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MENTAL STATUS EXAMINATION

MENTAL STATUS EXAMINATION

The mental status examination consists of the following components: Appearance

and behavior Speech and language Mood Thoughts and perceptions Cognitive function.

APPEARANCE AND BEHAVIOR

1. Level of Consciousness.
awake

and alert? understand your questions and respond.

2. Posture and Motor Behavior.


Does

the patient lie in bed, or prefer to walk around? Do they seem to be under voluntary control? Are certain parts immobile? Do posture and motor activity change with topics under discussion or with activities or people around the patient?

3. Dress, Grooming, and Personal Hygiene.


Is

clothing clean, pressed, and properly fastened? Note the patient's hair, nails, teeth, skin, and, if present, beard. How are they groomed?

4.Facial Expression.
Observe

the face, both at rest and when the patient interacts with others. Watch for variations in expression with topics under discussion. Are they appropriate? Or is the face relatively immobile throughout?

5.Manner, Affect, and Relationship to People and Things.


assess

the patient's affect, external expression of the inner emotional state. Does it vary appropriately with topics under discussion, or is the affect, labile, blunted, or flat? Does it seem inappropriate or extreme at certain points? If so, how? Note the patient's openness, approachability, and reactions to others and to the surroundings. Does the patient seem to hear or see things that you do not or seem to be conversing with

SPEECH AND LANGUAGE

note : the

characteristics of the patient's speech, Quantity


Is

the patient talkative or relatively silent? Are comments spontaneous or only responsive to direct questions? speech fast or slow? speech loud or soft?

Rate
Is

Loudness.
Is

Articulation
Are

of Words.

the words spoken clearly and distinctly? Is there a nasal quality to the speech?

Fluency.
This

involves the rate, flow, and melody of speech and the content and use of words. Be alert for abnormalities of spontaneous speech such as:

Hesitancies and gaps in the flow and rhythm of words

MOOD
Find out about the patient's usual mood level and how it has varied with life events. If you suspect depression, assess its depth and any associated risk of suicide.

The following series of questions is useful, proceeding as far as the patient's positive answers warrant:
Do

you get pretty discouraged (or depressed or blue)? How low do you feel? What do you see for yourself in the future? Do you ever feel that life isn't worth living? Or that you would just as soon be dead? Have you ever thought of doing away with yourself? How did (do) you think you would do it? What do you think would happen after you were dead?

THOUGHT AND PERCEPTIONS

Thought Processes.
Assess

the logic, relevance, organization, and coherence of the patient's thought processes as revealed in the patient's words and speech. Does speech progress logically toward a goal? Here you use speech as a window into the patient's mind. Listen for patterns of speech that suggest disorders of thought processes, as outlined on the table in next slide.

Thought Content.
Follow

appropriate leads as they occur rather than using stereotyped lists of specific questions. You may need to make more specific inquiries. If so, couch them in tactful and accepting terms. When people are upset like this, sometimes they can't keep certain thoughts out of their minds, or things seem unreal. Have you experienced anything like this? In these ways, find out about any of the patterns shown in table in next slide.

Perceptions.
Inquire

about false perceptions in a manner similar to that used for thought content. For example, When you heard the voice speaking to you, what did it say? How did it make you feel? Or, After you've been drinking a lot, do you ever see things that aren't really there? Or, Sometimes after major surgery like this, people hear peculiar or frightening things. Have you experienced anything like that? In these ways, find out about the following abnormal perceptions.

Abnormalities of Perception
Illusions:-Misinterpretations

of real external

stimuli Hallucinations:-Subjective sensory perceptions in the absence of relevant external stimuli.

Insight and Judgment. Insight.

Some

of your very first questions to the patient often yield important information about insight: What brings you to the hospital? What seems to be the trouble? What do you think is wrong? can usually assess judgment by noting the patient's responses to family situations, jobs, use of money, and interpersonal conflicts.

Judgment.
You

COGNITIVE FUNCTIONS

Orientation.
you

can ask quite naturally for specific dates and times, the patient's address and telephone number, the names of family members, or the route taken to the hospital.

Attention.

Digit Span.
to test the patient's ability to concentrate, perhaps adding that this can be difficult when people are in pain, or ill, or feverish. Recite a series of digits, starting with two at a time and speaking each number clearly at a rate of about one per second. Ask the patient to repeat the numbers back to you. If this repetition is accurate, try a series of three numbers, then four, and so on as long as the patient responds correctly. Jot down the numbers as you say them to ensure your own accuracy. If the patient makes a mistake, try once more with another series of the same length. Stop after a second failure in a single series.

Serial 7s.
Instruct

the patient, Starting from a hundred, subtract 7, and keep subtracting 7. Note the effort required and the speed and accuracy of the responses. Writing down the answers helps you keep up with the arithmetic. Normally, a person can complete serial 7s in minutes, with fewer than four errors. If the patient cannot do serial 7s, try 3s or counting backward.

Recent Memory.
This

could involve the events of the day. Ask questions with answers you can check against other sources so you can see if the patient is confabulating (making up facts to compensate for a defective memory).

New Learning Ability.


Give

the patient three or four words such as 83 Water Street and blue, or table, flower, green, and hamburger. Ask the patient to repeat them so that you know that the information has been heard and registered.

HIGHER COGNITIVE FUNCTIONS


Calculating Ability. Abstract Thinking. Proverbs. Similarities. Constructional Ability.

RECORDING YOUR FINDINGS

Mental Status: The patient is alert, wellgroomed, and cheerful. Speech is fluent and words are clear. Thought processes are coherent, insight is good. The patient is oriented to person, place, and time. Serial 7s accurate; recent and remote memory intact. Calculations intact.:- normal person

Mental Status: The patient appears sad and fatigued; clothes are wrinkled. Speech is slow and words are mumbled. Thought processes are coherent but insight into current life reverses is limited. The patient is oriented to person, place, and time. Digit span, serial 7s, and calculations accurate but responses delayed. Clock drawing is good.:- Suggests patient with depression