The Mental Status Exam

The mental status exam (MSE) is akin to the psychiatric physical exam, with observations focused on visible the impact of the person's mind. Envision as approaching someone from far away - what do you notice first, and as they approach?

Make sure questions are tailored to people's educational level. Some questions here are for screening of cognition (ie dementia); use appropriately and inoffensively. Record the time the MSE was carried out, as things can change rapidly.

 

 

general appearance and behaviour

body weight, apparent vs chronological age, facial expression

 

speech

 

All qualities of a patient's speech should be noted, including:

Language comprehension is also important. Assess repetition by picking a sentence which isn't affected by hearing loss - "today is a nice day". Also consider querying vocabulary by pointing to objects in the room. Reading and writing may also be relevant to assess.

 

 

emotional state

 

Mood is the sustained emotion a patient reports; "how's your mood?" or "how do you feel most days?" are good initial points. Record in patient's own words. Determine the intensity, duration, and frequency of any negative episodes, along with mood stability.

 

Affect is the observed emotion of the patient. Qualities include: euthymic (normal), depressed, elevated (hypomanic), anxious, expansive (contagiously cheerful). Range of emotions include: full, restricted, blunted, flat. stability: fixed, labile.

Mood congruence, appropriateness, and intensity

 

 

thought process

 

 

thought content

suicidal/homicidal ideation

obsessions: recurrent and persistent thoughts, impuses, or images which are intrusive or inappropriate

pre-occupations or ruminations: throughts at length

 

overvalued ideas: unusal/odd beliefs that are not yet delusions

magical thinking: belief that thinking something will make it happen; normal in kids

ideas of reference: similar to delusions of reference, but reality of the belief is questioned

delusions: fixed, falsed belief out of keeping with a person's background and firmly held despite incontroverable evidence to the contrary

thought insertion/withdrawal/broadcasting, or delusions of control: first rank symptoms

 

 

perception

"any of those different experiences"

hallucinations

illusions: misinterpretation of a real, external stimulus

depersonalization

derealization - feeling that world is unreal

 

 

cognition

The mini-mental status exam (MMSE) is a common means of assessing cognitive function.

level of consciousness and orientation to time, place, and person.

attention and concentration: months of the year backwards is common.

memory: immediate, recent, and remote. If necessary, use cues to discover if the problem is with encoding or retrieval.

visuospatial capacity:

manipulation of acquired knowledge: look for abstract thought - ie "an apple and an orange are both..."

 

 

insight and judgment

Insight is the ability to realize one has a physical or mental illness and to understand its implications.

Judgment is the ability to understand relationships between facts and draw conclusions that determine one's action

 

 

other frontal lobe tests