Mental status examination• Consciousness• Rapport• General appearance and motor behavior• Attention and concentration• Language functions• Orientation• Memory• Abstract ability• Judgment• General information• Calculation• Intelligence 2
Mental status examination• Thought o Stream o Form o Possession o Content• Mood and Affect• Perception• Other psychotic phenomena• Insight 3
Thought Stream- (Progress) o Spontaneity o Volume o Tonal fluctuations o Retardation o Pressured speech 4
• Poverty of speech: Restriction in amount, brief, concrete, unelaborate• Poverty of content: Long reply, adequate speech, less content 5
• Flight of Ideas:• Thoughts follow each other rapidly• No general direction of thinking• Connections between successive thoughts appear to be due to chance and can usually be understood (alliteration, clang)• E.g.: I live in Birmingham, Kingstanding, see the king, sing sing, bird on the wing…. 6
• Prolixity: Ordered flight of ideas• Speed not as fast• Despite irrelevances, able to return to the task• Circumstantiality:• Unnecessary and trivial details, but finally the point is reached• Goal is never completely lost 7
• Inhibition or retardation:• Train of thought is slowed down• Number of ideas, images decrease• Usually experienced as difficulty in making decisions, lack of concentration or loss of clarity of thinking• Depression 8
Mood and affect• Mood- Prolonged subjective prevailing state or disposition;• Sad, happy, worried, angry, fearful;• Depth; predominant mood over the last 1 week• Affect- Objective state; range, reactivity, mobility and communicability;• Depressed, elated, euphoric, anxious, perplexed, blu nted 9
Other psychotic phenomena• Somatic passivity- bodily sensations especially sensory symptoms experienced as imposed by external force• Made action, affect and impulse• Negative symptoms• Depersonalization and derealization 10
Insight• Awareness,• Attribution and• Acceptance of intervention 11
6 grades o Grade 1: Denial o Grade 2: Slight awareness but denying it at the same time o Grade 3: Awareness present but attribute it to external factors 12
o Grade 4: Awareness present but attribute it to something unknown, acceptanceo Grade 5: Intellectual insight- Awareness present, attributes it to psychological causes but does not apply it to future experienceso Grade 6: True emotional insight 13
Case summary• Basic data and socio-economic profile• Presenting complaints (including HOPI)• Relevant past, family, developmental, occupational history etc.• Pre-morbid personality• Relevant M.S.E. findings• Relevant Physical examination findings• Diagnosis• Management 14
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