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MENTAL STATUS EXAMINATION




                            1
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, acceptance

o Grade 5: Intellectual insight- Awareness present,
  attributes it to psychological causes but does not
  apply it to future experiences

o 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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Class 2

  • 2. 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
  • 3. Mental status examination • Thought o Stream o Form o Possession o Content • Mood and Affect • Perception • Other psychotic phenomena • Insight 3
  • 4. Thought Stream- (Progress) o Spontaneity o Volume o Tonal fluctuations o Retardation o Pressured speech 4
  • 5. • Poverty of speech: Restriction in amount, brief, concrete, unelaborate • Poverty of content: Long reply, adequate speech, less content 5
  • 6. • 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
  • 7. • 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
  • 8. • 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
  • 9. 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
  • 10. 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
  • 11. Insight • Awareness, • Attribution and • Acceptance of intervention 11
  • 12. 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
  • 13. o Grade 4: Awareness present but attribute it to something unknown, acceptance o Grade 5: Intellectual insight- Awareness present, attributes it to psychological causes but does not apply it to future experiences o Grade 6: True emotional insight 13
  • 14. 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