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- Throughout the exam, the child holds his piece of string up close in his peripheral visual field and flicks it between his fingers. At times the flicking generalizes to his whole hand, which he then rapidly flaps. His mother reports that he often...
- Other points: encompassing preoccupation with string is observed remember: reported encompassing interests must be in past 2 weeks. High pain threshold is observed. Pragmatic language difficulties are clearly observed throughout the exam as the...
- When you say, "Oh no you don't! His mother adds that he is an "easy child" and at school his play consists of lining up of blocks and other toys but when prompted he exhibits the capacity for symbolic play. There are no reported or observed preoccupations and no reported or observed sensory symptoms. There is also observed odd intonation, which makes the item score a 2. Repetitive Behaviors: He reports some compulsive-like behaviors but no motor stereotypy so this item gets a 1. He does exhibit some facial grimacing, which is a sign of an unrelated neurological condition. Preoccupations: There is observation of the patient's unusual preoccupation with noble gases. Because this preoccupation spontaneously encroaches into the clinical exam it is marked as observed and the item score is 2. View fullsize This patient has encompassing preoccupations.
- Search Overview The Mental Status Exam MSE is a psychiatry tool used to objectively, descriptively and thoroughly report a patient's mental state at the time of the clinical interview. It contains primarily information observed by the psychiatrist, not symptoms reported by the patient, with a few exceptions. The MSE is a part of every psychiatric clinical evaluation. It has a standard format just as the physical exam.
- It is interpreted in conjunction with the patient's history, physical exam and laboratory studies, leading to differential diagnosis. Consideration is given to all aspects of mental functioning. The MSE is utilized both for initial diagnosis and for assessing the course of a disorder and its subsequent response to treatment. Objectives Define the individual components of the MSE. Gain an understanding of which components of the MSE can be derived from observation of the patient. Increase your understanding of how to elicit the components of the MSE that require direct questioning of the patient. References Sadock, B. Signs and Symptoms in Psychiatry. Larsen, Paul D.
- Body habitus, eye contact, interpersonal style, style of dress Appearance: attention to detail, attire, distinguishing features e. Motor activity Akathisia: excessive motor activity e. Long-term deficit: advanced dementia, amnesia, dissociative disorder, movement disorder, previous stroke Where were you born? Where were you on September 11, ? What is your name? When were you born? Hallucinations: delirium, dementia, mania, schizophrenia, severe depression, substance use Do you think people are trying to hurt you in some way? Homicidality: mood disorder, personality disorder, psychotic disorder Are people talking behind your back? Obsessions: obsessive-compulsive disorder, posttraumatic stress disorder, psychotic disorder Do you think people are stealing from you? Phobias: anxiety disorder, posttraumatic stress disorder Do you feel life is not worth living?
- Suicidality: depression, posttraumatic stress disorder, substance use Do you see things that upset you? Have you ever heard or seen something other people have not? Have you ever thought about hurting others or getting even with someone who wronged you? Have you ever thought about hurting yourself? If so, how would you do it? Have you ever thought the world would be better off without you? Thought processes Organization of thoughts in a goal-oriented pattern Circumferential: patient goes through multiple related thoughts before arriving at the answer to a question Generally apparent throughout the encounter Anxiety, delirium, dementia, depression, schizophrenia, substance use Disorganized thoughts: patient moves from one topic to another without organization or coherence Tangential: patient listens to question and begins discussing related thoughts, but never arrives at the answer Visuospatial proficiency Ability to perceive and manipulate objects and shapes in space — Ask patient to copy intersecting pentagons or a three-dimensional cube on paper Delirium, dementia, stroke Draw a triangle and ask patient to draw the same shape upside down note: Each of these items may be suggestive of various diagnoses, but none are sufficient to make a diagnosis without a comprehensive clinical evaluation.
- These Tables are not comprehensive, but along with other resources provide relatively good coverage of how and when to administer an MSE and some useful vocabulary words. In addition to the Tables below, Dr. Thom Field from City University of Seattle has a set of training videos. Enough tangential speech from me. The Tables are below: Table 8. Descriptors of Client Attitude Toward the Examiner Aggressive: The client attacks the examiner physically or verbally or through grimaces and gestures. There is a clear effort to work with the interviewer to gather data or solve problems. Frequent head nods and receptive body posture are common. Guarded: The client is reluctant to share information about himself. When clients are mildly suspicious they may appear guarded in terms of personal disclosure or affective expression. Hostile: The client is indirectly nasty or biting. Sarcasm, rolling of the eyes in response to an interviewer comment or question, or staring off into space may represent subtle, or not so subtle, hostility.
Fundamental Guide To Conducting A Mental Status Examination (MSE)
This behavior pattern can be more common among young clients. Impatient: The client is on the edge of his seat. The client is not very tolerant of pauses or of times when interviewer speech becomes deliberate. She may make statements about wanting an answer to concerns immediately. There may be associated hostility and competitiveness. The client may yawn, drum fingers, or become distracted by irrelevant details. The client could also be described as apathetic. Ingratiating: The client is overly solicitous of approval and interviewer reinforcement. He may try to present in an overly positive manner, or may agree with everything the interviewer says. There may be excessive head nodding, eye contact, and smiles. Client voice volume may be loud and voice tone forceful. The client is the opposite of indifferent. Manipulative: The client tries to use the examiner for his or her own purpose. Negativistic: The client opposes virtually everything the examiner says.- The client may disagree with reflections, paraphrases, or summaries that appear accurate. The client may refuse to answer questions or be completely silent. This behavior is also called oppositional. Open: The client openly discusses problems and concerns. The client may also have a positive response to examiner ideas or interpretations. Passive: The client offers little or no active opposition or participation in the interview. Seductive: The client may move in seductive or suggestive ways. The client may make flirtatious and suggestive verbal comments. Suspicious: The client may repeatedly look around the room e. Table 8. Thought Process Descriptors Blocking: Sudden cessation of speech in the midst of a stream of talk. There is no clear reason for the client to stop talking and little explanation. Blocking may indicate that the client was about to associate to an uncomfortable topic.
- It also can indicate intrusion of delusional thoughts or hallucinations. Circumstantiality: Excessive and unnecessary detail provided by the client. Very intellectual people e. Circumstantiality or overelaboration may be a sign of defensiveness and can be associated with paranoid thinking styles. It can also simply be a sign the professor was not well-prepared for the lecture. Clang Associations: Combining unrelated words or phrases because they have similar sounds.
- Clanging usually occurs among very disturbed clients e. As with all psychiatric symptoms, cultural norms may prompt the behavior e. Usually, an idea is stimulated by either a previous idea or an external event, but the relationship among ideas or ideas and events is weak. However, unlike circumstantiality see above , the client never gets to the point. Clients who exhibit flight of ideas often appear over-active or overstimulated e. Many normal people exhibit flight of ideas after excessive caffeine intake—including one of the authors. Loose Associations: Minimal logical connections between thoughts. Bread is the staff of life. I think incest is horrible. It may take effort to track the links. Loose associations may indicate schizotypal personality disorder, schizophrenia, or other psychotic or pre-psychotic disorders.
- Extremely creative people also regularly exhibit loosening of associations, but are able to find a socially acceptable vehicle through which to express their ideas. Mutism: Virtually total unexpressiveness. There may be signs the client is in contact with others, but these are usually limited. Mutism can indicate autism or schizophrenia, catatonic subtype. Neologisms: Client-invented words.
- Unusual words may be taken from popular songs, television shows, or a product of combining languages. Perseveration: Involuntary repetition of a single response or idea. Perseveration is often associated with brain damage and psychotic disorders. Tangential speech: Tangential speech is similar to loose associations, but connections between ideas are even less clear. Tangential speech is different from flight of ideas because flight of ideas involves pressured speech. Word Salad: A series of unrelated words. Word salad indicates extremely disorganized thinking. Clients who exhibit word salad are incoherent. Characteristics of Different Perceptual Disturbances.
- PsychDB is an Amazon Associate and earns from qualifying purchases. Thank you for supporting our site! Why write down a mental status exam over and over again? Often times, the MSE can seem redundant. As a single data point in time, the MSE can sometimes be of limited clinical utility. However, with repeated MSEs, you can begin to develop a picture of how a patient's mental status is changing over time. It is especially helpful when other clinicians read your MSE of a patient in the past and compare to the current presentation.
- Think about how a psychotic individual's MSE might change over the course of a few hours, or how a manic patient might similarly fluctuate. Rate: fast, slow, normal, pressured Volume tone : loud, soft, monotone, weak, strong Fluency and Rhythm: slurred, clear, with appropriately placed inflections, hesitant, with good articulation, aphasic Response latency Emotion Affect vs. Mood Affect is momentary like the weather , while, mood is a prolonged emotion like the climate.
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Take Free Questions on this Article Continuing Education Activity The mental status examination is the physical examination for psychiatry. It is the defining status of the current state of the patient during evaluation. This activity defines mental status examination, describes the components of a mental status examination, how it can be useful in practice, and highlights how it can enhance diagnosis and treatment in psychiatric practice.- Objectives: Identify what a mental status examination is and how it can be used in practice. Describe the components of a mental status examination. Outline an example of mental status examination and how it can be documented. Summarize how a mental status examination can lead to early identification and better management of mental illness to improve patient outcomes. Each part of the mental status examination is designed to look at a different area of mental function to thoroughly capture the objective and subjective aspects of mental illness. Function The mental status examination is organized differently by each practitioner but contains the same main areas of focus. For the purposes of this activity, the mental status examination can divide into the broad categories of appearance, behavior, motor activity, speech, mood, affect, thought process, thought content, perceptual disturbances, cognition, insight, and judgment.
- Cognition can subdivide into different cognitive domains depending on what areas the practitioner determines necessary to assess. Each section below will detail the definition, the proper method of assessment, and how that information has a use in the diagnosis and monitoring of mental illness. Appearance This is a description of how a patient looks at observation. It can be determined within the first seconds of clinical introduction as well as noted throughout the interview. Details to be included are if they look older or younger than stated age, what they are wearing, their grooming and hygiene, and if they have any tattoos or scars. If a patient looks more youthful than their stated age, they may have a developmental delay or dress in an age-inappropriate manner. Patients that look older than their stated age may have underlying severe medical conditions, years of substance abuse, or often years of poorly controlled mental illness.
- Those with poor hygiene and grooming generally denote that in the context of their mental illness that they currently have poor functioning. Those with poor grooming or hygiene may be severely depressed, have a neurocognitive disorder, or experiencing a negative symptom of a psychotic disorder such as schizophrenia. Scars tell stories about old, significant injuries from accidental trauma, harm caused by another individual, or self-inflicted harm. Self-inflicted injuries frequently include superficial cutting, needle tracks from IV drug use, or past suicide attempts. They can also depict gang marks, vulgar imagery, or extravagant artwork.
- If a certain level of trust has been established through the interview, the interviewer can ask about the significance of the tattoos or scars and what story they tell about the patient. Behavior This is a description obtained by observing how a patient acts during the interview. First, it is essential to note whether or not the patient is in distress. If a patient is in distress it may be due to underlying medical problems causing discomfort, a patient having been brought against their will to the hospital for psychiatric evaluation, or due to the severity of their hallucinations or paranoia terrifying the patient. Next, a description of their interaction with the interviewer should be noted. A patient that is not cooperative with the interview may be reluctant if the psychiatric evaluation was involuntary or are actively experiencing symptoms of mental illness. Patients that are unable to be redirected often are acutely responding to internal stimuli or exhibit manic behavior.
- Lastly, it is important to note if the behavior the patient is displaying is appropriate for the situation. For example, it can be considered appropriate for a patient who was brought in via police for involuntary evaluation to be irritable and not cooperative. However, if in that same scenario, the patient was laughing and smiling throughout the interview, it would be considered inappropriate. Motor Activity This describes how a patient is moving and what kinds of movements they have. Motor activity can indicate an underlying mental illness or neurological disorder. Furthermore, as the dopamine system targeted by medications plays a vital role in the movement, it is especially essential in monitoring for medication side effects. One aspect of monitoring is the speed of movements. A patient with depression or a neurocognitive disorder may have psychomotor retardation. For example, if the gait is stiff, shuffling, or ataxic, this may point to an underlying neurological condition.
- One such neurological disorder is Parkinson disease, which is indicated by the cardinal triad is rigidity, bradykinesia, and resting pill-rolling tremor. If these symptoms are noted early by astute observation from the clinician, this can help lead to earlier diagnosis and treatment for such conditions. Practitioners unfamiliar with the condition often overlook catatonia but is critical to differentiate as it requires a separate treatment than the underlying psychosis. Alternatively, a patient with akathisia may be experiencing a side effect from an antipsychotic. Severe sudden rigidity seen after antipsychotic administration is considered an acute dystonic reaction. Although rare, in its most extreme form this can be life-threatening if it involves laryngeal muscles.
Saint Louis University Mental Status Exam | RehabMeasures Database
Thus, the practitioner needs to monitor and treat the slightest of reactions before they become more serious. Tardive dyskinesia is the neurological condition that arises from long-term antipsychotic administration that sustains these extrapyramidal side effects. Speech Speech is evaluated passively throughout the psychiatric interview. The qualities to be noted are the amount of verbalization, fluency, rate, rhythm, volume, and tone. It is of key importance to note the amount a patient speaks. If the patient speaks less than normal, they may be experiencing depression or anxiety.The Mental Status Examination: Key Terms And Resources | John Sommers-Flanagan
Alternately, English may be their first language, but they may have word-finding difficulty due to an altered mental status or a neurocognitive disorder. The rate of speech may be slow in depressed patients or those with a neurocognitive disorder. The pressured rate may indicate acute substance intoxication or that the patient is experiencing a manic episode. The rhythm of speech can provide clues to a number of diagnoses. Slurred speech may indicate intoxication. Dysarthria may indicate a possible motor dysfunction when speaking. Some patients have a neurocognitive disorder or hearing difficulties that may make them unable to control the volume of their voice. It is determined by directly asking the patient to describe how they are feeling in their own words.- For example, a patient may be minimally irritated versus extremely agitated. Some practitioners will also specify whether the affect is appropriate to the situation. Another descriptor clinicians may use to describe affect is whether the affect is congruent or incongruent with what the patient says their mood is. Thought Process This is a description of the organization of the thoughts expressed by a patient. Common descriptions of irregular thought processes are circumstantial, tangential, the flight of ideas, loose, perseveration, and thought blocking. A circumstantial thought process describes someone whose thoughts are connected but goes off-topic before returning to the original subject. On the other hand, a tangential thought process is a series of connected thoughts that go off-topic but do not return to the original topic. Flight of ideas is a type of thought process that is similar to a tangential one in that the thoughts go off-topic, but the connection between the thoughts is less obvious and more difficult for a listener to follow.
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