Mental Status Exam

Question 1

What are the 8 points of a mental status exam?

Answer 1

A Snake Moves Toward Prey Silently In Jungles

• Appearance, Attitude & Behavior
• Speech
• Mood & Affect
• Thought Form/Process & Content
• Perception
• Sensorium/Cognition
• Insight
• Judgment

Question 2

Appearance, Attitude & Behavior

Answer 2

• Describe overall appearance, emphasizing abnormalities
• Describe attitude toward examiner
• Describe physical behavior

Question 3

Speech

Answer 3

• Describe speech (not content of speech, but distinctive qualities of speech: rate, tone, rhythm, volume), emphasizing abnormalities
• **Normal: “fluent, w/ normal rate, rhythm & volume” **

Question 4

Mood vs. Affect

Answer 4

• Mood – describes patient’s subjective, internal state of feeling
• Affect – describes patient’s objective, external appearance of feeling
• Normally, affect is an accurate reflection of mood

Question 5

Describing the mood & affect of patients

Answer 5

• 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” **

Question 6

Thought Form/Process

Answer 6

• Thought form (process) describes how the patient is thinking
• Normal thought form: “logical, linear, goal-oriented”

Question 7

What are the abnormalities of thought form? (9)

Answer 7

• Thought blocking
• Poverty of thought
• Circumstantiality
• Tangentiality
• Loose associations (derailment)
• Clang associations
• Neologisms
• Perseveration
• Flight of ideas

Question 8

mind frequently goes blank

Answer 8

**Thought blocking **

Question 9

very little thought occuring

Answer 9

**Poverty of thought **

Question 10

takes a long time to get to the point

Answer 10

**Circumstantiality **

Question 11

logical, but never gets to the point

Answer 11

Tangentiality

Question 12

logical connections btwn thoughts break down

Answer 12

Loose associations (derailment)

Question 13

thoughts are expressed through sounds rather than meaning

Answer 13

Clang associations

Question 14

new words/phrases invented

Answer 14

Neologisms

Question 15

being stuck on a single thought

Answer 15

Perseveration

Question 16

rapid jumping from thought to thought (mania)

Answer 16

Flight of ideas

Question 17

**Thought content **

Definition

Abnormalities (9)

Answer 17

• 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

Question 18

fixed, false beliefs impervious to disproof or argument; many types

(grandeur, persecution, somatic, paranoid, etc)

Answer 18

Delusions

Question 19

belief that TV, radio, etc. are talking to or about patient

Answer 19

Ideas of reference

Question 20

belief that another person or force is controlling some aspect of patients thoughts or behavior

Answer 20

Ideas of influence

Question 21

upsetting, unstoppable thoughts

Answer 21

Obsessions

Question 22

irresistible urge to act on obsessional thoughts

Answer 22

Compulsions

Question 23

irrational, troublesome fears

Answer 23

Phobias

Question 24

consuming bodily concerns w/o medical cause, but not delusional

Answer 24

Hypochondriacal Symptoms

Question 25

always inquire & document in careful detail, intervene if necessary

Answer 25

**Thoughts of suicide** **Thoughts of violence**

Question 26

What are the _two most common_ perceptual disturbances?

Answer 26

Hallucinations Illusions

Question 27

What is a **hallucination**?

Answer 27

* Most common type of perceptual disturbance (Schizophrenia) * **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

Question 28

What is an **illusion**?

Answer 28

Misinterpretations of externally generated perceptions Often vague

Question 29

What is **sensorium**?

Answer 29

patient’s state of awareness & cognitive abilities

Question 30

What are some examples of **sensorium**? (11)

Answer 30

* **Alertness** – somnolent, obtunded, clouded, fluctuating * **Orientation** – to person, place, time, situation * **Concentration** – serial 7s or 3s, reverse spellings * **Memory** – immediate (retention & recall), recent, long-term * **Calculation** – everyday money questions work well * **Fund of knowledge** – geography, current events * **Abstract reasoning** – interpretation of proverbs, similarities * **Reading** – doctor writes “close your eyes”, then patient reads & does it * **Writing** – patient is asked to write a complete sentence * **Visuospatial ability** – patient is asked to draw a clock face, interlocking pentagons, or a cube * **Estimated intelligence** – “above/below/about average”

Question 31

**Insight** Definition When is it lacking

Answer 31

* 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 * **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

Question 32

**Judgment** Definition Impairment

Answer 32

* **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

Question 33

What is the **Folstein Mini-Mental Status Exam**?

Answer 33

* 1-page, structured instrument that covers most of the “Sensorium” items * Numeric score generated (30 pts = no gross cognitive defects) * ~10 minutes * Emphasis on cognition * Delirious patient will score low * Psychotic patient may or may not do well * Relatively objective way of monitoring cognitive changes