Mental status examination Maja (1) (1).pptxAmitSherawat2
The Mental Status Examination [MSE], also referred to as Mental State Examination, is an integral and essential skill to develop in a psychiatric evaluation. Conducting an accurate MSE helps elicit signs and symptoms of apparent mental illness and associated risk factors.
Mental status examination Maja (1) (1).pptxAmitSherawat2
The Mental Status Examination [MSE], also referred to as Mental State Examination, is an integral and essential skill to develop in a psychiatric evaluation. Conducting an accurate MSE helps elicit signs and symptoms of apparent mental illness and associated risk factors.
The Mental Status Examination Uniformed Service University o.docxcherry686017
The Mental Status Examination
Uniformed Service University of the Health Sciences
Department of Psychiatry
Objectives: At the completion of the class, students should be able to:
1. Describe the main components of the mental status examination
2. Compose a mental status examination based on a patient observation and
interview
3. Recognize the difference between thought process and thought content
4. Estimate degree of psychopathology based on the mental status examination
5. Document adequate safety (suicidal and homicidal) assessment of each
patient
The Mental Status Examination is an integral portion of the psychiatric interview.
It serves as a “snapshot” of the person you are evaluating. It should include all of the
pertinent observations and findings you accomplish during your encounter with the patient.
Not only is it important for describing the “state” of the patient, it is an important tool that
can help substantiate a diagnosis, convey information to another provider, and assist in
determining most appropriate step in treatment.
Based on the following sections, the mental status examination may appear quite
involved and complicated. This is not the case. As you will see, much of the information
for the mental status examination is obtained from the natural course of the interview.
It is important to state that the goal is not pinpoint the absolute correct term to
describe an observation. The beauty of the mental status examination is, even if you do
not know the specific term, you can use your own words and observations.
APPEARANCE
Yes, this is as straightforward as it sounds – this section describes how the patient
looks, smells, behaves, speaks, establishes eye contact, etc. If this section is thorough
enough, a reader of your mental status exam should be able to pick out the person out of a
room. The mental status exam starts when you first set eyes on the patient. The following
is a sample of items that should be included in the APPEARANCE section:
Ethnicity
Apparent age (younger, older, or appeared stated age)
Sex
Coordination/gait/notable movements
Adherence to social conventions (i.e., shakes hands, military bearing)
Build (Average, underweight, emaciated, petite, thin, obese, muscular)
Grooming (Good, poor, adequate, immaculate, neglected)
Dress (Casual, stylish, mismatched items, formal, tattered, appropriate
for particular setting)
Psychomotor activity (Described as increased in the case of agitation;
decreased in cases of depression or catatonia)
Page 1 of 9
A description of how the patient relates to the interviewer is a necessary
component of the APPEARANCE section. This is sometimes also described as the
“interpersonal style.”
Congenial
Guarded
Open/candid
Cooperative
Withdrawn
Distant
Annoyed/Irritable
Engaging
Hostile
Shy
Relaxed
Cautious
Defensive
Resistant
Speech is something you can also comm ...
No special investigations are always available or required to make a psychiatry diagnosis. All emphasis is put on proper detailed history taking and mental status examination. This slides provides the best approach one can use to come up with a psychiatric diagnosis.
How to take history and mental status examination for a psychiatry patient.
Making a formulation and assessment of premorbid personality.
A step guide for better clerkship and diagnosis making in psychiatry.
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The Mental Status Examination Uniformed Service University o.docxcherry686017
The Mental Status Examination
Uniformed Service University of the Health Sciences
Department of Psychiatry
Objectives: At the completion of the class, students should be able to:
1. Describe the main components of the mental status examination
2. Compose a mental status examination based on a patient observation and
interview
3. Recognize the difference between thought process and thought content
4. Estimate degree of psychopathology based on the mental status examination
5. Document adequate safety (suicidal and homicidal) assessment of each
patient
The Mental Status Examination is an integral portion of the psychiatric interview.
It serves as a “snapshot” of the person you are evaluating. It should include all of the
pertinent observations and findings you accomplish during your encounter with the patient.
Not only is it important for describing the “state” of the patient, it is an important tool that
can help substantiate a diagnosis, convey information to another provider, and assist in
determining most appropriate step in treatment.
Based on the following sections, the mental status examination may appear quite
involved and complicated. This is not the case. As you will see, much of the information
for the mental status examination is obtained from the natural course of the interview.
It is important to state that the goal is not pinpoint the absolute correct term to
describe an observation. The beauty of the mental status examination is, even if you do
not know the specific term, you can use your own words and observations.
APPEARANCE
Yes, this is as straightforward as it sounds – this section describes how the patient
looks, smells, behaves, speaks, establishes eye contact, etc. If this section is thorough
enough, a reader of your mental status exam should be able to pick out the person out of a
room. The mental status exam starts when you first set eyes on the patient. The following
is a sample of items that should be included in the APPEARANCE section:
Ethnicity
Apparent age (younger, older, or appeared stated age)
Sex
Coordination/gait/notable movements
Adherence to social conventions (i.e., shakes hands, military bearing)
Build (Average, underweight, emaciated, petite, thin, obese, muscular)
Grooming (Good, poor, adequate, immaculate, neglected)
Dress (Casual, stylish, mismatched items, formal, tattered, appropriate
for particular setting)
Psychomotor activity (Described as increased in the case of agitation;
decreased in cases of depression or catatonia)
Page 1 of 9
A description of how the patient relates to the interviewer is a necessary
component of the APPEARANCE section. This is sometimes also described as the
“interpersonal style.”
Congenial
Guarded
Open/candid
Cooperative
Withdrawn
Distant
Annoyed/Irritable
Engaging
Hostile
Shy
Relaxed
Cautious
Defensive
Resistant
Speech is something you can also comm ...
No special investigations are always available or required to make a psychiatry diagnosis. All emphasis is put on proper detailed history taking and mental status examination. This slides provides the best approach one can use to come up with a psychiatric diagnosis.
How to take history and mental status examination for a psychiatry patient.
Making a formulation and assessment of premorbid personality.
A step guide for better clerkship and diagnosis making in psychiatry.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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1.-Mental-Status-Examination Guide for Students
1. Mental Status Examination
(Bates, Chapter 5, page 158)
Components
• Appearance & Behavior
• Speech & Language
• Mood
• Thoughts & Perception
• Cognition (Memory, Attention, Information and Vocabulary, Calculations, Abstract Thinking, and Constructional ability)
The format that follows should help structure your observations, but is not intended as a step-by-step guide. Be flexible, but thorough. In some situations, however, sequence is important. If the
patient’s consciousness, attention, comprehension of words, and ability to speak are impaired, assess these deficits promptly. If the patient cannot give a reliable history, testing most of the
other mental functions will be difficult and merits an evaluation for acute causes.
Component of MSE What to observe Task of Examiner Task of Patient Possible Result
Appearance and Behavior
• Level of
Consciousness
• Is patient alert and
awake
• Does he understand
questions and can
respond
Ask questions.
If the patient does not respond to
questions,
- Speak to the patient by name
and in loud voice
- Shake the patient gently,
wakening a sleeper
If still no response, assess for stupor or
coma.
- Observe patient’s posture and
ability to relax and movement.
Answer questions of
examiner.
N: Awake and alert, response is appropriate and
reasonably quick.
A: Appears sleepy. Unable to respond to the
questions. Lethargic, Obtunded.
2. • Posture and Motor
Behavior
• Dress, Grooming, and
Personal Hygiene
- The patient’s posture
and ability to relax.
Note the pace, range,
and type of movement.
- How the patient is
dressed
- grooming of the
patient’s hair, nails,
teeth, skin, and, if
present, beard.
- Compare one side of
the body with the
other.
- Observe dress, grooming and
personal hygiene
- none
- none
N: Good posture and able to relax. Movements
are voluntary and spontaneous.
A: tense posture, restlessness,
and anxious fidgeting; the crying,
pacing, and hand-wringing of agitated
depression; the hopeless
slumped posture and slowed movements
of depression; the agitated
and expansive movements of a
manic episode.
N: Appropriately dressed. Clean clothing and
presentable. Groomed hair, nails and teeth.
A: Grooming and personal hygiene
may deteriorate in depression,
schizophrenia, and dementia. Excessive
fastidiousness may be seen in
obsessive–compulsive disorder. Onesided
neglect may result from a
lesion in the opposite parietal cortex,
usually the nondominant side.
3. • Facial Expression
• Manner, Affect, and
Relationship to
People and Things
- Observe the face both
at rest and
during conversation.
- Assess the patient’s
affect, or external
expression of the inner
emotional state.
- Observe the patient’s
openness,
approachability, and
reactions to others and
the surroundings.
Watch for changes in expression.
Is expression appropriate for topics
discussed? Is face immobile throughout?
Is affect appropriate to the topics being
discussed?
is the affect labile, blunted, or
flat? Does it seem exaggerated at certain
points?
Does the patient hear or see things not
present, or converse with someone who
is not there?
- none
- none
N: Facial expression is appropriate for topics
Note expressions of anxiety, depression,
apathy, anger, elation, or facial
immobility in parkinsonism.
N: Affect is appropriate to topics discussed.
A: Labile, blunted, flat, exaggerated. Patient hears
or sees things not present.
Speech and Language
• Quantity
• Rate
• Volume
• Articulation of
Words
Observe for patient’s speech
and language. Is the patient
talkative or unusually silent?
Are comments spontaneous, or
limited to direct questions?
Is speech fast or slow?
Is speech loud or soft?
Are the words clear and
distinct? Does the speech
have a nasal quality?
N: normal rate, volume and clear articulation of
words.
Note the slow speech of depression; the
accelerated louder speech of mania.
Dysarthria refers to defective articulation.
Aphasia is a disorder of language.
Dysphonia results from impaired volume,
quality, or pitch of the voice
4. • Fluency Rate, flow, and melody of
speech and the content
and use of words.
Watch for abnormalities of spontaneous
speech such as:
■ Hesitancies and gaps in the flow and
rhythm of words
■ Disturbed inflections, such as a
monotone
■ Circumlocutions, in which phrases or
sentences are substituted for a word
the person cannot think of, such as
“what you write with” for “pen”
■ Paraphasias, in which words are
malformed (“I write with a den”), wrong
(“I write with a bar”), or invented (“I
write with a dar”).
These abnormalities suggest aphasia
from cerebrovascular infarction.
Aphasia may be receptive (impaired
comprehension with fluent speech) or
expressive (with preserved comprehension
and slow nonfluent speech).
MOOD Ask the patient to describe his or her
mood, including usual mood level and
fluctuations related to life events.
“How did you feel about that?” for
example,
or, more generally, “How is your overall
mood?” The reports from family and
friends may be of value.
Moods range from sadness and melancholy;
contentment, joy, euphoria, and
elation; anger and rage; anxiety and
worry; to detachment and indifference.
THOUGHT AND
PERCEPTIONS
• Thought Processes Assess the logic, relevance,
organization, and coherence
of the patient’s thought
processes throughout the
interview
Ask patient that can be answered easily.
“What can you say about being
hospitalized right now?”
“You mentioned that
A: Circumstantiality, derailment, flight of ideas,
neologisms, blocking, confabulation,
perseveration, echolalla and clanging
Compulsions, obsessions, phobias,
and anxieties often occur in anxiety
5. • Thought Content
• Perceptions
• Insight
assess thought content, follow
the patient’s leads
and cues rather than asking
direct questions.
Some of your first questions to
the patient often yield
important
information about insight:
“What brings you to the
hospital?” “What seems to
a neighbor caused your entire illness.
Can you tell me more about that?”
“What do you think about at times like
these?”
“When people are upset like this,
sometimes they can’t keep certain
thoughts out of their minds,” or “ . . .
things
seem unreal. Have you experienced
anything like this?”
“When you heard the
voice speaking to you, what did it say?
How did it make you feel?”
“Sometimes after major surgery like
yours, people hear peculiar or
frightening
things. Has anything like this happened
to you?”
disorders.
A: Hallucination, Illusions
Patients with psychotic disorders
often lack insight into their illness.
Denial of impairment may accompany
some neurologic disorders.
6. • Judgment
be the trouble?” “What do you
think is wrong?” Note whether
the patient is
aware that a particular mood,
thought, or perception is
abnormal or part of an
illness.
Assess judgment by noting the
patient’s responses to family
situations, jobs, use of money,
and interpersonal conflicts.
Note whether decisions and
actions are based on reality or
impulse, wish fulfillment,
or disordered thought content.
What insights and values seem
to underlie
the patient’s decisions and
behavior? Allowing for cultural
variations, how do
these compare with a
comparable mature adult?
Because judgment reflects
maturity,
it may be variable and
unpredictable during
adolescence.
“How do you plan
to get help after leaving the hospital?”
“How are you going to manage if you
lose your job?”
“If your husband starts to abuse you
again, what will you do?”
“Who will take care of your financial
affairs while you are in the nursing
home?”
Judgment may be poor in delirium,
dementia, intellectual disability, and
psychotic states. Anxiety, mood disorders,
intelligence, education, income,
and cultural values also influence
judgment.
COGNITIVE FUNCTIONS
• Orientation assess orientation during the
interview.
Ask the ff: Disorientation is common when
memory or attention is impaired,
as in delirium.
7. • Attention Test of attention
Explain that you would like to
test the patient’s ability to
concentrate,
perhaps adding that this can be
difficult if the patient is in pain
or ill.
■Person—the patient’s name, and
names of relatives and professional
personnel
■ Time—the time of day, day of the
week, month, season, date and year,
duration
of hospitalization
■ Place—the patient’s residence, the
names of the hospital, city, and state
Digit Span
Recite a series of numbers, ask the
patient to repeat the numbers back to
you.
When choosing digits, use street
numbers, zip codes, telephone numbers,
and
other numerical sequences that are
familiar to you, but avoid consecutive
Serial 7s
Instruct the patient, “Starting from a
hundred, subtract 7, and
keep subtracting 7.
Note the effort required and the speed
and accuracy of
the responses.
Spelling Backward
This can substitute for serial 7s. Say a
five-letter
Digit Span
- Recite the numbers
back to examiner
Causes of poor performance include
delirium, dementia, intellectual disability,
and performance anxiety.
Poor performance may result from
delirium, the late stage of dementia,
intellectual disability, anxiety, or
depression. Also consider educational
level.
8. • Remote Memory
• Recent Memory
• New Learning Ability
Higher Cognitive Functions
• Information and
Vocabulary
Note the person’s grasp of
information, complexity of the
ideas, and choice of
vocabulary.
word, spell it, for example, W-O-R-L-D,
and ask the patient to spell it backward.
Inquire about birthdays, anniversaries,
social security
number, names of schools attended, jobs
held, or past historical events such as
wars relevant to the patient’s past.
Events of the day. Ask meal for breakfast
Give the patient three or four words such
as “83,
Water Street, and blue,” or “table,
flower, green, and hamburger.” Ask the
patient to
repeat them so that you know that the
information has been heard and
registered.
Begin assessing fund of
knowledge and vocabulary during the
interview. Ask about work, hobbies,
reading, favorite television programs, or
current events. Start with simple
questions, then move to more difficult
questions.
Remote memory may be impaired in
the late stage of dementia.
Recent memory is impaired in dementia
and delirium. Amnestic disorders
impair memory or new learning ability
and reduce social or occupational
functioning, but lack the global features
of delirium or dementia. Anxiety,
depression, and intellectual disability
may also impair recent memory.
N: pt can remember words
Information and vocabulary are relatively
unaffected by psychiatric disorders
except in severe cases. Testing
helps distinguish adults with life-long
intellectual impairment (whose information
and vocabulary are limited)
from those with mild or moderate
dementia (whose information and
vocabulary are fairly well preserved).
9. • Calculating Ability
• Abstract thinking
■ The name of the president, vice
president, or governor
■ The names of the last four or five
presidents
■ The names of five large cities in the
country
Test the patient’s ability to do
arithmetical calculations,
starting with simple addition and
multiplication
(“What is 4 + 3? . . . 8 + 7?”)
(“What is 5 6? . . . 9 7?”)
Test the capacity to think abstractly in
two ways.
Proverbs. Ask the patient what it means
“A rolling stone gathers no moss.”
Note the relevance of the answers and
their degree of concreteness or
abstractness.
For example, “You should sew a rip
before it gets bigger” is concrete,
whereas “Prompt attention to a problem
prevents trouble” is abstract.
Poor performance suggests dementia
or aphasia, but should be measured
against the patient’s fund of knowledge
and education.
Average
patients should give abstract or semiabstract
responses.
Concrete responses are common in
people with intellectual disability,
delirium, or dementia, but may also
reflect limited education. Patients
with schizophrenia may respond
concretely or with personal and
bizarre interpretations.
10. • Constructional
Ability
Similarities. Ask the patient to tell you
how the following are alike:
An orange and an apple
A church and a theater
A cat and a mouse
A piano and a violin
Note the accuracy and relevance of the
answers and their degree of
concreteness
or abstractness. For example, “A cat and
a mouse are both animals” is abstract,
“They both have tails” is concrete, and
“A cat chases a mouse” is not relevant.
copy figures of increasing
complexity onto a piece of blank unlined
paper. Show each figure one at a time
and ask the patient to copy it as well as
possible
With intact vision and motor ability,
poor constructional ability suggests
dementia or parietal lobe damage.
Intellectual disability can also impair
performance.