The Mental Status Exam

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The Mental Status Exam
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Key Elements

• Observational components
• Components obtained via questioning
• Formal cognitive examination
• Elements
• Useful standardized tests

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Observational Components

• Appearance and behavior
• Mood and Affect
• Speech
• Thought processes

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Appearance and Behavior

• Level of consciousness
• Ethnicity, gender, apparent age
• Hygiene and clothing
• Motor activity, abnormal movements
• Facial expressions
• Relationship to interviewer

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Mood and Affect

• Type
• Anger
• Anxiety
• Depression
• Euphoria
• Lability
• Appropriateness
• Intensity

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Speech

• Rate
• Rhythm
• Pressured
• Latencies, thought blocking
• Circumstantial
• Extraneous sounds, verbal tics
• Use of language
• Neologisms

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Thought Processes

• Associations
• Loose
• Flight of ideas
• Tangentiality
• Blocking
• Incoherence
• Perseveration

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Components Obtained via Questioning

• Thought content
• Cognition

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Thought Content

• Delusions
• Paranoid
• Grandiose
• Somatic
• Thought broadcasting
• Thought control
• Mood congruent vs. mood incongruent

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Thought Content

• Hallucinations
• Auditory
• Visual
• Tactile
• Olfactory
• Anxiety symptoms
• Suicidal ideation
• Homicidal ideation/thoughts of violence

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Cognition

• Attention and concentration
• Orientation
• Language
• Memory
• Immediate, recent, remote
• Verbal and visual
• Abstraction
• Insight
• Judgment
• Reading and writing

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Standardized Cognitive Tests
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Standardized Cognitive Tests

• Brief, easy to use, known comparators
• Limitations
• Miss subtle deficits
• Examples
• MMSE
• SLUMS
• Cognistat
• Others