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Mental Status Examination Rapid Record Form Number Mental Status Examination Rapid Record Form Number © 2000 Jeff Patrick. Those studying, researching or practicing psychology or psychiatry, and those organizations that support them may freely duplicate, modify, distribute, and use this form. Name Circumstance of presentation Date of birth Gender M F 5 Tick where appropriate General Description Catatonia Mood and Affect Perception Appearance Catalepsy Mood Hallucinations Exited Weight Ecstatic Hypnagogic Stupor Obese Euphoric Hypnopompic Rigidity Over-weight Expansive Auditory Posturing Under-weight Elevated Visual Cerea Flexibilitas Emaciated Euthymic Olfactory Negativism Hair Dysphoric Gustatory Bizarre style Speech Anhedonic Tactile Unnatural color Speech Rate Depressed Somatic Unshaven Rapid Alexithymic Lilliputian Other Features Slow Grieving Mood-congruent Wounds Intelligibility Other Emotions Mood-incongruent Scars Slurred Panicked Hallucinosis Tattoos Mumbled Fearful Synesthesia Jewelry Stutters Anxious Trailing Glasses Accented Tense Disassociation Volume Dental braces Agitated Hysterical anesthesia Loud Grooming Apathetic Macropsia Whispered Disheveled Irritable Micropsia Soiled Speech Quality Angry Depersonalization Hesitant Body odor Other Signs Derealization Emotional Halitosis Ambivalence Fugue Monotonous Dress Mood Swings Multiple personality Stereotypical Undressed Neuro-Vegetative Agnosia Underdressed Unspontaneous Anorexia Anosognosia Overdressed Echolalia Insomnia Autotopagnosia Bizarre Verbigerative Hypersomnia Visual agnosia Militaristic Speech Quantity Diminished Libido Astereognosia Behavior Garrulous Constipation Talkative Prosopagnosia Walk Affective Expression Responsive Gait/march Normal Taciturn Limp Restricted Mutism Shuffle Blunted Attitude to Examiner Assisted Flat Combativeness Seductive Appropriateness Playful Cataplexy Appropriate Ingratiating Aggressive Inappropriate Friendly Repetition Labile Gestures Cooperative Interested Twitches Current Treatment Stereotypical Attentive Current psychotherapy Automatism Frank Mimicry Indifferent Echopraxia Evasive Overactivity Defensive Current psychoactive medication Psychomotor Agitation Hostile Hyperactivity Tic Sleepwalking Compulsion 5 Tick where appropriate Thought Process Phobia Sensorium & Cognition Intelligence Content of Thought Simple Consciousness Mild retardation Social Moderate retardation Poverty of thought Disoriented Acrophobia Severe retardation Overvalued idea Clouding Agoraphobia Profound retardation Trend of thought Stupor Claustrophobia Dementia Egomania Delirium Xenophobia Pseudodementia Monomania Coma Zoophobia Hypochondria Coma vigil Judgment Obsession Thought Form Twilight state Critical Compulsion General Dreamlike state Automatic Noesis Mental disorder Somnolence Impaired Unio mystica Neurosis Orientation Insight Psychosis Delusions Time Disorientation Impaired insight Reality testing Bizarre Place Disorientation Denial of disorder Formal thought dis. Systematized Person Disorientation External locus of disor- Mood-congruent Illogical thinking Concentration der Mood-incongruent Dereism Intellectual insight Serial 7’s inattention Nihilistic Autistic thinking True insight Magical thinking Easily distracted Somatic Reliability Paranoid Concrete thinking Often distracted Abstract thinking Memory Reason to fake bad Persecutory Reason to fake good Specific Remote memory deficit Grandeur Compulsory examina- Neologism Recent past deficit Referential tion Self-accusatory Word salad Recent memory deficit Control Circumstantiality Immediate recall deficit Summary Thought withdrawal Tangentiality Information & Intelli- Global Functioning Thought insertion Incoherence gence 10 Imminent harm 20 Possible harm Thought broadcasting Perseveration Attention 30 Serious Impairment Infidelity Condensation Distractible 40 Major Impairment Erotomania Irrelevant answers Selective attention 50 Serious Symptoms Pseudologia fantas- Loosening Suggestibility 60 Moderate Symptoms tica Derailment Folie à deux Risk Assessment 70 Mild Symptoms Flight of ideas Hypnotized Clang association 80 Slight Impairment Preoccupations Memory 90 No Symptoms Suicidal Ideation Blocking Localized amnesia 100 Superior Function Ideation history Glossolalia Generalized amnesia Previous attempt/s Disturbances of speech Selective amnesia Current ideation Pressured Continuous amnesia Impulsiveness Voluble Paramnesia Viable plan Poverty of Speech Fausse reconnaissance WARNING Available means Poverty of Content Retro. falsification The contents of this Settling of affairs Dysprosody Confabulation document are strictly Hostile Intent Dysarthria Déjà entendu confidential. It or any Previous intimidation Aphasic Disturbances Déjà pensé part of it may not be pos- History of violence Motor Déjà vu sessed, duplicated or Current intent Sensory Jamais vu used in any way without Impulsiveness Syntactical Hypermnesia the consent of both the Viable plan Jargon Eidetic images owner and the person to Available means Global which it pertains. Indications & Recommendations ________________________________________ Signature of Examiner Date © 2000 Jeff Patrick. Those studying, researching or practicing psychology or psychiatry, and those organizations that support them may freely duplicate, modify, distribute, and use this form. Selected glossary Dereism. A loss of connection with reality and logic, where Nihilistic Delusion. The delusion of non-existence of the thoughts become private and idiosyncratic (odd or pe- self, or part of the self. Abstract thinking. Thinking characterised almost exclu- culiar). Noesis. The belief that one has a divine calling. sively by cognitive abstractions, rather than immediate Dysarthria. Difficulty producing speech. Obsession. A recurrent and persistent thought, impulse, or sensory experience. Dysphoric. Feeling unwell or unhappy. image. Acrophobia. Fear of heights. Dysprosody. A speech impairment characterised by a loss Overvalued idea. An unreasonable and sustained belief Affect. The pattern of observable behaviours which is the of control of intonation and rhythm. that is maintained with less than delusional intensity. expression of a subjectively experienced feeling state Echolalia. The repetition or echoing of verbal utterances Paramnesia. False recollection of events that have never (emotion) and is variable over time in response to made by another person. occurred. changing emotional states. Echopraxia. Involuntarily imitation the movements of Perseveration. Mental operations carry on past the point Agoraphobia. A fear of being in places or situations in another. Echopraxia is also known as echomotism. that they serve a function. E.g. What day is it? Mon- which escape might be difficult or embarrassing, or in Ecstatic. A sensation of being carried away by overwhelm- day. What time is it? Monday. which help may not be available should a panic attack ing delight. Poverty of Content. Speech that conveys little information occur. Egomania. Preoccupation with oneself. because it is vague or baron. Alexithymic. Relatively undifferentiated emotions (unable Eidetic images. The ability to retain an accurate, detailed Poverty of Speech. Less speech than normal. to identify or express emotion), and thinking tends to visual image of a complex scene or pattern (some- Poverty of thought. Speech that conveys little information dwell excessively on the mundane. Detached, and times popularly known as photographic memory). because of vagueness, empty repetitions, or stereo- may seem to dissociate. Erotomania. Excessive sexual desire, or exaggerated typed or obscure phrases. Anhedonic. An inability to enjoy anything, even things belief in one’s sexual conquests or ability. Prosopagnosia. The inability to recognise familiar faces, once enjoyed. Euphoric. An exaggerated feeling of well-being or elation. although they react physiologically as if they do recog- Anosognosia. Ignorance of the presence of disease, Euthymic. Mood in the normal range, neither depressed or nise the person. specifically of paralysis. elevated. Pseudodementia. A severe form of depression in which Astereognosia. The inability to recognise common objects Fausse reconnaissance. Delusional (false) recognition of cognitive changes mimic those of dementia. by touch. persons or places. Pseudologia fantastica. Grossly exaggerating medical Autistic thinking. An abnormal absorption with the self, Flight of ideas. Speech consists of a stream of acceler- symptoms or personal details. marked by interpersonal communication difficulties, a ated thoughts with abrupt changes from topic to topic Psychomotor Agitation. Describes a morbid increase in short attention span, and inability to treat others as and no central direction. action or movement presumed to result from psychic people. Folie à deux. The sharing of a fantasy by two closely rather than physical (organic) disturbance. Automatism. Automatism refers to activity performed associated friends. Reality testing. The lack of ability to evaluate the external without conscious awareness and usually followed by Formal thought disorder. A disturbance in the form of world objectively and to differentiate adequately be- complete amnesia. thinking rather than an abnormality of content. tween it and the internal world. Autotopagnosia.
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