Mental Status Examination

General Description Apperance Category Body type Posture Poise Clothes Grooming Hair Nails Description Healthy Sickly ill at ease Poised Old/young looking Childlike Disheveled Bizarre Attitude 2ward Cooperative Perplexed examiner Friendly Apathetic Attentive Hostile Interested Playful Frank Ingratiating Seductive Evasive Defensive Contemptuous Guarded Record level o rapport Speech Describe by Quality Rate of production Quantity Px can b describe Talkative by Garrulous Voluble Taciturn Unspontaneous Normally responsive to cues from interviewer Speech Rapid or slow Loud Whispered Slurred Staccato Mumbled Spontaneous Speech impairment : stuttering Unusual rhythm Accent

Overt Behaviour & Psychomotor Activity Physical manifestation Restlessns Wringing o hands Pacing Qualitative & Mannerisms quantitative motor Tics behaviour Gestures Twitches Stereotyped behavior Echoproxia Hyperactvt Agitation Combativens Flexibility Rigidity Gait Agility Describe any Aimless purposeless actvt Note Psychomotor retardation Generalized slowing o body mvmnt Mood & Affect Mood Pervasive & sustained emotion & colors d persons perception of world Include Depths Instensity Duration Flunctuation description Depressed Empty Despairing Guilty Irritable Hopeless Anxious Futile Angry Selfcontemptuous Expansive Frightened Euphoric Perplexed Mood can be Labile Fluctuating Alternating rapidly btwn extreme Affect Px present emotional responsivens, inferred from d pxs facial expression include amount & range o expressive behaviour Describe as w/in norm range constrict: range & intensity o expression Blunt : emotional expression further Flat : no sx of affective xpression, monotonous voice, immobile face

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2 disturbance: Hallucination Describe : sensory system involved content time/ circumstances any feeling of depersonalization or derealization feeling of formication? Illusion Hv u ever heard voices or other sounds that no one else could hear or when no one else was around? Hv u experienced any strange sensations in ur body that others do x seem to see?

Perception

Thought of content Refer to what a person actually thinking : ideas, belief, preoccupation, obsessions Disturbance include Delusions Preoccupation Obsession Compulsion Phobias Plans Intentions Recurrent ideas o suicide Specific antisocial urges Sensorium & Cognition Assess brain fx include : Intelligence Capacity of abstract thought Level of insight & judgement Level of ~ consciouns describe by Clouding Somnolence Stupor Coma Lethargy Alert Orientation Time Place Person Remote Childhood data Important events known to hv occurred when px was younger or free o illns Personal matters Neutral material Recent past Past few months Recent Past few days Memory What px did yesterday What px had for b/fast, lunch, dinner Immediate Digit span measures retention & Ability to repeat 6 figures recall aftr examiner dictates them 4ward & backward Ability to repeat 3 words immediately & 3-5 min later [ ] Using serial 7 From 100 substract 7 Only 2 mistake in 2 minutes r allowed Attention Calculations Spell world backward Name 5 things w particular letter
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Thought Process/form Way in which a person puts 2gether ideas & associations Described as Logical + coherent Completely illogical Incomprehensive Disturbance o thought Circumstantiality continuity Loss o capacity for goaldirected thinking Px bring in many irrelevant & parenthetical comments but eventually does get back to ori point Tangentiality Disturbance in which px loses thread o conversation, pursues divergent thought stimulated by various exterbal/ internal irrelevant stimuli, never returs to ori point Rambling Evasive Perseverative Thought process Incoherent/incomprehensible impairment connection o thought (word salad) Clang associations Punning (association o double meaning) Neologism (new word created by px by combining or condensing other words) Note any of Loosening of association? Vague or empty thought? Overabundance or poverty of thought?
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Reading & writing Visuospatial ability Abstract thought

Information Intelligence

Read a sentence Write a simple but complete sentence Ask px to copy a figure : clock face, interlocking pentagon Similarities? Meaning of proverbs Describe by: Concrete (giving specific example to illustrate d meaning) Overly abstract (giving too generalized an explanation) Any trouble wif mental task? Related wif vocub & general fund of knowledge

Fund of knowledge Abstract reasoning

What is distance btwn KL and Seremban? How an apple & orange are alike? Which one does not belong in this group : a pair of scissors, a canary & a spider? Why?

Impulsivity Is px capable of controlling sexual, aggressive, & other impulse? Can be determined : Px recent hx Behavior observed during interview Judgement & Insight Judgement Does px understand likely outcome of px behavior? Can px predict what px would do in imaginary situation? (what px would do if smell smoke in crowded theatre) Insight Is px degree of awarens & understanding about being ill Level of insight 1. Complete denial of illns 2. Slight awarens of being sick & need help but denying it at same time 3. Awarens of being sick but blaming it on others on external factors or orgnic factors 4. Awarens that illness is caused by something unknown in d px 5. Intellectual insight : admission that d px is ill & that symptoms or failures in social adjustment r caused by d px own particular irrational feeling or disturbances w/out applying this knowledge to future experiences 6. True emotional insight : emotional awarens of motives & feelings w/in px & important person in px life which can lead to basic changes in behavior Realibility Examiners impression on px realibility & capacity to report px situation ACCURATELY Whether truthfulns or veracity

Questions Used to Test Cognitive Fx Alertns Observation Orientation What is ur name? who am I? What place is this? Where is it located? What city are we in? Concentration Starting at 100, count backward by 7 (or 3). Say d letters of alphabet backward starting wif Z Name the months of d year backward starting wif December Immediate Repeats these number aftr me : 1,4,9,2,5 Recent What did u hv for breakfast? What were u doing b4 we Memory started talking this morning? I want u to remember these 3 things : yellow pencils, a cocker spanial, Cincinnati. Aftr few minutes Ill ask u to repeat them Long term What was ur address when u were in 3rd grade? Who was ur teacher? Calculation What is cost of 3 oranges if dozen oranges cost RM4? If u buy something that cost RM3.75 & u pay with RM 5 how much change should u get?

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