The mental status exam

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Mental Status Exam

  1. Appearance: grooming, hygiene, clothing.
  2. Attitude: ability to interact with interviewer. (cooperative, guarded, hostile, manipulative, etc.)
  3. Behavior: unusual characteristics or movements, psychomotor activity, degree of eye contact, mechanics of speech
  4. Mood: internal emotional tone as observed by interviewer, but in patient’s own words– dysphoric, euphoric, angry, euthymic, anxious.
  5. Affect: external range of expression observed by interviewer – flat, blunted or restricted, labile, full /wide range/appropriate. 
  6. Thought process: use of language – quality and quantity of speech. Rate, tone, and fluency of speech – pressured speech, poverty of speech, blocking, flight of ideas, loose associations, tangentiality, circumstantiality, echolalia, neologisms, clanging, perseveration, ideas of reference. Goal-directed and logical vs. disorganized and underproductive.
  7. Thought content: hallucination, delusions, and other perceptual disturbances – illusions, derealization, depersonalization, suicidal or homicidal ideation.
  8. Sensorium/Intelligence and cognitive functioning: level of alertness; orientation – person, place, and date; attention and concentration – spell world backwards; short term memory – recall 3 objects after 5 min.; fund of knowledge – name past 5 presidents, 5 large cities, or historical dates; calculations – serial 7’s; abstraction – proverb interpretation.
  9. Insight: does pt display an understanding of his current problems, and the implication of these problems?
  10. Judgment: patient’s ability to make sound decisions regarding everyday activities – best judged by patient’s history of decision making rather than hypothetical questions.
  11. Memory and Orientation: It’s good to include an MMSE (Maxwell’s has one on the purple pages, or use a PDA program) in your initial note on a patient.
  12. Summary and axis