The document describes a comprehensive mental status examination evaluating consciousness, attention, behavior, language, thought processes, memory, and insight. It categorizes various levels of consciousness, types of attention and concentration tests, and detailed assessments of mood, affect, cognition, and memory functions. Specific clinical observations and tasks are outlined to assess cognitive and perceptual abilities across different brain regions.

1. Mental Status Examination

2. Mental Status ExaminationConsciousnessLevel of consciousnessArousal (Eye opening closing)AttentionConcentrationOrientationKinetic melodyAffectMoodBehaviorCognitionLanguageMemoryThinking: Content, SpeedReasoningJudgmentAbstract thinkingInsightConstructionPraxisGnosis

3. ConsciousnessConsciousness is Awareness of self and environment or knowledge of one's own mental process (subjective)Arousal and Level of consciousnessContent of consciousness or CognitionTest for responsiveness (objective)Verbal, motor , and vegetative response to visual, verbal, tactile and noxious stimuli, one step or two step commandLevel of response: Meaningful -> not meaningful -> reflex -> none Verbal word, phrase or sentence

4. Level of ConsciousnessAlert: awake, aware, interesting, responsive to stimuliLethargic (drowsy): Can be roused but cannot maintain arousal. Stuporous: Can be roused with intense stimulationComatose: Cannot be roused with any stimuliConfusion: Unable to think in customary speed and clarity. Altered awareness and responsiveness with inattention and distractibility.Delirium: confused, agitated and hallucinating.

5. B. Attention and Concentration (RAS)Alertness is aroused and attend to all extraneous stimuli.Attention is the capacity to focus on single stimuli and screen out irrelevant stimuli.Clinical: noting the distractibility while history taking.Digit span: (forward and backward) Letter spanAlphabet repetition read randon alphabets and asks to tap when particular alphabet repeated.Word repetitionSentence repetition

6. Concentration is the ability to focus attention over a more extended period of time.Seven subtraction Random letter repetition

7. C. Behavior (limbic system, prefrontal area, caudate area)Clinical assessment: Observation of a patient’s mood, facial expression, clothing, and ability to relate to the examiner. Appearance. Clothing and grooming. Bizarre, seductive, soiled, stained.Motor activity: Increased activityDecreased activityTicsRepetitive actsFacial expression: Normal, blunted, abnormal twitchingMood and affect: Affect is immediate overt expression of an emotional state. Mood is more sustained or underlying emotion.Behavior: Irritability, demanding, anger and euphoria, helplessness

8. D. LanguageComprehensionExpressionRepetitionReadingWritingNaming

9. Comprehension: Identification of color, object, action, letter, number and forms.Body part identificationOne, two and three step commandComplex ideation materialTwo ideas (boat/stone sink in water)Story comprehension

10. Expression:Word outputFluencyProsody: loss of melodic aspect of speech (emotional speech – right hemisphere corresponding to Broca’s area) GrammarParaphasias:Verbal - Green -> Redliteral - Green -> GretNeologism: Green -> GrumpWord finding difficultyAutomatic speech: number, alphabet, month, days, poem, song.

11. Reading: Oral reading, word phrase and sentenceReading comprehensionSymbol Word Oral spelling, Word, picture matching, Reading sentence

12. WritingMechanical: name, addressPrimer level dictation, letter, number, word, sentence, paragraphWritten confrontation namingNarrative writing

13. RepetitionWordPhraseSentence

14. Naming:Responsive naming (what do we tell time with)Visual confrontation naming: object, color, action, letter, number, formBody part namingObject naming: Animal, vegetable and fruit

15. Thought (Speed, content, coherence and logic)FormReduced content: poverty of ideas, associated with vague repetition, overtly abstracts speech, which contains little information.Circustantiality: delay in reaching the point, because of unnecessary detail and parenthetical speechDerailment: shift in thinking from one topic to another. Loss of association. Tangentiality: Loosing of association or derailment in response to the examiners questions. Shift in topic at first may be related but progressively move further away from the starting topic.Blocking: sudden cessation of speech because of thought was lost or mind became blankFlights of idea: accelerated speech and rapid shift in topic. Speech may become disorganized and incoherent. Syntax and vocabulary are usually intact.Clang association: a form of derailment in which shift in topic are based on the sound of words rather than the meaning.Confabulation: apparent fabrication of facts or events to fill gaps in memory. Neologism: are new words or distortion of standard words.Echolalia: the echoing of words or phrases of others. Often associated with perseveration repetition of the same wordsPerseveration: persistent repetition of words and phrases. Word salad: syntax is lost, vocabulary is idiosyncratic.

16. Content of ThoughtAn illusion:is a misperception of real external stimuli.A delusion: is a false personal belief based on an incorrect interpretation of realityHallucination: i. Auditory: ii. Visual iii. Olfactory iv. Gustatory v. TactileAssaultive thought: wishes or intensions to harm an individual or less commonly an institution or organization.Homicidal thoughts: wishes or intension to kill another person, these may be vague or poorly formulated or may be impulsive.Homicidal plans: the intensions or wishes to kill have been crystallized into a potentially real threat. Feeling of hopelessness: Feeling of guilt:i. Suicidal thoughts:j. Suicidal plansObsessions: recurrent, persistent ideas, images, or impulses that are not experienced as being produced voluntarily but as being invaded thoughts. Phobias: irrational, persistent, fear of an object, activity or situation that produces a wish to avoid the stimulus. Closeness to the stimulus causes increased feeling of anxiety and over activity of autonomic nervous system.Sexual concerns:Somatic preoccupation: Religiosity.

17. MemoryShort term memory: testing require a patient to be attentive, cooperative and good comprehensionRecall of recent event, confirm with relativeFour semantically unrelated words, sentence, Objects, design, Short storyRemote memory: Personal Historical events

18. Constructional ability (graphomotor)A complex task involving visual, perceptual and analytical function of the occipital and parietal lobes and the motor planning and action of the prefrontal and frontal lobes. Both hemisphere are involved but, right parietal lobe produces more severe impairment in performance.Copy two and three-dimensional objects and shapes.

19. CalculationMeasure the ability of a person to perform mental arithmetic. Performance is highly correlated to intelligence and education. Normal attention concentration and language memory are prerequisite. Simple calculationSerial 7 subtraction

20. Abstract thinkingSimilarities: to abstract the essential relationship between word pairs consisting of objects and ideas.Ask the patient how word pairs are alike (e.g. turnip and cauliflower; chair and table, painting and symphony)Proverb interpretation: depends on the patient’s cultural, intellectual and educational background. Prefrontal and frontal cortex involved.e.g. Rome wasn’t built in a day.

21. Conceptual abilityPrefrontal cortex. Ask to complete following sentence. A C E G ---1 4 7 10 ---AZ BY CX D—Hydrangea 789876332Jewel 46883Hat ----- (any three letter number)

22. Judgment Refer to the patient’s understanding of what he has done or will do in various situations. To see the patient’s ability to cope with difficult situation.InsightRefers to the patient’s awareness of the significance of his symptoms and illness. Which may range from partial to full understanding of the origin, nature and prognosis.

23. Frontal LobeObserve: Behaviour, Attention, Memory, Motor, Speech, Planning, BladderMotorBilateral/ LeftKinetic melodyFrontal release signGagenhaltanGait apraxiaEye movementAkinetic, abulic, (mesial)Right Motor neglectMotor impersistenceDysprosodyEuphoriaEmotional liability, euphoria, dysphoriaJocularity (Orbital)Lack of social judgment (orbital)BehaviouralUtilization and imitation behaviorIntelligence, attention, concentration and learning

24. Temporal lobeAuditory comprehensionVerbal memory dominantVisual memory non dominantVegetativeEmotionQuadrinopias

25. Parietal LobeAny hemisphereCortical sensationOptico kinetic nystagmusQuadrinopiaDominantRight left orientationFinger agnosiaAcalculiaAgraphialogicogramatical and syntactical languageOptic alexiaNon dominantNeglect (bisect line, dazy, clock drawing)Spatial disorientation (map drawing, object in a room)Constructional apraxia ( two and three dimentional)Dressing apraxiaBilateralIdeomotorapraxia

26. Occipital lobeHmianopiasNaming color, shape, object, face, pictureReading

27. Callosal functionAnteriorLeft hand praxisLeft hand agraphiaMiddleMatching left finger, left handNaming object in left handPosteriorNaming object left fieldRight hand constructional apraxia