The Psychiatric Mental Status Examination

The Psychiatric Mental Status Examination

Observe

The Psychiatric History Chief complaint History of Present Illness Past History Medications Family History Social History Review of Systems

Overview General Emotion Thought Cognition Judgment and Insight Reliability

General

General Description Appearance Motor Behavior Speech Attitudes

General Description Appearance Prominent features "such that a portrait ” Eye contact Dress and grooming Age/appearance

General Description Motor Behavior Gait Freedom of movement Firmness and strength of handshake Any involuntary or abnormal movements Pace of movements Purposefulness of movements Degrees of agitation

General Description Speech Rate Spontaneity Intonation Volume Defects

General Description Attitudes How the patient related "degree of cooperativeness“ Evaluator’s attitude

Emotion

Emotions Mood Affect

Mood Definition Patient report versus inference

Mood Euthymic Angry Euphoric Apathetic Dysphoric Apprehensive

Emotion Affect Definition

Affect Appropriateness Intensity Mobility Range Reactivity

Thought

Thought Process Content

Thought Process Manner of organ./form. thought. Stream of Thought Goal directedness/Continuity Other Abnormalities of Thought Process

Thought Process Connectedness/Organization Circumstantiality Tangentiality Loose Association Word Salad

“I was home” “And now I’m here” Start Finish “I felt some chest pain” “So I told my son” “And he called an ambulance”

“I was home” Start “I felt some chest pain” “So I told my son” “My son, maybe you know him” “He’s a doctor too” “He always worries so much” “And now I’m here” Finish “What was my point? Oh, yeah”

“I had five boys ” “Do you have children” “I was home” Start “I felt some chest pain” “So I told my son” “If only he’d settle down and “My son, have He’s some really children” great” “And now I’m here” Finish

Thought Process Other Clanging Echolalia Neologisms Perseveration Thought blocking

Thought Content Perceptual disturbances Delusions Other

The cognitive exam Consciousness Orientation Concentration and attention Calculations Memory Intelligence

55-59 60-64 65-69 70-74 75-79 80-84 85 0-4 22 23 22 22 21 20 19 5-8 26 26 26 26 25 25 23 HS 28 28 28 27 27 25 26 College 29 29 29 28 28 27 27

Insight and Judgment

Insight

Insight Patient’s capacity to Acknowledge/Appreciate illness Associated implications Consequences

Insight Drugs/alcohol Dementia/cognitive problems Psychosis Severe mood problems Somatoform disorders

Judgment

Judgement The process of Consideration Formulation Leading to a Decision Action

Judgement Requires Insight Cognitive functioning Other abstract abilities Conceptualization Forward thinking Appreciation of what “rational people” would do.

Reliability

Reliability Intellect honesty and motivations psychosis/organic defects magnification/understatement

Examples