MENTAL STATUS

• Consciousness. Is being aware of one’s own existence, feelings and thoughts and aware of the environment. This is the most basic of mental status function.
• Language. Using the voice to communicate one’s thoughts and feelings. The humanness of a person greatly depends on his ability to communicate. Its loss has a great impact on the social dimension of a person’s life.
• Mood and affect. Both of these elements deal with the prevailing feelings. Affect is a temporary expression of feelings or state of mind. Whereas, mood is more durable, a prolonged display of feelings that depict the whole emotional life
• Orientation. It is the awareness of the outside world in relation to the self.
• Attention. It is the power of concentration, the ability to focus on one specific thing without being distracted by many environmental stimuli.
• Memory. It is the ability to lay down and store experiences and perceptions for later recall.
• o   Remote memory brings up years’ worth of experiences.
• o   Recent memory evokes day-to-day events.
• Abstract reasoning. Is pondering a deeper meaning beyond the concrete and literal.
• Thought process. Is the way a person thinks, the logical train of thought,
• Thought content. What the person thinks specific ideas, beliefs, and the use of words.
• Perceptions. An awareness of objects through the five senses.
• The 4 major components of mental status examination are as follows:

  A - Appearance

  B - Behavior

  C - Cognition

  T - Thought process
• Posture. The posture is erect, and the position is relaxed
• o   Sitting on edge of chair

  o   Curled in bed

  o   Tense muscles

  o   Darting watchful eyes

  o   Frowning

  o   Restless pacing

  These findings may indicate anxiety.
• o   Sitting slumped in chair

  o   Slow walk

  o   Dragging feet

  These findings may indicate depression.
• Body movements. Body movements are voluntary, deliberate, coordinated and smooth and even.
• o   Restless

  o   Fidgety movements

  These findings may indicate anxiety.
• Dress. The dress is appropriate for the setting, session, age, and social group. The clothing fits and is put on appropriately.
• Grooming and hygiene. The patient is clean and well-groomed; hair is neat and clean; women have moderate or no makeup; men are shaved or beard or mustache are well groomed. The nails are clean.
• o   Inappropriate dress

  o   Poor hygiene

  o   Lack of concern with appearance

  These findings may indicate depression and severe Alzheimer’s disease.
• o   Inappropriate dress (e.g., wearing three layers of clothing on a warm day)

  o   Provocative manner of dressing combined with bizarre make-up.

  These findings may indicate mental disorders like schizophrenia, histrionic personality.
• A.    Level of consciousness. The patient is awake, alert, aware of stimuli from the environment and within the self and responds appropriately to stimuli.
• Alert (Conscious) – Appearance of wakefulness, awareness of the self and environment
• Lethargy - mild reduction in alertness
• Obtundation moderate reduction in alertness. Increased response time to stimuli
• Stupor Deep sleep, patient can be aroused only by vigorous and repetitive stimulation. Returns to deep sleep when not continually stimulated
• Coma (Unconscious) - Sleep like appearance and behaviorally unresponsive to all external stimuli (Unarousable unresponsiveness, eyes closed).
• Septicemia: is a serious bloodstream infection. It’s also known as blood poisoning.
• Hypoxia: a condition that causes deficiency in in the amount of oxygen reaching the tissues.
• Facial Expression. The look is appropriate to the situation and changes appropriately with the topic. There is comfortable eye contact unless precluded by cultural norm (e.g., direct eye contact may be viewed as a sign of disrespect in some cultures)
• o   Flat, mask like facial expression

  These findings may indicate depression and Parkinsonism.
• Speech. The patient makes laryngeal sounds effortlessly and shares conversation appropriately.
• (SPEECH) Normal: The pace of the conversation is moderate, and the stream of talking is fluent.
• Rapid-fire, pressured and loud talking (manic disorder)
• Normal: articulation (ability to form words) is clear and understandable.
• Neologism - a term used to describe the use of words that only have meaning to the person who uses them, independent of their common meaning (term is derived from psychiatry, first attested in English 1772, root word French)
• Mood and affect. Judge this by body language and facial expression and by asking directly, "How do you feel today? Or "how do you usually feel?'
• The mood should be appropriate to the person's place and condition and change appropriately with topics. The person is willing to cooperate with the nurse.
• Attention Span. Check the patient’s ability to concentrate by noting whether he or she completes a thought without wandering. Note any distractibility or difficulty attending to you.