MENTAL STATUS EXAMINATION

1
MENTAL STATUS EXAMINATION

• Examination of current functioning
• Symptom driven
• Brief and extended

2

• MSE has many parts which can be arranged in many
  patterns based upon need and preference
• Choose your own format and can be semi-
  structured
• Made up of your observations and objective
  questions to the client
• Behavior aspects are observed
• Cognitive aspects are tested

3
BEHAVIORAL ASPECTS

• Physical characteristics
• Gender
• Age (stated and apparent)
• Ethnicity
• Physical characteristics and body type
• Position/ posture record
• Abnormal traits natural or acquired
• Eye contact

4

• Alertness and levels of consciousness
• Full levels or awareness and ability to respond
  to a variety of situations
• Hypervigilance or hyperarousal
• Decreased levels of consciousness stupor,
  drowsy, comatose, lethargic

5

• Clothing and attire
• Causal, contemporary, or out of date
• Unusual clothing or colors
• Hairstyle, color
• Grooming

6

• Motor activity
• Dominant body activity
• Excessive motion psychomotor agitation
• Hand motions and gestures (picking or scratching)
• Mannerisms unnecessary behaviors which are part
  of goal directed activity
• Posturing
• Negativism or turning away
• Waxy flexability
• Tics

7

• Facial Expression
• Fixed or motionless
• Facial tics
• Chewing and lip smacking
• Pained
• Glancing around

8

• Voice
• Volume, pitch and clarity
• Grammar and dialect
• Impediment
• Tone friendly, hostile, afraid?

9

• Attitude toward you the examiner
• Cooperative or obstructionistic
• Friendly or hostile
• Open or secretive
• Involved or apathetic
• Changes in attitude

10
MOOD AND AFFECT

• Mood is the way a person claims to be feeling
• Affect is the way a person appears to be
  feeling
• Types of mood
• Normal calm, euthymic, pleasant, unremarkable
• Angry belligerent, hostile, sullen, frustrated
• Euphoric cheerful, elated, happy
• Apathetic bland, dull
• Dysphoric despondent, distraught, hopeless
• Apprehensive anxious, fearful, frightened,
  panicky, tense, worried

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• Affect
• Intensity heightened, exaggerated, blunted,
  flat
• Range restricted, broad
• Appropriateness congruence to stated mood
• Mobility or changeability. Labile/volatile,
  constricted, fixed or immobile

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FLOW OF THOUGHT

• Speech reflects thought
• Associations, or the way words are put together
• Rate and rhythm of speech

13

• Associations
• Spontaneity
• Loose associations flight of ideas,
  tangentiality, poverty, blocking, clang,
  echolalia, neologisms, preservation, word salad

14

• Rate and Rhythm of speech
• Push of speech
• Latency of response (pauses)
• Stuttering
• Circumstantial
• Distractibility
• Monosyllabic
• Mutism

15
COGNITIVE ASPECTS

• Introduction of exam routine, time involved,
  positive feed back when appropriate
• Thought and ideation content
• Perception
• Cognition
• Insight and judgment

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THOUGHT and IDEATION CONTENT

• Delusions a fixed false belief that cannot be
  explained by education or culture (see page 119
  in text for good examples). These beliefs may be
  clear from the start or develop through
  questioning
• Delusions can be first dimension related to
  reality not willing to accept alternatives to
  environmental events
• Delusions can be second dimension related to
  content somatic, persecutory, grandiose, thought
  broadcasting, jealousy, death, ideas of reference

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• Obsessions Persistent ideation which is
  ego-dystonic
• Compulsions Acts performed repeatedly even
  though understood as inappropriate
• Phobias Unreasonable and intense fear associated
  with some object or situation
• Thoughts of violence HI or SI
• Illusions Misrepresentations of actual sensory
  stimuli

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• Depersonalization feeling of identity loss
• Ideas of reference
• Derealization feeling reality has changed
• Hallucinations false sensory perceptions
  occurring in the absence of any related external
  sensory stimulus (auditory, visual, tactile,
  gustatory, olfactory)

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COGNITION

• Orientation time, place and person
• Attention and concentration spelling backward,
  serial 7s, recitation of months or weeks
• Registration repeat a short list of information
  as in three or five words
• Short term memory recall of three items over a
  few minutes
• Long term memory presidents
• Abstract thought (tests executive functioning)
  proverbs, similarities

20

• Visuoconstructional ability drawing or copying
  figures such as a clock or a map (abilities are
  necessary for everyday functioning)

21
INSIGHT AND JUDGEMENT

• Insight self understanding regarding current
  circumstances
• Judgment ability to decide on the appropriate
  course action to achieve realistic goals