Mental Status Examination: Sweekaar Academy of Rehabilitation Sciences, Secunderabad
Mental Status Examination: Sweekaar Academy of Rehabilitation Sciences, Secunderabad
Mental Status Examination: Sweekaar Academy of Rehabilitation Sciences, Secunderabad
Secunderabad.
Mental Status Examination
• The Mental Status Exam, is just that, an exam. It is your
chance to observe the patient, and record for the reader an
accurate account of your observations of what the patient was
like at the time you saw them. It is not a place for
summation, and the use of terms like “normal” or “within
normal limits” to summarize aspects of the exam is inadequate
and inappropriate.
• The purpose of the exam is to give a "snapshot" of the patient
as he presented during the interview.
• It is cross sectional, but it is not limited to one point—the
examiner assesses throughout the interview, and then records
the data in a structured format.
Components of the Mental Exam
• The full mental status exam is a systematic
check of emotional and cognitive functioning.
• Four components:
A = Appearance
B = Behavior
C = Cognition
T = Thought Processes
Complete Mental Status Exam
Appearance and Behavior Thought and Perceptions
Appearance Thought Processes
Posture and Motor Behavior Thought Content
Dress, Grooming and Personal Perceptions
Hygiene Insight
Facial Expression Judgment
Attitude, Manner, Rapport
elated).
obsessional traits.
• A high degree of attention to fashion may suggest narcissistic
usually also the failure to take food or fluid. Accordingly, the life of the
with the arms out sideways in the middle of the front path, but it is usually
to sit or stand.
• ‘Catatonic Rigidity’ in which a posture is maintained against the
position of the patient’s limbs, and in the process the limbs feel
sometimes minutes.)
Attitude To Interviewer
• Form of the speech rather than content is considered here. Do they say much
or little, speak loudly or quietly, talk spontaneously or only in answer, slowly
or quickly, hesitantly or promptly, to the point or wide of it, coherently,
anxiously, discursively, loosely with interruptions, with sudden silences, with
frequent changes of topic? Record content- do they use strange words or
syntax, rhymes, puns, clang associations? Write examples of these verbatim .
MOOD
• Mood has been defined (Kaplan and Saddock, 1991) as a
pervasive and sustained emotion, subjectively experienced and
reported by the patient, as well as observed by others.
• Emotional state recorded in the patient’s own words (e.g.,
“depressed,” “anxious,” “scared,” “happy,” “angry”).
• As mood has a subjective component, it is necessary to
enquire. Must be followed by a comment as to whether this is
consistent with the interviewer’s finding.
MOOD
• Direct question such as 'How do you feel in yourself?', 'What is
your mood like ?', 'How about your spirits?'.
the constancy of the mood during the interview, those influences that
specify any indications that the patient is concealing their true feelings.
Assessment of mood on various dimension: A particular mood is not necessarily
individual is very difficult but there are some dimensions on which mood can be
(a) Quality: mood can be characterized as depressed, dysphoric, elevated irritable. Quality
of mood can be assessed by asking the patient “how do you feel?” & “And what is
your mood?”
(b) Stability: to what extent does mood remain constant over time. It can be assessed by
(c) Reactivity: ability to react emotionally to the innate changes in the environment and it
is assessed by asking “Does your mood ever change?” or “When does your mood
change?”
(d) Intensity: A degree to which a emotion is experienced and is clinically
assessed by asking “what is it like to feel this way?” or “on the scale of 0-
(e) Duration: Duration is regarded as the basis for the experience of the
passage of time. It can be assess by asking “How long have you felt this
way?”
• Do you ever feel you'd be better of dead and away from it all?
• Have you made any arrangements for your affairs after your death?
WARNING SIGNS OF SUICIDE
• Prior suicide attempts
• Depression
• Social withdrawal
• Self-mutilation
• Anorexia
• Mobility
• Reactivity
• Assessment of affect
• There are some qualities of sad and happy mood which are as follows-
c) Exaltation: feeling of intense elation and grandeur; seen in sever mania((Taylor & Vaidya,
2006).
d) Ecstasy: intense sense of rapture or blissfulness; seen in delirious and stupors mania.
quality of emotion and the situation. (Taylor & Vaidya, 2006). Paramimia refers as
expression of an emotion that is the exact opposite of what is expected under the
• Appropriate (normal) affect: The affect suggests the full range and
• Flat affect: When the affect is flat, there is little if any change in
• Types of hallucinations:
– Visual hallucinations
• Suicidal ideation,
• Homicidal ideation,
• Paranoid content,
• and Phobias.
• Concentration
• Calculation
• Memory: Registration
– ability to repeat information immediately
• Short term recall: debatable how long to wait. Should
introduce other information in the interim
• Long term
brain disorders)
• To test concentration and attention, ask the patient to tell the days
"world", their own last name, or the ABC's backwards. Give digits
life with that given by others, and by examining the patient's account for intrinsic
evidence of gaps or inconsistencies. Record memory for recent events whether there
• Short-term (immediate) memory test: The most common test is to ask the patient to
repeat sequences of digits. Three digits are given first and the patient is asked to
repeat them. If this is performed successfully, four digits are given and so on, until
three or four unrelated words. Patients are advised that their memory should
be tested, that they will be given some words to remember, and that later in
the interview they will be asked to recall them. The words are said at the rate
of about one word per second. The patient is asked to repeat them, to ensure
that they have been registered properly. The interview then proceeds and the
patient is distracted and must attend to other material. Some minutes later the
• Remote memory : The names and dates of birth of the patient’s children may
also be available, as might the patient’s wife’s (in the case of a married male)
response to tests? How does the patient regard them and other details
• Requires
– Insight
– Cognitive functioning
– Other abstract abilities
– Conceptualization
– Forward thinking
– Appreciation of what “rational people” would do.
JUDGMENT
• Judgment: appropriate responses to social situations. Provide a
common scenario and ask what they would do (e.g. "If you found a
letter on the ground in front of a mailbox, what would you do with
it?"). What do they propose to do when they have left the hospital
or clinic? What is the patient's attitude to supervision and care?
present illness, & the course Then list the main symptoms & signs that
negative findings, but include those that help to exclude other possible
diagnoses. These basic data are derived chiefly from the history of the
present illness, the mental state, & physical examinations, & are used to
determine the diagnosis in the next section. Note that this is not usually the
diagnosis and to rule out the alternatives, and also list any that you think are required
to improve your understanding of the etiology . Give reasons for investigations if they
are not self-evident. Remember that the thorough investigation of an illness requires
effective enquiry into all the relevant domains of the bio-psychosocial model; hence
• Treatment : Outline the treatment plan that you wish to follow. This should stem
logically from your discussion of the etiology as well as from the diagnosis.
with regard to both the symptoms and subsequent function and the risk of relapse.
When do we do a full mental status exam?