D R . J A M E S M . A L O , R N , M A N , M A P , P H D

Mental Status Examination

AppearanceYes, appearance is justas straightforward as itseems. For examplehow does your patientlook, smell, behave, orspeak .

What can you say aboutthis patient?

Age Grooming

Sex Dress

Build Activity

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AppearanceHow the patient relatesto the interviewer isalso important.

Is the patientwithdrawn, cooperative,distant, shy, relaxedcautious, hostile orFRIGHTENED?

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SpeechSpeech patterns can beassessed for speed.Some illness conditionshave concomitantspeech patterns. One ofthose patterns is acharacteristic rate.

� Rate and amount¡ Normal (culturally derived)¡ Pressured –rapid speech¡ Slow-difficulty finding words¡ Impoverished or paucity of speech

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SpeechSometimes calledprosody-rhythm alsoalludes to the quality ofthe voice

� Rhythm¡ Stuttering¡ Monotone¡ Slurred¡ Mumbled¡ Poor articulation¡ Clear¡ Coherent

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SpeechThe softness ofloudness of voice canindicate sensoryproblems, e.g.,deafness, moodproblems, e.g.,depression or mania; orcognitive problems,e.g., dementia

� Volume¡ Soft-spoken¡ Loud¡ Poor articulation

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Speech

� Spontaneity¡ Animated- excited¡ Little detail¡ No speech

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Eye contactUsually included in theAppearance section, becautioned to respect thecultural componentof eye contact.

No eye contact isconsidered rude insome cultures anddirect eye contact isconsidered rude inother cultures

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Mood andAffectMood- the subjectivestate of a person or howthe person “feels”

.

� Mood¡ Euthymic (normal)¡ Euphoric (elated)¡ Dysphoric (sad)

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Mood

� Some other recognized subjectivefeelings (mood) are:

� Anxious� Calm� Irritated� Angry

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AffectAffect is the outwarddisplay of mood andcan be judged on fourparameters:

Range

Intensity

Lability

Appropriateness

� Range¡ The degree of variation in emotion¡ Expansive¡ Normal¡ Restricted – Dull- Blunted¡ Flat

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IntensityEmotional power beingemitted from thepatient

� Intensity¡ High Low

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LabilityMoodiness or the“swing” of moods

Outside of highlyemotional events suchas weddings, labileaffect can be noted insome diseaseconditions, e.g. chronicalcoholism, or bipolardisorder 1.

� Labile affect¡ Extreme change in a short period of

time¡ Laughing and crying at the same time

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AppropriatenessAffect- the outwarddisplay of mood –should be congruentwith mood andcircumstances.

� The patient below says, “I am sohappy today.” His affect isinappropriate to his mood andcircumstance.

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OrientationAreas of orientation arePerson

Place

Time

and

Circumstance

� Failure of orientation usuallyoccurs in the following sequence:

� Time� Place� Person

Never document person is orientedtimes three. Properdocumentation is person isoriented to person, place, andtime.

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CircumstanceNot understanding thatthis presentation is alesson on the mentalstatus exam andthinking it is a group ofcartoons is amisunderstanding ofthe circumstance orCONFUSION

� Confused is the attribute given topersons who become unaware ofthe circumstances surroundingthem.

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CONFUSIONSometimes calleddisorientation tocircumstance

Confusion is quitecommon in high anxietystates or in delirium,dementia, or mooddisordered states

� So, a person can be oriented toperson, place, and time and stillbe confused.

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Intellectualand CognitiveFunctioningTwo closely relatedattributes

Intelligence isconsidered to be

Average

Above Average

Below Average

� Intellectual Capacity is based on:¡ Vocabulary¡ Ability to understand complex concepts¡ General fund of information

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CognitionCognitive ability isusually examined bytesting

Level of Abstraction

Executive Function

Memory

� Level of Abstraction� Don’t cry over spilled milk.

� Does the patient interpretliterally?

� How are an orange and a bananaalike?

� Both are fruit or both are in theworld?

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ExecutivefunctionThe ability to make asequence or plan

� Executive function- How to studyfor an exam in NUR 103

¡ 1. Order a latte grande¡ 2. Add extra sugar¡ 3. Sit by the library¡ 4. Study for the exam¡ 5. Get a good night’s sleep

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MemoryThe first memory to belost is recent.

� Memory¡ Recent -within the relative past short

time e.g. breakfast¡ Remote – not in the relative past short

time e.g. name of first boyfriend¡ Recall-ability to say one’s SS #¡ Retain- ability to learn and then recall

new information, e.g., nurse’s name.

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A special caseConfabulation issometimes used bypersons with braindamage or dementia.

Confabulation is theconstruction of unrealevents which seem real,even to the person whoconstruct them, yet thee vents are unreal.

� Confabulation

� “I went out on a date with BradPitt last night.”

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ThoughtProcessesThe only way toexamine is by analyzingspeech:

Tangentiality

Circumstantiality

Flight of Ideas

Blocking

Loose Associations

Perseveration

� Tangentiality– digressing, oftenmultiple times, during therelating of an episode or story.Noted in states of high anxiety

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ThoughtProcessesCircumstantiality isnote d with personswho are highly anxious,suffer from Bipolardisorders, or fromDementia

� Circumstantiality- an unnecessarytelling of details when relating anepisode or story.

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ThoughtprocessesBlockng is noted in highanxiety states,depressive states, andin thought disorderedconditions

� Blocking---train of thought stopsin mid sentence.

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Flight of IdeasMoving quickly fromone idea to another in avery short period oftime. Often noted inpersons with Bipolardisorder

� Flight of Ideas

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ThoughtProcessesLoose associations aremost often noted inpersons suffering fromSchizophrenia

� Loose Associations- words spokenat random and not in sentences

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ThoughtProcessesPerseveration- theinability to move on toanother topic or thecontinual return to thesame topic

� Perseveration� Now is the time for every good

man to come to the aid of thecountry. Now is the time for everygood man to come to the aid ofthe country. Now is the time forevery good man to come to the aidof the country. Now is the time forevery good man to come to the aidof the country. Now is the time forevery good man to come to the aidof the country. Now is the time forevery good man to come to theaide of the country

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ThoughtContent

Delusions- false beliefs

Life themes-recurrentbeliefs

Control-degree ofcontrol over one’sthoughts

� Delusions—false beliefs� --Ideas of reference¡ (People are talking about me)

� --Paranoid¡ (People are after me)

� --Grandeur¡ (I am the President of ..)

� --Nihilistic¡ (My muscles are disappearing)

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� Life themes-Recurrent beliefs� --Loss� --Anger� --Victimization

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ThoughtControlThese disorders ofthought are often foundin persons who sufferfrom schizophrenia

� Thought Control¡ Thought broadcasting (thinking one’s

thoughts are being heard by others)

¡ Thought insertion (thinking one’sthoughts are being inserted bysomeone or something else)

¡ Thought withdrawal (thinking one’sthoughts are being stolen)

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PerceptualProblemsAll senses can beinvolved in sensoryperceptual problems

Hallucinations

Illusions

� Hallucinations- the experiencingof a perception in the absence of astimulus

� Auditory (hearing voices)� Visual (seeing people of objects)� Tactile (feeling things)� Gustatory (tasting things)� Olfactory (smelling aromas)

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Illusions- common infatigue and delirium

� Illusions --the experiencing of amis-perception

� Auditory (hearing a sound andthinking it is a knock on the door)

� Visual (seeing a towel andthinking it is a cat)

� Tactile (feeling a touch andthinking it is a burn)

� Gustatory (tasting onions andthinking they are chocolate)

� Olfactory (smelling fish andthinking it is apple pie)

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Finalcomponents ofthe MSEJudgment

Insight

Impulse control

� Judgment- stable quality ofpersons decision making

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� Insight- the ability for one tounderstand his or her condition.

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Impulsecontrol

� Impulse control-the ability to talkout rather than act out.

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“Learners’ are learning from experiences they haveexperienced which cannot be taught by teachers except

themselves.”- Dr. James M. Alo

Thank you.

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