MENTAL HEALTH

1. The Mental Status
Examination
MS.SASIKALAVATHI ARUNACHALAM MSc N OBG
PRINCIPAL
HARYANA COLLEGE OF NURSINGMD,

2. What is the Mental Status
Examination?
• Sum total of observations made during
a psychiatric interview via:
– Direct Inquiry about subjective symptoms
– Objective findings (signs)

3. Why is it the Mental Status
Exam so Important?
• Almost all psychiatric diagnoses are
made, at least in part, clinically
– i.e. from taking a history, making
observations during the interview, etc.
– Not solely from laboratory values, virology
reports, or imaging studies
– Thus, greater emphasis on direct
observations of patient

4. Mental Status Examination
• Can be divided into 2 sections:
– 1. Observational Data
• Most areas assessed while taking a
history
– 2. Formal Cognitive Testing: MMSE
(Mini-Mental State Exam), etc.

5. What You’ll Want to Observe:
• Appearance
• Behavior
– Cooperation/ Attitude
• Speech
• Thought Process/Form
• Thought Content

6. What You’ll Want to Observe:
• Perceptions
• Mood and Affect
• Insight and Judgment
• Cognitive Functioning and Sensorium

7. Appearance
• Attire
• Hygiene and Grooming
– “Disheveled”- ruffled appearance
– “Unkempt”- poor attention to grooming

8. Appearance
• Body habitus, nourishment status
– General description of body type/ build, and
nutritional status

9. Behavior- Movements
• Range and Frequency of Spontaneous
Movements
– Psychomotor activity
– Abnormal movements

10. Psychomotor Activity
• Psychomotor refers to
movements that appear driven
from within, by one’s internal
emotions at the time
– Psychomotor Agitation, vs.
– Psychomotor Retardation

11. Psychomotor Agitation
defined
• Physical restlessness, usually with a
heightened sense of tension and
increased arousal
• Results from emotions such as anxiety,
anger, and confusion
• Common Signs include: hand-wringing,
fidgeting, frequent shifts in posture, foot-
tapping

12. Psychomotor Retardation
• An overall slowness of voluntary and
involuntary movements
– Results from emotions such as apathy,
depression, etc.

13. Abnormal Movements
• Mannerisms: goal-directed,
complex behaviors carried out in
an odd way or inappropriate
context

14. Abnormal Movements
• Tardive Dyskinesia (TD)- involuntary
choreoathetoid movements of delayed
onset, resulting from long-term
antipsychotic use
• Primarily seen in peri-oral region:
mouth, lips, tongue, face

15. Disorganized Behavior
• Seemingly purposeless, random, non-
goal directed, often complex behaviors
(may include mannerisms)
– Ex. Disrobing in public, urinating on
oneself, dancing, posturing, etc.

16. Cooperation/ Attitude
• Attitude/Relatedness
• Eye contact
• Level of Alertness/ Attentiveness
– Easily distracted
– Hypervigilant (constantly scanning the
environment)

17. Qualities of Speech
• Quantity/Amount
– Too much
– Too little
– None = mutism (absence of speech)

18. Qualities of Speech
• Articulation- clarity with which words
are spoken
– dysarthric (poorly articulated speech)

19. Qualities of Speech
• Rate
– Slowed/halting vs. Normal vs. Rapid

20. Speech Rate
• “Pressured”: increased rate (and
amount); driven to keep talking;
uninterruptible

21. Disorganized Speech
• Speech that is lacking in meaning
and/or inappropriate for the context
• Usually reflective of an underlying
“disorganized thought process”

22. Prosody
• The emotional valence/intonations of
speech; adds emphasis, maintains
listener’s interest
• Speech lacking in Prosody is monotone
and boring

23. Thought Process/ Form

24. Thought Process/ Form
• How ideas are put together, organized,
and ultimately produced (as speech)
• Assessed via speech, writing, and
behavior

25. Normal Variants or
Pathological?
• Circumstantiality- overly detailed;
over-inclusive; but eventually gets to the
point
• Tangentiality- starts out in general
vicinity of goal /target, but never
reaches the end point

26. Abnormalities: Idiosyncracies
• Idiosyncracies: Private use of words,
language; illogical; understanding is
unique to the patient; irrational

27. Abnormal Thought
Processes: Flight of Ideas
• Ideas are linked by primitive
associations such as rhyming, and
punning
• Has a rapid quality
• Often with a sensation of “racing
thoughts”

28. Looseness of Associations
• Looseness of Associations- Ideas
only obliquely related, if at all
• In its extreme form there is a loss of any
meaningful connections between ideas
and it’s unclear how someone decides
to go from one topic to the next

29. Thought Content

30. Thought Content (TC)
• Refers to predominant themes,
preoccupations the person has
• For our purposes, it’s usually about
making sure they don’t have abnormal
thoughts

31. Normal vs. Abnormal TC
• Normal = absence of abnormalities
• Abnormal:
– Delusions
– Obsessions
– Suicidal /Homicidal Ideations

32. What’s a Delusion?
• Fixed false (untrue) belief, not
culturally sanctioned (not just unique,
but accepted in that person’s culture)
– “Fixed” means they’re 100% convinced it’s
true- ie, good luck trying to convince them
otherwise
• Range from implausible (unlikely but
non-bizarre) to impossible (bizarre)

33. Perceptual Abnormalities
• Illusions
• Hallucinations

34. Illusions
• Misperceptions of external stimuli
– There’s something there, but the person is
misinterpreting it as something else
– Ex. a chair may look like a person to
someone who is delirious

35. Hallucinations
• False sensations in the absence of
external stimuli (ie. Anything real)

36. Mood and Affect
How they describe emotional
state vs. what you see

37. Mood
• Mood: internal feeling state
– It’s subjective
– Ex. “happy”, “angry”, “nervous”, “fine”

38. Affect
• Observable, external expression of
emotional tone
– It’s objective

39. Insight and Judgment
• Insight- understanding and
appreciation of current situation, illness
• Judgment- ability to make sound
decisions; best assessed via recent
history

40. The End