Mental status examination

1. MENTAL STATUS
EXAMINATI
ON
Shrijana Kayastha
Master nursing

2. Mental Status
Examination
Mental status is the total expression of a
person's emotional responses, mood,
cognitive function, and personality. It is
closely linked to the individuals executive
functioning
i.e. motivation, initiative, goal formation,
planning and performing, self-monitoring,
and integration of feedback.

3. Introductio
n
The MSE is one component of exam and may
be viewed as the psychological equivalent of
the physical exam. It is an important
component to a neurological evaluation.
It is made up of our observation and objective
question to the client. Behavior aspect are
observed. Cognitive aspect are tested .

4. Introductio
n
Concernedwith symptoms, sign and behavior during the
interview;
It is usually conducted after the history. Somewhat
blurring distinction between history and mental state
examination. Uses a standard series headings under
which the relevant phenomena, or their absence, are
recorded
It provides much of the key diagnostic information .

5. Introductio
n
Core skill needed by all health professional.
- Learned from study, observed form
interviewer.
experience
d
- Individual and cultural difference
- It is imperative to keep in mind the many ways
individuals vary in their behavior and abilities.
- Normal behavior within one culture, may appear
disturbed or irrational within another culture.

6. Major component of
MSE
General appearance and
behavior Appearance
Age
Gende
r
Race
Body build
Posture
Eye
contact
Dress
Grooming
Manner
Attentiveness to
examiner Emotional

7. Description of
components
General appearance and behavior
 The process of observation starts from the first moment we
see the
patient.
 What is their manner and behavior in the waiting room. Are
they sitting quietly, pacing around, or laughing to
themselves?
 The dirty, unkempt(not neat or tidy) look may indicate self-
neglect.
 Facial expression: mood; mouth corner turn down, vertical
furrows
in the brow(depression)
 Horizontal creases on the forehead, widened palpebral

8. General appearance and behavior contd…
 General appearance and behavior
 Posture and movement: sit with hunched shoulders,
the head and gaze inclined downwards, sit on the
edge of the chair with hands gripping its sides,
overactive and restless, tardive dyskinesia and
catatonia
 Social behavior: unduly familiar or dis-inhibited, if they
were elsewhere than in a medical interview(dementia),
behave aggressively (anti-social behavior)
Description of
components

9. BEHAVIOR
AL
ASPE
CT
 Physical Characteristics:
-Gender
-Age (stated and apparent)
-Ethnicity
-Physical characteristics and body type
-Position/ posture record
-Abnormal traits: natural or acquired
-Eye contact
 Alertness level of consciousness
-Full levels or awareness and ability to respond
to a variety of situations
-Hypervigilance or hyperarousal
-Decreased level of consciousness: stupor,
drowsy, comatose, lethargic

10. • Rate, quantity, difficulties in speaking, and floe of speech; it’s
content e.g usually fast and decreased in amount, as in
mania, or slow, sparse and monotonous, in depression.
• Dysphagia or dysarthria
• Neologisms; private word invented by the patient,
often to describe morbid experiences.
• Flow of speech: disturbances in the stream or form of
thoughts e.g. sudden interruptions: thought blocking,
rapid shifts from one topic to another suggests flight
of ideas.
Speec
h

11. Mood and
Affect
“Mood” is the way aperson claims to be feeling
“Affect” is the way aperson appears to befeeling
Types of Mood
i. Normal: calm, euthymic, plesant, unremarkable
ii. Angry: belligerent, hostile, sullen (bad tempered), frustrated
iii. Euphoric: cheerful, elated, happy
iv. Apathetic: bland, dull
v. Dysphoric: despondent(sad without much hope),
distraught(extremely upset sothat you can’t think properly),hopeless
vi. Apprehensive: anxious, fearful, frightened, panicky, tensed,
worried
(depersonalization and de-realization)

12. Mood and
Affect
 What is your mood like? Or How are you in your
spirits?
 What do you think will happen to you in the future?
Affect
 “Intensity”: heightened, exaggerated, blunted, flat
 “Range”: restricted, broad
 “Appropriateness”: Congruenceto statedmood
 “Mobility” or changeability: labile (varies)/Volatile,
constricted, fixed or immobile

13. COGNITIVE
ASPECTS
 Introduction of exam: routine, time involved,
positive feedback when appropriate
 Thought and ideation content: stream and
form of thought and content of thought e.g.
delusion, obsession
 Perception
 Cognition – insight and judgment

14. THOUG
HT
Thought content
Description of what the patient is thinking
about
Suicidal
ideation
Death
wishes
Homicidal
ideation
Depressive
cognition
Obsessio
ns
Ruminations (to think
deeply about sth)
Phobia
s
Paranoid
ideation
Magical
ideation
Delusion
s
Overvalued
ideas

15. Thought
Process
Description of the way in which patient
thinks
• Associatio
n
Coherence
Logic
Stream
Clang associations
• Preservation
Neologism
Thought

16. • Delusions: a fixed false belief that can not be explained by education or culture.
These beliefs may be clear from the start or develop through the 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/ insertion, jealousy, death, idea of reference
• Obsessions: persistent ideation which is ego-dystonic
• Compulsions: Acts performed repeatedly even though understood as
inappropriate
• Phobias: Unreasonable and intense fear associated with some objects or
situation.
• Thought of violence
• Illusions: Misinterpretations of actual sensory stimuli
Thought
Process

17. Perceptio
n
• Perceptual disturbances include hallucinations and illusions
-Hallucinations may occur in any sensory modality, but are
most commonly auditory(visual, tactile, gustatory, and
olfactory)
-Illusions have some basis in reality
-Depersonalization: feeling of identity loss (self experienced as
unreal)
-Derealization: feeling reality has changed (environment
experienced as unreal)
• Dejavu
• jamaisvu

18. Orientatio
n
Orientation and consciousness refers to aclient’s awarenessof
his/her self and situation
• Clients are evaluated in terms of their Orientation to
person,
place and time
Consciousness is rated from Alert to Comatose
•
• Delirium (clouding of
consciousness)
• Dementia (global intellectual/ mental
decline clouding of consciousness)
without

19. Memory and
Intelligence
It can be quiet risky to assess Memory and
intelligence is a short interview, but some general
statements are usually made
• Remote, recent and immediate memory can be
assed (amnesia, confabulation)
• Because intelligence is often based on verbal facility,
special care should be taken when working with
diverse clients
-General knowledge, simple arithmatic calculation
and reading, writing

20. • Attention and concentration
Distractibility
Procedures: Serial 7s and 3s, digits
forwards and backwards (days months in
reverse order)
• Abstract thinking/Concrete
By proverb testing
Similarities and difference between
familiar objects

21. INSIGHT AND
JUDGEMENT
• Insight: self understanding regarding current circumstances
(awareness of
illness)
- None ( there is no problem, denial of illness)
- Superficial (some minimum awareness of a difficulty but still using
denial)
- Situational Focus ( external factors are the problem)
- Intellectual (Intellectualization and rationalization without true
emotional connection)
- True Insight (understanding situation with the emotional impetus to
master situation)
• Judgment: ability to decide on the appropriate course action to