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Mental Status Exam

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Mental Status Exam MENTAL STATUS EXAM The Mental Status Exam (MSE) is an assessment of the individual’s current state of mind. It assesses the range, quality, and depth of perception, thought processes, feelings, and psychomotor actions. Direct observation of the individual is required for the completion of the MSE. The observation occurs before, during and after the formal clinical interview while the clinician is in direct view of the individual. Specific questions to assess certain domains of the MSE are also required. The following information is included as a guide only. Clinical judgment regarding a MSE is paramount in completing this exam. © 2003 Lakeview Center, Inc. MENTAL STATUS EXAMINATION DEFINITIONS I. LEVEL OF COOPERATION Normal: In rate, tone, volume patient’s feelings state (during the interview) Slow: Rate less than average Appropriate: Emotional tone consistent with Pleasant: Agreeable manners, behavior Fast pressured: Rate greater than average content of speech, thought and ideas. Cooperative: Willingness and ability to work Soft: Decreased volume Inappropriate: Emotional tone inconsistent with with others in a common effort. Loud: Increased volume content of speech, thought of ideas Attentive: Ability to sustain focus on one Monotone: No fluctuation in tone Expanded: Excess of joy or sadness, a wide activity. Slurred: omission, reduction or substitution of range Disturbance: difficulty finishing tasks, easily sounds Labile: Rapid, abrupt changes in feeling tone distracted or having difficulty in concentration. Stuttering: Involuntary disruption or blocking of Constricted: impoverished, inhibited, a spectrum speech of feelings not elicited II. GENERAL APPEARANCE Mutism: Inability to speak Blunted: A severe reduction in the intensity of Poverty of Speech: Restricted amount of speech, feeling tone Appears to be Stated Age monosyllables Ambivalence: Contradictory feelings present at General State of Physical Health Logorrhea: copious, logical speech the same time. Dress: Neat, clean or disheveled Echolalia: repetition of one person’s words by Hygiene: Bathed, groomed, shaved or not. another. VIII. MOOD (Subjective) Motor Aphasia: Ability to speak is lost but III. ATTITUDE understanding remains The patient’s report of his/her feeling state over the past several weeks. The position or posture that an individual presents to others. Euthymic: Normal, level range of mood, implying absence of depression or elation Sensitivity: Easily hurt or damaged, delicate, Irritable: Easily annoyed and provoked to anger. susceptible. VI. BEHAVIOR AND PSYCHOMOTOR Dysphoria: An unpleasant, painful or anguished Passive: Inactive submissive, no opposition. ACTIVITY state Dependent: Requires assistance from others. Euphoria: intense elevation with feelings of Dramatic: Vivid, emotional, with flair. Normal: grandeur Entitlement: Exaggerated sense of importance. Increased Amount: Excessive body movement. Apathetic: Lack of feeling or emotion Perfectionist: Demands higher quality of A.Hyperactivity: Supranormal amount of Grief: Sadness appropriate to real loss performance from self and others more than is purposeful, goal directed activity. Depressed: Spirits low required by the situation. B. Agitation: Increased purposeless, goalless Anhedonia: Loss of interest in and withdrawal Anti-authority: Hostile to or opposes social behavior from all regular and pleasurable activities. establishments, legal authorities, etc. Decreased Amount: (Psychomotor Retardation) Alexithymia: Inability or difficulty in describing Eccentric: Odd, deviation from established Diminution or poverty of movement, lethargic or being aware of one’ s moods or emotions norms. Tic: Twitching or spasmodic movement Diurnal Variation: Consistent shift in feeling Manipulative: Self-serving, controlling for own Tremor: Trembling, shaking during 24-hour period. Ex: Better morning, advantage. Trichotillomania: The unnatural impulse to pull worse as day progresses Suspicious: Distrustful, guarded. out one’s own hair Mood-Congruent: Content of thoughts, feelings, Impulsive: Prone to act spontaneously. Pacing: Walking back and forth mood appropriate Aggressive: Forceful, ready, pushy. Alexia: failure of muscle coordination; Mood-Incongruent: Content of thoughts, Irregularity of muscle action feelings has no association with mood. IV. FACIAL EXPRESSIONS Akathisia: Motor restlessness, inability to sit still Dystopia: Involuntary, irregular chronic Normal: Appropriate to the situation contortions of the muscles of trunk and Happy: Content, enthusiastic extremities X. THOUGHT CONTENT SAD: down and out, frowning Dyskinesia: Involuntary bucco-facial Anxious Worried: Uncertain, apprehensive movements The specific topics, details or matters presented Silly: Trivial, frivolous Catatonia: motor anomalies during the interview. Embarrassed: Self-conscious A. Mannerisms: Odd, repetitive movements, Angry: Irritation, resentment, rage goal- directed Ego-syntonic: Ideas that are in harmony with an Expressionless: Lacks facial tone B. Stereotype: Odd repetitive movements. Not individual’s concept of self. Avoid Direct Eye Contact: Avoids contact with goal directed. Guilt: Self-reproach, responsibility for imagined examiner C. Echopraxia: Automatic copying of offenses Stares into Space: Disinterested, distracted, lost examiner’s movements or posture Anomia: Alienation, lack of direction in space D. Catalepsy: Awkward posture or position for Unworthiness: Critical of one’s worth or ability Omega Sign: Furrowed brow (sustained prolonged period Helplessness: Incapable of assisting one’s self. contraction of corrugator muscle) E. Flexibilities (Waxy Flexibility) Hopelessness: utter despair, problems can’t be Encountering resistance when moving extremity solved which is maintained in an odd position. Somatic Preoccupation: Overly concerned with body functions VII. AFFECT (Objective) Obsessions: Persistence of an unwanted thought V. Speech that cannot be eliminated from consciousness The children’s observation/evaluation of the Compulsion: Pathological need to act on an impulse which, if resisted anxiety Ruminations: Excessive worry, repetitive or real situation one has experienced 120 seconds. Short Term: Events of past 5-10 continuous speculation Hallucination: An incorrect sensory perception minutes. Recent-Events or items of day, week, in the absence of actual external stimulus or month. Past-Birthdate, anniversaries, Doubting/Indecision: Uncertainty A. Auditory: False perception of sound significant past experiences Grandiosity: Exaggeration of one’s worth 1)Elementary Noises A. Amnesia: Partial or total inability to recall 2) Complete: Voices or words past experiences B. Visual: False perception of eight consisting of B. Fugue: Amnesia, then assuming a new Ideas of Reference: incorrect assumption that formed and unformed images. identity real events or incidents have direct reference to C. Olfactory: False perception of smell C. Confabulation: Unconscious filling of gaps in one’s self D. Gustatory: False perception of taste memory with imagined or untrue experiences Overvalued Ideas: Fanatically maintained E. Tactile: False perception of touch or surface Attention and Calculation notions, such as the superiority of one’s sex, sensation A. County by threes-1,4,7,---(1-40) nation, or race over others F. Somatic: False perception of things occurring B. County backwards from 21-1, 20-19, 18, Paranoid Ideation: Belief that one is singled out to one’s body C. Process Digits: Forward-Three (6-35) for unfair treatment G. Extracampine: Sees objects outside the to eight (82673829)backwards-Three(183)to Hyper-Religiosity-Excessive concern with sensory field. Ex: Behind his back eight (72485136) spiritual matters H. Kaleidoscopic: Vivid colors with geometric D. Simple arithmetic: 6+8, 50-12; 8x9 Phobic Thoughts: Irrational, unrealistic fears. A. patterns E. Spell Words: World, State (Forward, Specific-Circumscribed dread of discreet object Hypnagogic: False perception occurring while Backwards) or situation. (Ex-spiders, snakes); B. Social- falling asleep F. Sentence Learning: “No ifs, ands, or Dread of public humiliation(public speaking, Hypnopompic: False perception occurs while buts”(Repeat) performing, eating in public) awakening from sleep G. Identity Objects: (Dystopia) Example: Pen, Delusion: A fixed false belief Synesthesia: A perceptual disturbance in more watch, shoe. A. Persecution: false belief that one is being than one modality. Hearing colors, smelling H. Copy Design: Visual Motor Integrity(Draw harassed or cheated music. two triangles which must connect at one point) B. Grandeur: false belief of one’s importance, power, or identity XII. SOMATIC COMPLAINTS Fund of Information: Who is the President? C. Reference: False belief that behavior of Vice-President? County in which you reside? others, events, or objects refers to one’s self. Sleep: Normal, Difficulty getting to sleep, State Capital? How many weeks are there in a D. Control: False belief that one’s will, thoughts diminished amount of sleep, early morning year? What direction are you traveling when and feelings are controlled by external forces awakening(terminal insomnia) going from San Francisco to Boston? 1) Thought Withdrawal: Thoughts are being Eating Habits: Appetite-normal, increased, Insight: Awareness of how one’s own removed by external forces decreased. Unusual food cravings, binge eating, personality traits and behaviors contribute to 2) Thought Insertion: Thoughts are being self-induced vomiting. symptoms and problems. To understand cause
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