Mental Status Examination Rapid Record Form Number

© 2000 Jeff Patrick. Those studying, researching or practicing psychology or , and those organizations that support them may freely duplicate, modify, distribute, and use this form.

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5 Tick where appropriate General Description Mood and Affect Perception Appearance ‡ Catalepsy Mood ‡ 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 ‡ ‡ 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

WARNING

which it pertains. The contents of this document are strictly document sessed, duplicated or confidential. It or any the consent of both the used in any way without Critical Automatic Impaired Impaired insight Denial of disorder disor- External locus of Intellectual insight True insight Reason to fake bad Reason to fake good Compulsory examina- 10 Imminent harm 20 Possible harm 30 Serious Impairment 40 Major Impairment 50 Serious Symptoms 60 Moderate Symptoms 70 Mild Symptoms 80 Slight Impairment 90 No Symptoms 100 Superior Function Mild retardation Mild retardation retardation Moderate Severe retardation retardation Profound Pseudodementia owner and the person to part of it may not be pos- part of it may Judgment ‡ ‡ ‡ Insight ‡ ‡ ‡ der ‡ ‡ Reliability ‡ ‡ ‡ tion Summary Global Functioning ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Intelligence ‡ ‡ ‡ ‡ ‡ ‡

hem may freely duplicate, modify, distribute, and use this form. and use this distribute, modify, duplicate, freely hem may

Signature of Examiner Signature of Examiner Date

______Distractible Distractible Selective attention Folie à deux Hypnotized Localized amnesia Generalized amnesia Selective amnesia Continuous amnesia Paramnesia Fausse reconnaissance Retro. falsification Confabulation Déjà entendu Déjà pensé Déjà vu Jamais vu Hypermnesia Eidetic images Disoriented Disoriented Clouding Stupor Delirium Coma Coma vigil Twilight state Dreamlike state Somnolence Time Disorientation Place Disorientation Person Disorientation Serial 7’s inattention distracted Easily Often distracted Remote memory deficit Recent past deficit Recent memory deficit Immediate recall deficit gence Attention ‡ ‡ Suggestibility ‡ ‡ Memory ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Sensorium & Cognition Sensorium Consciousness ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Orientation ‡ ‡ ‡ Concentration ‡ ‡ ‡ Memory ‡ ‡ ‡ ‡ Information & Intelli-

ychology or psychiatry, and those organizations that support t that support and those organizations psychiatry, or ychology

Simple Social Acrophobia Agoraphobia Claustrophobia Xenophobia Zoophobia Phobia Neurosis Reality testing Formal thought dis. Illogical thinking Dereism Autistic thinking Magical thinking Concrete thinking thinking Abstract Neologism Word salad Circumstantiality Tangentiality Incoherence Perseveration Condensation Irrelevant answers Loosening Derailment Flight of ideas Clang association Blocking Glossolalia Pressured Voluble Poverty of Speech Poverty of Content Dysprosody Dysarthria Motor Sensory Syntactical Jargon Global

‡ ‡ ‡ ‡ ‡ ‡ ‡ General ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Specific ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Disturbances of speech ‡ ‡ ‡ ‡ ‡ ‡ Aphasic Disturbances ‡ ‡ ‡ ‡ ‡ Thought Form ‡

Risk Assessment

Systematized Mood-congruent Mood-incongruent Nihilistic Somatic Paranoid Persecutory Grandeur Referential Self-accusatory Control Thought withdrawal Thought insertion Thought broadcasting Infidelity Erotomania Pseudologia fantas- Bizarre History of violence Current intent Impulsiveness Viable plan Available means Previous intimidation Ideation history Previous attempt/s Current ideation Impulsiveness Viable plan Available means Settling of affairs Preoccupations Tick where appropriate Tick where

Poverty of thought Poverty idea Overvalued Trend of thought Egomania Monomania Hypochondria Obsession Compulsion Noesis Unio mystica

‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ tica ‡ Suicidal Ideation ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Hostile Intent ps practicing or researching © 2000 Jeff Those studying, Patrick.

Indications & Recommendations Content of Thought Content ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ 5 Process Thought ‡

Selected glossary Dereism. A loss of connection with reality and logic, where Nihilistic . 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 . 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. A condition where one cannot identify or Fugue. A condition in which an individual suddenly aban- Referential Delusion. A delusion centred on the idea that describe their own body parts. Individuals can dress dons a present activity or lifestyle and starts a new events, objects, or other persons in one's environment themselves appropriately and use their body normally, and different one for a period of time. have a particular and unusual significance. but they cannot talk about their bodies. Garrulous. Given to excessive and often trivial or rambling Retrospective falsification. Where the person changes Bizarre Delusion. A delusion that involves a phenomenon talk; tiresomely talkative. the reporting of past events, or now has only selective that the person's culture would regard as totally im- Global Aphasia. The loss of all ability to communicate. memory of what was more fully remembered previ- plausible. Glossolalia. Fabricated, meaningless speech. ously. Blocking. Repeated and abrupt halt to speech as a result Gustatory . Hallucination of taste. Sensory Aphasia. A condition characterised by fluent but of losing one's train of thought. Halitosis. Bad breath. meaningless speech and severe impairment of the Catalepsy. A trancelike state with loss of voluntary motion Hallucinosis. A mental state in which the person has ability understand spoken or written words. and failure to react to stimuli. continual hallucinations. Somatic Delusion. A delusion whose main content per- Cataplexy. Sudden, dramatic decrement in muscle tone & Hypermnesia. Extreme power of memory. A capacity for tains to the appearance or functioning of one's own loss of deep reflexes that leads to muscle weakness, immediate registration and precise recall of much body. paralysis, or postural collapse. Usually caused by out- more detail than is thought possible under ordinary Somatic Hallucination. Hallucination involving the sensa- burst of emotion: laughter, startle, or sudden physical circumstances. tion of being strangled, feeling that insects are crawl- exercise; one of the symptoms of narcolepsy. Hypnagogic Hallucination. Threatening hallucinations at ing beneath the skin, or feelings of sexual stimulation. Cerea Flexibilitas. Waxy flexibility in which a limb remains the moment of falling asleep. Somnolence. A very sleepy state. where placed; often seen in catatonia. Hypnopompic Hallucination. Threatening hallucinations Synesthesia Hallucinations. The hallucination of a sense Circumstantiality. Slowed thinking incorporating unneces- at the moment of waking from sleep. other than the one being stimulated. For example, a sary trivial details. Eventually the goal of the thought is Hypochondria. Abnormal anxiety about one's health; the sound may evoke sensations of colour. reached. persistent neurotic conviction that one is or is likely to Syntactical Aphasia. Difficult in arranging words in their Clang association. Speech in which words are chosen become ill. correct sequence. because of their sounds rather than their meanings. Hysterical anaesthesia. Sensory loss due to a mental Systematised Delusion. A single false belief with multiple Claustrophobia. Fear of being trapped in confined state. elaborations or a group of false beliefs that the person spaces. Infidelity Delusion. The belief that one’s partner is sexu- relates to a single event or theme. Coma vigil. Awake, but without conscious awareness. In ally unfaithful. Taciturn. Habitually untalkative. this vegetative state persons can open their eyelids Jamais vu. The experience of being unfamiliar with a Tactile Hallucination. Hallucination of touch. occasionally and demonstrate sleep-wake cycles. person or situation that is actually very familiar. Tangentiality. Replying to a question in an oblique or They also completely lack cognitive function. Jargon Aphasia. Incoherent, meaningless speech. irrelevant way. Compulsion Catatonia. Muscular rigidity; a tendency to Labile. Repeated and rapid shifts from one extreme to Thought broadcasting. The belief that one's thoughts are remain in a fixed stuporous state for long periods; the another. being broadcast out loud so that they can be per- catatonia may give way to short periods of extreme Lilliputian Hallucination. Hallucination that people or ceived by others. excitement. objects are smaller than they are. Thought insertion. The belief that certain of one's Compulsion. Repetitive ritualistic behaviour or mental Loosening. Speech characterised by slipping from one thoughts are not one's own, but rather are inserted activity. train of thought to another loosely related train of into one's mind. Concrete thinking. Thinking characterised almost exclu- thought. Thought withdrawal. The belief that one would like to sively by immediate sensory experience, rather than Macropsia. Seeing everything in the field of view as larger think a thought, but someone or something has re- cognitive abstractions. than it really is. moved the thought. Condensation. Speech in which two or more separate Magical thinking. The belief that one's thoughts, words, or Tic. Part of the body moves repeatedly, quickly, suddenly concepts are not differentiated. actions will cause or prevent a specific outcome in and uncontrollably. Confabulation. A plausible but imagined memory that fills some way that defies commonly understood laws of Trailing Hallucinations. Hallucination that moving objects in gaps in what is remembered. nature. are seen as a series of discrete discontinuous images. Control Delusion. The belief that one’s thoughts or Micropsia. Seeing everything in the field of view as smaller Trend of thought. Thinking with a tendency toward or actions were under some outside control. than it really is. centring on a particular idea with a particular affect. Déjà entendu. Subjectively inappropriate impression of Monomania. Preoccupation with a single object. Unio mystica. The belief that one has a unity or union by familiarity of something just heard with an undefined Mood-congruent Hallucinations. Hallucination in which secret rites. More generally, the unity or union in the memory of same. the content is mood appropriate. spirit of an individual with that of the Supreme Being or Déjà pense. Subjectively inappropriate impression of Mood-incongruent Hallucinations. Hallucination in which some other superior or leader. familiarity of something just thought with an undefined the content is not mood appropriate. Verbigerative. Involuntarily repeating of certain words memory of same. Motor Aphasia. A condition in which expression by speech and/or phrases. Déjà vu. Subjectively inappropriate impression of familiarity or writing is severely impaired. Visual agnosia. The inability to recognise common objects of a present experience with an undefined past. Multiple personality. Two or more distinct personalities by sight. Depersonalization. A loss of contact with one’s personal alternately prevail in the same person. Voluble. Dominates conversation with a ready flow of reality. Detachment from self. Mutism. Unable or unwilling to speak. speech. Derailment. A pattern of speech in which a person's ideas Negativism. Opposition or resistance, either covert or Word salad. Speech that is an incoherent and incompre- slip off one track onto another that is completely unre- overt, to outside suggestions or advice. hensible mix of words and phrases. lated. Neologism. The use of a newly made up word, or an Xenophobia. Fear of strangers or foreigners. Derealization. Feelings of unreality or strangeness. everyday word used in an idiosyncratic way. Zoophobia. Fear of animals.