MENTAL STATUS EXAMINATION NCMH Lecture 1

- The sum total of examiner’s observations and - Statements about the patient’s mood should
impressions of the psychiatric patient at the time include depth, intensity, duration, and fluctuations
of the interview. - Common adjectives: depressed, euphoric, empty,
- Can change from day to day or hour to hour guilty, hopeless and frightened
- A description of the patient’s appearance, speech, a - Can be labile, fluctuating or alternating rapidly
actions, and thought during the interview between extremes
- even when a patient is mute, is incoherent, or
refuses to answer questions, the clinician can Affect
obtain a wealth of information through careful - The patient’s present emotional responsiveness,
observation inferred from the patient’s facial expression,
including the amount and the range of expressive
MSE Parameters behavior
- General Description - May or may not be appropriate or suitable with
- Appearance patient’s emotional responses in the context of the
- Overt Behavior subject the patient is discussing
- Attitude - Can be described as within nor mal range
- Mood and Affect (euthymic), constricted, blunted or flat
- Speech
- Thinking Speech
- Form - Describes the physical characteristics of speech in
- Content terms of its quantity, rate of production, and
- Perceptions quality
- Sensorium and Cognition - Maybe described as talkative, unspontaneous, or
- Alertness normally responsive to cues from the interviewer
- Orientation (Time, Place, Person) - Can be rapid or slow, pressured, hesitant,
- Concentration emotional, dramatic, monotonous, loud, whispered,
- Memory (Immediate, Recent, Long Term) slurred, or mumbled
- Calculations - Speech impairments, such as stuttering, and any
- Fund of Knowledge unusual rhythms (termed dysprosody) or accent
- Abstract Reasoning should be noted
- Insight
- Judgment Thought Process (Form of Thinking)
- Be aware that assessing thought is dependent
General Appearance greatly on its manifestation through speech and
- Describes the patient’s appearance and overall thus also how much of though disorder is in truth
physical impression, as reflected by posture, ‘speech disorder’
clothing, and grooming - Overabundance vs. a poverty of ideas or rapid
- Examples of items: body type, posture, clothes, thinking vs. slow or hesitant thinking, vague or
grooming, hair, and nails empty:
- Common terms: healthy, sickly, ill at ease, poised, - Do the patient’s replies really answer the
old looking, young looking, disheveled, childlike, questions asked, and does the patient have the
and bizarre capacity for goal-directed thinking?
- Signs of anxiety are noted: moist hands, perspiring - Are there responses relevant or irrelevant?
forehead, tense posture, wide eyes - Is there a clear cause-and-effect relation in the
patient’s explanations?
Over Behavior and Psychomotor Activity - Does not describe what the person is thinking but
- Describes both the quantitative and qualitative how the thoughts are formulated, organized, and
aspects of the patient’s motor behavior expressed
- Includes: mannerisms, tics, gestures, twitches,
stereotyped behavior, hyperactivity, agitation, Formal Thought Disorders
combativeness, rigidity, gait. - Circumstantiality: over inclusion of trivial or
- Describe restlessness, wringing of hands, pacing, irrelevant detail that impede the sense of getting to
and other physical manifestations the point
- Note psychomotor retardation or generalizaed - Tangentiality: in response to a question, the
slowing of body movements patient gives a reply that is appropriate to the
general topic without actually answering the
Attitude Towards the Examiner question.
- can bedescribed as: cooperative, friendly, attentive, - Doctor: have you had any trouble sleeping
interested, frank, seductive, defensive, hostile, today?
playful, evasive, or guarded; any number of other - Patient: I usually sleep in my bed, but now I/m
adjectives can be used sleeping on the sofa.
- record the level of rapport established - Derailment: (synonymous with loose associations)
A breakdown in both the logical connection
Mood and Affect between ideas and the overall sense of goal-
Mood directedness. The words make sentences, but the
- A pervasive and sustained emotion that color the sentences do not make sense
person’s perception of the world

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MENTAL STATUS EXAMINATION NCMH Lecture 2

- Flight of ideas: a succession of multiple Questions Used to Test Cognitive Functions

associations so that thoughts seem to move 1. Alertness
abruptly form idea to idea; often (but not - Observation
invariably) expressed through rapid, pressured 2. Orientation
speech - What is your name?
- Clang associations: thoughts are associated by the - Who am I?
sound of words rather than by their meaning - What place is this? Where is it located?
(e.g.,through rhyming or assonance) - What city are we in?
- Neologism: the invention of new words or phrases 3. Concentration
or the use of conventional words in idiosyncratic Starting at 100, count backward by by 7 or 3
ways Say the letters of the alphabet backward
- Perseveration: repetition of out of words, phrases, starting with Z
or ideas Name the months of the year backward
- Thought blocking: a sudden disruption of thought starting with December
or a break in the flow of ideas 4. Memory
Immediate
Though Content (Mental Trends) Repeat these numbers after me:
- refers to what a person is actually thinking about: 1, 4, 9, 2, 5
ideas, beliefs, preoccupations, a=obsessions and Recent
compulsions What did you have have for breakfast?
- thoughts occurring to the patient What were you doing before we started talking this
- inferred by what the patient spontaneously morning?
expresses as well as responses to specific Remember three things spoken to the patient after 5
questions minutes.
- Delusions: false belief, based on incorrect inference Long Term
about external reality, not consistent to patient’s Where did you study elementary?
intelligence or cultural backgrounds and cannot be Who was your teacher?
corrected by reasoning or contradictory proof or 5. Calculations
evidence If you buy something that costs P3.75 and you pay a
- can have themes that are persecutory or P5 bill, how much change should you get?
paranoid, grandiose, jealous, somatic, guilty, What is the cost of three oranges if a dozen oranges
nihilistic, or erotic cost P24.00?
- Overvalued idea: false or unreasonable belief 6. Fund of knowledge
sustained beyond the bounds of reason held with Who is the leader of KKK?
less intensity than a delusion What body of water lies between South America and
- Preoccupations of thought: centering of though Africa?
content on a particular idea, associated with a 7. Abstract Reasoning
strong affective tone Which one does not belong in this group: a pair of
e.g., paranoid trend or a suicidal or scissors, a canary, and a spider? Why?
homicidal preoccupation How are an apple and an orange alike?
- Obsession: persistent and recurrent idea, thought,
or impulse that cannot be eliminated from Insight
consciousness by logic or reasoning; obsessions - a patient’s degree of awareness and understanding
are involuntary and ego-dystonic about being ill
- Compulsion: pathological need to act on an - 6 levels of insight
impulse that, if resisted, produces anxiety; 1. Complete denial of illness
repetitive behavior in response to an obsession or 2. Slight awareness of being sick and needing help,
performed according to certain rules, with no true but denying it at the same time
end in itself other than to prevent something from 3. Awareness of being sick but blaming it on others,
occurring in the future. on external factors, or on organic factors
4. Awareness that illness is caused by something
Perception unknown in the patient
- Includes hallucination, illusions, and feelings of 5. Intellectual insight: admission that the patient is
depersonalization and derealization (extreme ill and that symptoms or failures in social
feelings of detachment from the self or the adjustment are caused by the patient’s own
environment) particular irrational feeling or disturbances
- The sensory system involved (e.g., auditory, visual, without applying this knowledge to future
taste, olfactory, or tactile) and the content of the experiences
illusion or the hallucinatory experience should be 6. True emotional insight: emotional awareness of
described the motives and feelings within the patient and
the important persons in his or her life, which can
Sensorium and Cognition lead to basic changes in behavior
- portion that seeks to assess brain function,
including orientation and memory, concentration, Judgment
intelligence, and capacity for abstract thought - During the course of history taking, the
psychiatrist should be able to assess many aspects
of the patient’s capability for social judgment

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MENTAL STATUS EXAMINATION NCMH Lecture 3

- Test Judgment
- Does the patient understand the likely outcome
of his or her behavior, and is he or she
influenced by his understanding?
- Can the patient predict what he or she would do
in imaginary situations (e.g., smelling smoke in
a crowded movie theater)?

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