent with season or time of day
* Meticulous
* Level of hygiene
* Unique application of clothing or make-up
b) Features of physical appearance:
* Apparent age in relation to chronological age
* Approximate weight and height
* Body modifications
* Emaciation
c) Facial expression:
* Relationship to expressed mood or thought content
* Wincing in pain
d) Eye contact
Avoids eye contact
Stares directly into examiners eyes
What is included in the behaviour subsection?
Under this heading the clinician should describes the non-verbal behaviour that occurs during the interview. It is important to specifically describe the behaviour or motor activity without attributing it to a specific cause.
If there are marked changes in the person’s behavior during the interview the clinician should note whether these changes seem to occur in relation to specific circumstances or topics discussed.
What is included in the attitude subsection?
Under this heading, the clinician should describe the person’s prevailing attitude toward the clinician, and toward the experience of being interviewed. The use of adjectives is useful when documenting information in this section.
Any change in attitude during the course of the interview should be documented; it should be noted whether these changes are gradual or occur in response to specific topics or circumstances. Additionally, level of rapport established should also be documented.
What are the subsections of Emotional State?
Mood
Affect
Anxiety
What is included in Mood?
Under this heading should be recorded how the person feels. The person’s subjective account of mood in terms of its’ depth, intensity, duration, reactivity, and stability.
Words which are used by the patient rather non—non-specifically include ‘depressed, hyper, and tense’, and if these words are used by the patient an attempt should be made to elicit and record the meaning of the word to the individual patient.
Some adjectives which the patients may use in their descriptions, along with the above, include: ‘irritable, panicky, terrified, angry, enraged, elated, euphoric, empty, guilty, hopeless, helpless, futile, and self-contemptuous’.
What is included in Affect?
Under this heading clinicians should record their observations and assessment of the patient’s prevailing mood or moods. This combines observations of the patient’s facial expression, gestures, speed of psychomotor response, and a subjective evaluation of the content of patient’s description of herself/himself.
Documentation of affect includes range, change in pattern, intensity, and appropriateness. Appropriateness of affect is, if the emotional expression is appropriate to the content of what the patient is thinking or speaking. For example, a young person with schizophrenia recounts the death of her father, laughed and giggled during her account — indicating inappropriateness, or incongruous affect. The constancy of the affect during the interview should be attended to, and the influences which change the affect during the interview should be noted.
What is included in anxiety?
In this area the a description of the person’s fears, worries, and anxieties are documented. Attention should be paid to whether the anxieties are generalized and non-specific (free floating), or specifically related to particular situations, activities, persons, or objects (phobias).
The physical observations made previously which indicate an anxious state should be re-emphasized, such as moist hands, perspiring forehead, tense, rigid posture, sitting on the edge of the seat, motor restlessness, a strained or quavering voice, hand wringing, or fidgeting with one’s fingers or clothing.
What is included in speech?
1) Volume
* Loudness
* Quiet
2) Rate
* Pressured
* Slowed
* Appropriate
3) Quality
* Fluctuations in tone
4) Comprehension
* Understands instructions
* Misinterpretations
5) Clarity
* Understandable
What are the subsections of Thought Processes?
Rate of thought
Flow of ideas
Form of thought
What is included in rate of thought?
- Does the patient appear to think rapidly or slowly, show a paucity of ideas or an over-abundance of ideas?
- Commonly used descriptive words:
o Rapid
o Slow
o Overabundance of ideas
What is included in flow of ideas?
- Is there a connectedness or organization to the person’s thoughts?
- Are the connections logical – are they easily understood?
- Are they relevant or irrelevant; coherent or incoherent?
- Commonly used descriptive words:
o Tangentially
o Circumstantiality
o Flight of ideas
o Loosening of associations
o Echolalia
o Word salad
o Neologisms
o Perseveration
What is included in form of thought?
- Does the person seem to be pre-occupied and hesitant?
- Is the person able to think beyond the most overt meaning?
- Do the answers he gives answer the questions asked? Does the person provide very little detail, or do they provide an excessive amount of irrelevant detail?
- Does there seem to be blocking?
- Commonly used descriptive words:
o Blocking
o Paucity of ideas
o Impoverished
o Overly inclusive
o Non-sequiturs
What is included in thought content?
In this area the person’s prevalent thoughts and pre-occupations – what they are thinking about – is described. The person’s answer to questions such as “what do you see as your main worries?” should be summarized. Are there anxieties or pre-occupations with the present life situation, with the future, with the past, with the safety of self or others?
Findings in this area will provide information related to the following symptoms:
a) Phobias
b) Obsessions
c) Compulsions
d) Delusions
e) Physical concerns
f) Anti-social urges
g) Ideas of reference
h) Ideas of influence
i) Thought insertion
j) Thought broadcasting
k) Thought withdrawal
What subsections are included in the risk assessment?
Suicidal or homicidal ideation, intent, and plan
Content of delusions and hallucinations
What is included in determining the suicidal or homicidal ideation?
Suicidal or homicidal ideation, intent, and plan
o The duration, frequency, persistence and intensity of these thoughts
o The ability of the individual to control them
o The desire and intention of the individual to act upon them
o Likely actions in the event of increasing intensity of suicidal/homicidal ideation or decreasing control over these thoughts, and
o The existence and nature of any developed suicide or homicide plan
What about the content of delusions and hallucinations are included in the risk assessment?
ideation or decreasing control over these thoughts, and
o The existence and nature of any developed suicide or homicide plan
Delusional thought content, and the manner in which delusional beliefs impact on the person’s life or behaviour
The content of auditory hallucinations, if present
o The ability of the individual to control them
o The effect that the hallucinations have on the person’s quality of life
o The impact of the hallucinations on the person’s behaviour
o Likely actions in the event of increasing intensity
The presence of command hallucinations
o The ability of the individual to control them
o The impact of the hallucinations on the person’s behaviour
o Likely actions in the event of increasing intensity
What is included in perception?
Any preceptual disturbances:
Hallucinations
Illusions
Misidentification
Depersonalization
What is a hallucination?
False sensory perceptions in the absence of an external stimulus. Hallucinations may involve bodily sensations, such as deadness, pain or other tactile feelings, or may involve the special senses – auditory, visual, olfactory or taste.
When might hallucinations be normal?
Hallucinations may be normal if they occur when the patient is falling asleep or waking from sleep when they are called hypnagogic and hypnopompic, respectively.
What is an illusion?
Are misinterpretations of actual external events and they may involve the same sensory modalities. The distinction between hallucinations and illusions is important, as hallucinations are more often indicators of serious psychiatric disturbance than are illusions.
What is a misidentification?
Is occurs when the individual falsely believes he recognizes a stranger.
What is depersonalization?
A sense of unreality or estrangement. For example: a patient described looking in a mirror and although recognizing that his face was his own, it lacked the personal quality that he had normally associated with himself.
What are the subsections of cognitive state?
Consciousness
Orientation
Concentration and Attention
General information
Intellectual ability/intelligence
Memory
Judgment
Abstract thinking
What is inlcuded in consciousness?
Describes the person’s level of awareness. The person may be alert, drowsy, delirious, stuporose, or comatose.
What is included in orientation?
- Time: Is the person able to identify the date correctly, the time of day, month, season?
- Place: Does the person know where he is?
- Person: Does the person know who he/she is and does he recognize his relationship with the clinician?
As a general rule, people with dementia, disorientation to time occurs before disorientation to place. Orientation to person is maintained the longest.
What is included in concentration and attention?
Assess how easily the person’s attention is aroused and sustained his/her ability to concentrate on the topic at hand, and how distractible or diverted his/her attention is from these topics.
A formal, structured way of assessing concentration and attention is to ask him to relate the days of the week in reverse order, do simple subtraction problems such as counting backwards from 69 to 45.
What is included in general information?
Questions regarding the patient’s general information and grasp should be varied according to the patient’s educational level and his experiences and interests. Sample questions include: being able to name the current Prime Minister and his political party, the Premier of the province, the capital city, etc.
What is included in intellectual ability/intelligence?
This is not tested directly, but the patient’s approximate intelligence should be gauged from his history, general knowledge, his education and occupational records. If there seems to be a wide disparity between his functioning as ascertained from the history, and that which had been gauged from assessment of his orientation, concentration and attention, and present general information, this should be noted.
What is included in memory?
For the purpose of testing, memory is divided into remote memory, recent memory, and immediate retention and recall. Each of these functions should be tested separately in any patient in whom there is a suspicion of impairment.
- Remote Memory: can be tested by asking about important events known to have occurred when the patient was younger or free of illnesses.
- Recent Memory: can be generally assessed by questioning the person as to activities that occurred earlier in the day, such as “What did you have for breakfast?” (as long as these facts can be verified). It is sometimes useful at the end of the interview, to ask the patient if he remember your name or some other event that happened earlier in the interview, as these will be part of his recent memory period.
- Immediate Retention and Recall: require specific testing. Individuals should be able to repeat six figures after the examiner has listed them. The figures should be randomly chosen. The individuals should also be able to repeat back to the examiner in reverse order four digits.
What is included in judgment?
Judgement is a process of forming an opinion or conclusion based on information about a situation that can lead to a decision or action. Social judgment may be largely assessed during the person’s history. Judgment may be tested by asking the person what he/she would do in imaginary situations, such as “what would you do if you found a stamped, addressed envelope on the street?” or “What would you do if you were sitting in a crowded theatre and smelled smoke?” The clinician could also ask the person “how do you think your hallucinations (insert and presenting symptom) should be handled?”
What is included in abstract thinking?
The capacity for abstract thinking, that is, the ability to make generalizations can be tested by asking the patient to interpret a proverb. The reply may evidence normal ability to think in the abstract, concreteness of thought or bizarre thinking.
For example: Proverb – “stitch in time saves nine.”
a) Abstract interpretation – “A little prevention can prevent a lot of work”
b) Concrete interpretation – “When your shirt has a tear in it you should put a stitch in it or you may end up having to put many stitches in it.”
c) Bizarre interpretation – “I laughed and laughed and laughed until I was in stitches.”
You may also ask the person to identify similarities.
For example: “How are an apple and an orange similar?”
a) Abstract interpretation – “They are both fruit.”
b) Concrete interpretation – “They are both round.”
c) Bizarre interpretation – “I eat and eat them to turn into a pumpkin.”
What is the difference in onset between depression, dementia, and delirium?
Depression - gradual or sudden
Dementia - gradual, insidious onset
Delirium - sudden and acute
What is the difference in awareness between depression, dementia and delirium?
Depression - aware of condition
Dementia - unaware of or minimizes condition
Delirium -unaware of condition; may experience hallucinations or delusions
What is the difference in motor behaviour between depression, dementia and delirium?
Depression - slowed motor behaviours
Dementia - wandering behaviour
Delirium -varies between hypo and hyperarousal
What is the difference in mood between depression, dementia and delirium?
Depression - withdrawn, apathetic, anhedonia
Dementia - fluctuates, happiness/sadness, defensive behaviour
Delirium - anxious, restless, mixed hallucinations and illusions
What is the difference in affect between depression, dementia and delirium?
Depression - flat emotionless affect
Dementia - inappropriate or no interaction with others
Delirium - fluctuating and nonsensical interactions with others
What is the difference in physical symptoms between depression, dementia and delirium?
Depression - somatic complaints
Dementia - health usually good until terminal stage
Delirium - acute medical illness, drug reaction
What is the difference in memory between depression, dementia and delirium?
Depression - memory usually intact, but evaluation may be difficult due to low motivation
Dementia - early losses ability to perform calculations or find directions; confabulates
Delirium -fluctuating performance, forgets most of experience
What is the difference in sleep between depression, dementia and delirium?
Depression - sleep difficulties
Dementia - disturbed sleep-wake cycles; may sleep less than usual but have high energy levels
Delirium - behaviour disorders worsen at night
What is the difference in self-care between depression, dementia and delirium?
Depression - poor hygiene, decreased motivation, actual ability is unchanged
Dementia - functional impairment, ability decreases
Delirium - often unable to perform ADLs
What is the difference in consciousness between depression, dementia and delirium?
Depression - no change
Dementia - no change
Delirium - fluctuates
What is included in insight?
Under insight, a statement should be made as to the degree of self-awareness and understanding. It involves the capacity to examine many aspects, viewpoints, and consequences of an issue before forming an opinion or making a decision.
In the context of the mental status examination, assessment of insight focuses on both the person’s self-awareness that there is a problem or illness, and to the non-delusional understanding of its cause or meaning. Insight also includes how realistic the patient’s assessment is of the severity of his illness, of his weaknesses and sensitivities, and of his strengths.
Insight may be affected by a person’s intellectual ability, cognitive function, defense mechanisms, personality style, presence or absence of a thought disorder and cultural context.
The clinician will ask the person “what do you think is the problem?” and/or “do you think that there is anything that will help you feel better?” Responses will fall within the following continuum:
- complete denial of illness
- awareness of being ill and needing help and denying it at the same time
- awareness of being ill and blaming it on others
- aware that illness is due to something in themselves
- aware of illness and attributing their illness correctly to biological or psychological or social factors
What is included in volition?
In this section the person’s level of drive, goal directness, and will power should be documented. For example: the person may be apathetic, driven or have a strong conviction and purpose. One of the ways to assess this area is to ask the client “what do you think the likelihood is of you achieving this goal?” Then exploring the reasoning behind the answer provided.
What is included in physical functioning?
Any disturbance in the person’s sleep habits should be recorded here as specifically as possible. Sleep disturbance should be categorized as:
a) Primary difficult falling asleep;
b) Primarily early morning awakening, or
c) Mixed, or other – describe;
d) Hypersomnia
Change is appetite should be also noted, together with documented weight loss or gain. Any condition that has the potential to affect the person’s mental state should be recorded here. Examples include: temporal lobe epilepsy, asthma, liver failure, hypothyroidism, multiple sclerosis, etc.
What are the components of the MSE?
- general description
- emotional state
- speech
- thought process
- thought content
- risk assessment
- perception
- cognitive state
- insight
- volition
- physical functioning
What is a mental status?
MENTAL STATUS: the organized recording of a psychiatric interview and examination in which the Clinician’s observations of the patient’s behavior, and the patient’s replies to specific questions are carefully documented to give a picture of the patient’s general health, appearance, speech, form and content of thought, perceptual processes, date of consciousness, cognitive state, insight, and judgment.
What is affect?
AFFECT: the emotional feeling tone attached to an object, an idea or a thought. The term includes inner feelings and their external manifestations.
What is anxiety?
ANXIETY: an unpleasurable affect consisting of physical changes and a subjective feeling of fear. In contrast to normal fear, the danger or threat in anxiety is unreal. The subjective feeling is an uncomfortable dread of impending danger, accompanied by overwhelming awareness of being powerless; an inability to perceive the unreality of the threat; pro-longed feeling of tension and an exhaustive readiness for the expected danger.
What is perception?
PERCEPTION: refers to the reception of many physical stimuli that bombard a person (sights, sounds, feelings, odors, taste, etc.) and the mental processes by which such data are organized. Through perception a person makes sense out of the many stimuli that bombard him.
What is consciousness?
CONSCIOUSNESS: the level of awareness, degree of alertness
What is cognition?
COGNITION: mental process of knowing, thinking and becoming aware
What is insight?
INSIGHT: awareness and understanding of one’s illness and the symptoms of illness, with or without an awareness of their causes and result.
When discussing appearance, what is appropriate?
APPROPRIATE: clothing worn is suitable for the ensuing activity or environment
When discussing appearance, what is neglected?
NEGLECTED: dress and personal hygiene indicate that the client is either incapable of or has disregarded self-care
When discussing appearance, what is unkempt?
UNKEMPT: disheveled, inattentive to personal appearance or hygiene
When discussing appearance, what is bizarre?
BIZARRE: inappropriate dress or attire which suggests extravagance or eccentric style
What is affective interaction and what section would it fall under?
AFFECTIVE INTERACTION: behavior during the interview that is emotionally charged
Behaviour and Motor Activity; General Description
What is aggressive and what section would it fall under?
AGGRESSIVE: forceful, verbal or physical. It is the motor counterpart to the effect of anger or hostility
Behaviour and Motor Activity; General Description
What is agitation and what section would it fall under?
AGITATION: state of anxiety associated with severe motor restlessness
Behaviour and Motor Activity; General Description
What is akinesia and what section would it fall under?
AKINESIA: a lack of physical movement
Behaviour and Motor Activity; General Description
What is cataleptic and what section would it fall under?
CATALEPTIC: condition in which the person maintains the body position into which he is placed
Behaviour and Motor Activity; General Description
What is dystonic and what section would it fall under?
DYSTONIC: a motor disturbance usually observed as a side effect of phenothiazine drugs and major tranquilizers which consists of uncoordinated and spasmodic movements of the body and limbs, such as arching of the back, twisting of the body & neck
Behaviour and Motor Activity; General Description
What is echopraxic and what section would it fall under?
ECHOPRAXIC: imitation of another person’s movements
Behaviour and Motor Activity; General Description
What is overactive and what section would it fall under?
OVERACTIVE: excessive motor activity
Behaviour and Motor Activity; General Description
What is negativism and what section would it fall under?
NEGATIVISM: opposition to suggestions of the interviewer to behave in a certain fashion
Behaviour and Motor Activity; General Description
What is a startle reaction and what section would it fall under?
STARTLE REACTION: reflex motor response to a sudden, intense stimulus associated with a sudden increase in the level of consciousness. It occurs in normal persons in an acute anxiety state
Behaviour and Motor Activity; General Description
What is a tic and what section would it fall under?
TIC: involuntary, spasmodic, repetitive motor movements of a small segment of the body
Behaviour and Motor Activity; General Description
What is withdrawing and what section would it fall under?
WITHDRAWING: moving away from or retreating
Behaviour and Motor Activity; General Description
What is mannerism and what section would it fall under?
MANNERISM: are seen in normal people and are not a persistent as stereotypes, are more in keeping with the person’s personality. They are more frequently in evidence with people under some stress. Examples include shoulder shrugging, repeated clearing of the throat, blinking
Behaviour and Motor Activity; General Description
What is sterotypy and what section would it fall under?
STEREOTYPY: a repetition of the motor action as is seen in chronic schizophrenic states. At times it is highly organized and appears to be ritualistic act
Behaviour and Motor Activity; General Description
What is rigid and what section would it fall under?
RIGID: gait and other movements appear stiff and puppet-like, indicative of severe lack of flexibility
Behaviour and Motor Activity; General Description
What is coordinated and what section would it fall under?
CO-ORDINATED: movements exhibit a normal degree of flexibility and harmony with no sign of impaired motor control
Behaviour and Motor Activity; General Description
What is retarded and what section would it fall under?
RETARDED: movements are slow, labored and limited
Behaviour and Motor Activity; General Description
What is tremulous and what section would it fall under?
TREMULOUS: movements indicate impaired motor coordination, ranging from fine muscular tremors to spontaneous, spasmodic jerking
Behaviour and Motor Activity; General Description
What is assaultive and what section would it fall under?
ASSAULTIVE: physically aggressive and threatening, striking out at others
Behaviour and Motor Activity; General Description
What is bizarre and what section would it fall under?
BIZARRE: refers to behavior characterized by odd, eccentric, grotesque or erratic acts; unconventional
Behaviour and Motor Activity; General Description
What is self-abusive and what section would it fall under?
SELF-ABUSIVE: refers to self-inflicted punishment and injury and acts of violence against self.
Behaviour and Motor Activity; General Description
What is restless and what section would it fall under?
RESTLESS: unsettled, fidgety, wandering, agitated
Behaviour and Motor Activity; General Description
What is pacing and what section would it fall under?
PACING: restlessness, characterized by continual walking
Behaviour and Motor Activity; General Description
What is hysterical and what section would it fall under?
HYSTERICAL: behavior which is marked by excitable, emotional outbursts
Behaviour and Motor Activity; General Description
What is tantrums and what section would it fall under?
TANTRUMS: refers to uncontrolled, angry outbursts of bad temper
Behaviour and Motor Activity; General Description
What is stuperose and what section would it fall under?
STUPEROSE: lethargy, in which the patient is immobile, out of touch with his surroundings and exhibits little or no responses to stimuli
Behaviour and Motor Activity; General Description
What is decreased interest and what section would it fall under?
DECREASED INTEREST: intellectual behavior which shows signs of diminishing awareness of, response to, or concern about others, employment, activities, surroundings; indicative of varying degrees of recession into a state of mental and emotional detachment
Behaviour and Motor Activity; General Description
When discussing behaviour, what is appropriate?
APPROPRIATE: behavior is suited to the requirements of the prevailing situation
Behaviour and Motor Activity; General Description
What is regressive and what section would it fall under?
REGRESSIVE: going back to a more infantile or immature level
Behaviour and Motor Activity; General Description
What is automatic obedience and what section would it fall under?
AUTOMATIC OBEDIENCE: patient shows a pathological degree of compliance with the instructions of the examiner
Behaviour and Motor Activity; General Description
What is compulsive movements and what section would it fall under?
COMPULSIVE MOVEMENTS: the result of an irresistible urge to perform a certain act. Example: irresistible need to continually wash hands
Behaviour and Motor Activity; General Description
