MENTAL EXAM

• Mental status examination


  A structured assessment of the patient's behavioral and cognitive functioning
• Components of the mental status examination

  • Appearance and general behavior
  • Level of consciousness and attentiveness
  • Motor and speech activity
  • Mood and affect
  • Thought and perception
  • Attitude and insight
  • Higher cognitive abilities
• Mental status examination


  • Includes descriptions of the patient's appearance, behavior, level of consciousness, motor and speech activity, mood and affect, thought and perception, attitude and insight, and higher cognitive abilities
• Cognitive functions assessed


  Alertness, language, memory, constructional ability, and abstract reasoning
• The mental status examination is a core skill of mental health practitioners and a key part of the initial psychiatric assessment
• Purpose of the mental status examination

  To obtain evidence of symptoms and signs of mental disorders, assess danger to self and others, and gather information on the patient's insight, judgment, and capacity for abstract reasoning
• Mental status examination process

  1. Systematic collection of data based on observation of the patient's behavior during the interview

  2. Use of open and closed questions

  3. Structured tests to assess cognition

  4. Information recorded as free-form text using standard headings
• Major components of the mental status examination

  • Appearance
  • Behavior
  • Speech
  • Mood
  • Thoughts
  • Perceptions
  • Cognitive abilities
  • Insights
  • Risk
• Appearance


  Includes apparent age, height, weight, manner of dress and grooming, body type, posture, hair and nails
• Appearance and behavior indicators

  • Colorful or bizarre clothing
  • Unkempt, dirty clothes
  • Signs of malnutrition
  • Needle track marks - drug abuse
• Behavior


  Includes general behaviour, level of distress, degree of eye contact, attitude towards the interviewer
• Motor activity


  Includes level of psychomotor activity, presence of gait abnormalities, and purposeless, repetitive unusual posture or movement
• Motor activity abnormalities


  • Tremors
  • Akathisia
  • Dyskinesias
  • Catatonic posturing
  • Echopraxia
  • Waxy flexibility
  • Akathisia
  • Akinesia
  • Dystonia
  • Oculogyric crisis
  • Opisthotonus
  • Tardive dyskinesia
  • Ataxia
• Speech


  Includes rate, rhythm, volume, and amount of speech
• Speech abnormalities


  • Alogia
  • Poverty of speech
  • Mutism
  • Echolalia
  • Flight of ideas
  • Pressured speech
  • Clang association
  • Neologism
  • Circumstantiality
• Mood and affect


  Mood is the internal, subjective, sustained emotional state, while affect is the externally observable, changeable emotional tone or state
• Mood and affect abnormalities

  • Blunted affect
  • Flat affect
  • Apathy
  • Ambivalence
  • Abulia
  • Anergia
  • Elation
  • Euphoria
  • Dysthymia
  • Depression
  • Mania
• Thought processes


  Includes flow of ideas, vagueness, and incoherence
• Thought process abnormalities


  • Circumstantiality
  • Tangentiality
  • Word salad
• Thought content


  Includes ideas, beliefs, and suicidal/homicidal ideations
• Thought content abnormalities


  • Delusions (grandiose, persecutory, religious, control)
  • Hypochondriasis
  • Phobia
  • Alogia
• Perception


  Includes hallucinations, which are perceptions in the absence of external stimuli
• Hallucination types


  • Gustatory
  • Visual
  • Olfactory
  • Tactile
  • Auditory (third person, second person)
• Memory


  Includes confusion, anterograde amnesia, retrograde amnesia, déjà vu, jamais vu, dementia, and delirium
• Cognition


  Includes level of consciousness, orientation, concentration, and memory
• Insight


  Awareness of problems and their implications, recognition of illness and benefits of treatment, and motivation to change
• Judgement


  Capacity to make sound, reasoned and responsible decisions
• The mental status examination is used, together with the psychiatric history, to generate a diagnosis and a treatment plan