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Mental Status

Examination
First of all, Remember in your mental state exam station to
introduce yourself, then you have to ask all the parts of the
patient profile and then get a chief complaint with brief history of
presenting illness, because during this time you are able to assess
the appearance of the patient, the behavior and the attitude all
the together. You are also able to assess the speech and the
thought form-process, which you have to comment on at the end
of the speech assessment, so in other words assess thought
process with the speech of the patient and you could mention it
just as ( thought process intact at the end of it)
Second of all, regarding the history taking, we are required to
take history of presenting illness, which means you start with the
chief complaint, then analyze it (onset, duration , precipitating and
relieving factor etc..) and when you come to the associated
symptoms only do those related to the chief complaint. Ya3ni if
chief complaint was ekte2ab shadeed, zai ma aja ele abelna ask
associated symptoms related to depression. You should then ask
about
Opposite episodes.
Impact on life. Which includes family, society and function,
by function we mean everything in life not just work or study
but everyday activities.
Substance abuse be2anwa3oh. Smoking , tea, coffee,
nescafe, Alcohol, drugs without prescription.
Suicide, suicide, suicide !!
Last thing drugs and their side effect
Past psychiatric history and family psychiatric
Forget all about past medical and surgical or any family
history or allergies or personal history! Kollo 3al fade
Bel akher eza dal wa2et ask related associated sympyoms,
for example if it was depression ask about mania because it

could be bipolar, ask about psychosis because it could


happen or have happened.

In mental status examination we have to look throughout the


following
1. Appearance, behavior, motor, and attitude.
2. Speech
3. Thought
4. Mood and affect
5. Perception
6. Cognition
7. Judgment
8. Insight
9. Suicide/homicide

So now we will start talking about each one separately:


1)
Appearance, behavior & motor, and attitude:
-Appearance: that mean how the patient looks in front of the
examiner, and here we have to cover the following.

Gender

Age ( looks younger, older than stated?!)

Clothes; tidiness, cleanness, appropriate or not. Color ( bright


colors could guide you to mania!!)

Hygiene; good or not.

Posture; appropriate or not. Example akathesia


EX. In schizophrenia you find the patient sitting over the table or
on the window.

Grooming; appropriate for age, gender, culture, and situation.

Jewelry or any cosmetics

Any added stuff to the body, tattoos scars

Others: Pupil size ( drug intoxication) , bruises ( suspicion of


abuse), needle marks ( drug abuse), eroding of tooth ( eating
disorder), superficial cuts ( self-harm)
-Behavior & motor: that means how the patient behaves in front of
the examiner.

Tics; abnormal muscle contraction "motor or vocal" and could be


simple or complex.

Eye contact; which will be absent in case of depression.

Notice all extrapyramidal symptoms, important.

Stereotype; abnormal behavior that could be "verbal or motor"


which is not goal directed.

" , "
.

Mannerism; abnormal behavior that could be "verbal or motor"


which is goal directed.
" , "
,, .
-Attitude:

Cooperative, hostile, evasive, guarded, apathic etc


2)
Speech:
Which include the following

Rate; fast "mania", slow "depression", average "normal people or


mania"

Articulation; average, or dysarthric "we have to exclude general


medical condition stroke- and medication BZD, metoclopramide,
antipsychotic".

Tone; hyper "mania", hypo "depression", or average.


* pressurized speech "fast, rapid, continuous, and uninterrupted" which
seen mainly in manic episodes of bipolar disorder.
3)

Thought:
Here we have to cover two concepts
-Form
Loosening: no connection between one idea and the other.
Flight of thought: there is slight connection between one idea
and the other.
Circumstantialities: the patient speaks a lot BUT at the end he
can reach the point that you want.
Tangintiality: the patient speaks a lot without reaching the point
that you want.
Clang association: the patient connects the words due to
phonetics rather than its actual meaning. My car is red. Ive been in
bed. It hurts my head.

Perseveration: patient repeats one answer for many questions.


, , ...
Word salad: patient speaks a lot without any connection.

Neologism: patient speaks new words which are not being
understood by anyone except the patient himself.
-Content
Here we have to cover the following

Delusion: fixed abnormal believe that is not accepted by our


culture and not changeable by reasoning and it is almost always
pathological and morbid.
Types:
1. Primary; sudden delusion, delusion of mood, delusion of
memory, delusion of perception.
2. Secondary; due to general medical condition or substance
abuse.
3. Position of thought;
Insertion "someone inserts the ideas in his mind"
Withdrawal "someone stole his thought"
Broadcasting "people around him knowing his thought
without being told about it"
4. Other;
Paranoid/persecution:
Grandiose:
Guilty:
Reference:
Control:
Of love: more in female
Infidelity: more in male
...
Suicide: how many times, the way, why, the consequence.
Some attempt to suicide just to pay attention, other attempt
then they decide not to die so they go and seek medical help and
others attempt because they need to die and those may or may
not die.
..
Phobia

Obsession

compulsion: repetitive thought and behaviors respectively.

4)
Mood and Affect:
-Mood is subjective and we ask about it at the time of interview and
during the last period.
-Affect is objective that is noticed by the examiner during the interview
which could be
Flat; no expression regardless the mood either good or bad "-ve
symptom schizophrenia"

Labile; changeable regardless the mood "mood disorder,


dementia, or delirium"
Congruent; the affect is appropriate with the mood "mania"
Incongruent; the affect is inappropriate with the mood
"schizophrenia"
..
" "
.." "
" .." "
" .
affect Mood in patients own words

.
5)
Perception:
Here we have to cover the following
Hallucination; sensory experience without presence of external
stimulus which include the following,
"
..."
1. Auditory: hearing voices in both ears BUT not in one more
than the other.
2nd person: someone gives commands for the patient and
consider as the most dangerous type and here we have to
admit the patient.
3rd person: here the patient is the 3rd person in the
conservation.
Running: here someone repeats the patient activity.
Thought echo: here the patient hears his own thought.
*mostly occur in schizophrenia.
2. Visual: we have to exclude organic cause or substance
intoxication.
3. Gustatory/olfactory: tasting or smelling something strange,
and mostly occur in temporal lobe epilepsy "complex partial
seizure".
" "
!
4. Tactile: feeling tangling and like something move under the
skin which is mostly occur in substance abuse.
Illusion: sensory experience with presence of external stimulus
BUT with misinterpretation. Seen in two cases la thaleth lahoma :
delirium and intoxication.
!!

Depersonalization: the patient thinks that some part of his


body is not belonging to him.
!!
Derealisation: here the patient didn't see the thing on its reality.

!!
6)
Cognition:
Here we have to cover the following
Consciousness; here we can use the Glasco Coma Scale "GCS"
BUT actually it's enough to that the patient is alert drowsy
lethargic stupor comatose.
Orientation;
Time: what is the time? What day of the week is it? What is the
date of today? dd/mm//yy

Place: where we are now? Country, city, building, floor, room.
Person: who sit beside you? Ask about persons around him!
Attention and concentration; we ask the patient to count the
numbers from 100 down by subtract 7 OR we ask him to name the
day of the week oppositely!! Serial 7s test
Memory;
Immediate: we tell the patient about 3 words and ask him to
repeat it directly " , ,"
Recent: we ask the patient to recall the same 3 words after 5
minutes.
Late: we ask the patient about famous events! " ,
,"

Abstract thinking; we give the patient simple calculations!


"We give him proverb and ask him about the meaning of it"
Calculations;
"5+10-3 OR 30
15"

General knowledge; we ask about the name of the president or


about name of historical places! " , ,
"!
7)
Judgment:
Here we give the patient situation or scenario and start changing it to
know if he can change his thinking accordingly or not.
" ,"!!
8)
Insight:

Does the patient know that he is psychologically ill and in need for
treatment?
Full insight; patient 100% believe that he is psychologically ill and
need treatment.
Partial; patient believe that he is psychologically ill BUT he didn't
believe that he will benefit from the treatment or vice versa.
Lack of insight; patient didn't believe that he is psychologically ill
and in need for treatment.


9)
Suicide: either attempt or thought of suicide. How many
times , the way and why or zai ma 7akena abel!
10)
Premorbid assessment: this was given by more than one
doctor with different answers always, we have 8, but Ill put the
five they all said and agreed upon first.
1)

Trait and character.




2)
Social relations with others.

3)
Hobbies and interests

4)
Mood! Predominant mood before sickness

5)
Religion

6)
Anxiety trait. Zai ma sa2alna 3n el trait bel awal.
7)
Abnormal movements.
8)
Past history of admission to hospitals, mental hospitals or
prison?
...

(: The End
:Done by
Mohammed AlHawamdeh
Edited by : Saed Jarrar :P