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    Mental Status Examination

    Uploaded by

    Sidhartha Mohapatra
    It explains how to take mental status examination.All the steps have been explained.

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    © All Rights Reserved
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    Mental Status Examination

    Uploaded by

    Sidhartha Mohapatra
    21 views28 pages
    It explains how to take mental status examination.All the steps have been explained.

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    © © All Rights Reserved

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    PPTX, PDF, TXT or read online from Scribd

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    It explains how to take mental status examination.All the steps have been explained.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    21 views28 pages

    Mental Status Examination

    Uploaded by

    Sidhartha Mohapatra
    It explains how to take mental status examination.All the steps have been explained.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 28

    Mental Status

    Examination
    introduction

     Themental status examination (MSE) is a


    standardized format in which the clinician
    records the psychiatric sign and symptoms
    present at the time of interviews.
     The cue ASEPTIC can be used to remember the
    components of the Mental Status Examination

     A - Appearance/Behavior

     S - Speech

     E - Emotion (Mood and Affect)

     P - Perception (Auditory/Visual Hallucinations)

     T - Thought Content (Suicidal/Homicidal Ideation) and Process

     I - Insight and Judgement

     C – Cognition
     General Appearance/ behavior (GAAB)
     Note the posture, clothes, grooming, and cleanliness

     Make note of any evidence of self-harm (cuts on wrists/legs),

    significant weight loss, or signs of physical injury (think domestic

    abuse

     Movement and Gait


     Look for any unusual movements: gait abnormalities, tics,

    psychomotor agitation or retardation, tremor (at rest or with

    movement)
     Behavior

     Note any mannerisms, gestures, expressions, eye contact,

    ability to follow commands/requests, compulsions

     Attitude

     Note if the patient is cooperative, hostile, open, secretive,

    suspicious, lazy, easily distracted, focused, or defensive


    Level of Consciousness
     Is the patient attentive, alert, drowsy, lethargic,

    stuporous, asleep, confused, fluctuating

     You may need to do further cognitive testing if

    there is concern (see cognition section below)


    i. You may want to quickly ask about orientation:

    ii. What is your full name?”

    iii. “Where are we at (floor, building, city, county, and


    state)?”

    iv. “What is the full date today (date, month, year, day of the
    week, and season of the year)?”

     Rapport

    i. Is the rapport good, fair, or bad?

    ii. Does the patient trust you and do you have a good
    connection/relationship?
    “Mr. D, 25/M, moderate built, appearing of stated age
    who seems overtly kempt and wearing flashy dresses
    and a sunglass, is neat and tidy entered the room and
    took the chair before asking. He is cooperative but
    over-familiar and blurting out answers for all questions
    Example-1
    immediately. Eye contact and rapport was established
    GAAB
    instantaneously. He seems alert, unusually joyful and
    hyperactive”
    Speech

     Quantity of speech

     Talkative, spontaneous, expansive, paucity, poverty of

    speech (i.e. - Very little is said)

     Rate of speech

     Fast, slow, normal, pressured

     Volume (tone) of speech

     Loud, soft, monotone, weak, strong


     Fluency and rhythm of speech

     Incoherent, clear, with appropriately placed

    inflections, hesitant, with good pronunciation,

    aphasic

     Response latency

     How long does it take the patient to respond?

     Emotion
    Mood And Affect
    • Emotion consists of mood and affect.
    • Mood is how the patient subjectively tells you they're feeling
    • Ask the patient: “How are you feeling?” Or “How is your mood?”
    • Affect is what you objectively observe
    • Note the appropriateness of the patient's affect on the current
    situation
    • Other descriptors for affect include:
    • Fluctuations in affect: labile, even, expansive
    • Range of affect: broad, restricted
    • Intensity of affect: blunted, flat, normal, hyper-energize
    • Quality of affect: sad, angry, hostile, indifferent, euthymic, dysphoric,
    detached, elated, euphoric, anxious, animated, irritable
    Perception
    • Illusions are misperceptions of actual stimuli, and are either a
    misinterpretation or clear error in perception (e.g. – Patient
    feels as though a clock has eyes, that wind blowing is whispered,
    or they see figures moving in the dark at night when leaves on a
    tree are blowing)
    • Illusions are non-pathologic – most individuals can point to a
    time when they had a misperception or fleeting perception (e.g.
    – Thinking of hearing one's name called when no one else is
    home, or thinking someone is hiding in the dark at night).
    • Hallucinations are perceptions in the absence of sensory stimuli
    in any of the five senses (auditory, visual, gustatory, olfactory,
    and tactile).
    “I keep hearing these voices since last few months.
    It is mostly two people, a man and a woman talking
    among themselves. I hear their voices even when no
    one is around. They start and stop automatically. I
    can’t stop it even if I want to. They know my name.
    EXAMPLE
    They always talk about me, mostly nasty stuff. I
    Perception-1
    know they are there as I can listen to them clearly ”

    3rd Person Auditory Hallucinations


    Thought
    • Thought content may include:
    • Delusions
    • Delusions are fixed, false beliefs. These are unshakable beliefs that are
    held despite evidence against it, even though there is no logical
    support for it.
    • Delusions may have erotomanic, grandiose, jealous, persecutory,
    and/or somatic themes.
    • Also consider if there is an extensive delusional belief system that
    supports the delusion (e.g. - Patient may have a very intricate and
    detailed explanation of why they believe they are being targeted)
    • If not a delusion, then could it be an overvalued idea?
    • Overvalued ideas are unreasonable and sustained beliefs that is
    maintained with less than delusional intensity (i.e. - The person can
    acknowledge the possibility that the belief is false)
    6. COGNITIVE
    FUNCTIONS(i)

    ORIENTATION ATTENTION/ MEMORY


    CONCENTRATION
     Time  Attention: Ability to attend to a  Immediate
    specific stimulus
     Place  Recent
     Concentration: Sustained
     Person  Remote
    attention over a period of time
     Serial Subtraction  3 Word
     Month/Days Backwards Recall
     Digit Span Test
     If you are concerned about cognition, start by asking the
    patient if they know the date, location of where they are,
    and their name. This can give the clinician a very rough
    sense of the person's overall cognition, but is only a
    start.
    Serial Subtraction (Serial 7s)

    Serial Subtraction (Serial 3s)


    DEMO
    3 Word Recall Test Serial Subtraction
    3 Word Recall
    Insight

    • When assessing insight, ask yourself: what is the patient's


    understanding of the world around them and their illness?
    • Are they able to reality test? (I.E. - Are they able to see the
    situation as it is?)
    • Are they help-seeking? Help-rejecting?
    • Insight can be described as:
    • Poor (patient may be in complete denial of their symptoms or
    diagnosis, or there may be some slight awareness)
    • Fair
    • The patient may understand their symptoms or diagnosis
    intellectually “on paper,” but fail to understand it emotionally, or
    fully grasp the impact of it on their life
    • Good/Excellent
    • Overall, a good intellectual and emotional understanding of their
    symptoms or difficulties. Patient is acutely aware of their symptoms
    or illness, and also of their limitations and strengths. Their symptoms
    are likely to be in remission, and they know when to reach out for
    help and when to rely on themselves.
    Judgment
    • When considering judgment, ask yourself: what have the
    patient's recent actions been?
    • Have they done anything to put themselves or other
    people at harm?
    • Are they behaving in a way that is motivated by
    perceptual disturbances or paranoia?
    • What is your confidence in the patient's decision
    making?
    Judgment

    • Judgment can be described as:


    • Impaired (for individuals who are acutely intoxicated)
    • Poor (in the context of acute psychosis in schizophrenia or
    dementia)
    • Good (patient is aware and makes decisions in a way that
    does not put them or others in harm)
    • Keep in mind there is no formal way of describing judgment,
    and even the descriptors may vary among clinicians
    SIMILARITIES: Bird and Plane

    DISSIMILARITIES: Apple and Orange

    PROVERB: “Barking dog seldom bites”


    DEMO
    Abstraction
    TEST JUDGEMENT: Letter Test/ Fire Test Judgement
    Y O U
    A N K
    T H

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