Mental Status Exam

0:00 this talk is an introduction to the mental status exam the mental status exam is an essential skill for the psychiatrist it involves observation of the 10 aspects of a patient's mental status listed here when you're first learning these components it may be helpful to group them into larger categories such as Behavior emotions thoughts and cognition let's walk through the different components of a mental status exam in the table I'll present the terminology you might use to describe someone who has a normal mental status and Below I'll show common terminology I use to describe abnormal mental status you'll see that each component has a spectrum of presentations for appearance I generally comment on the patient's apparent age sex and grooming if this is a patient I

0:45 will need to pick out of a crowd for example in a busy impatient millu then I might include additional visible identifiers such as clothing hair color tattoos and so on when describing a patient's level of grooming I tend to use the phrases disheveled for core grooming well- groomed for average grooming and meticulous for a high level of grooming for Behavior I comment on the patients level of psychomotor agitation how responsive they are to questions and their level of eye contact when describing psychomotor agitation I use words like slowed calm fidgeting disruptive and aggressive for different levels of agitation however it is also helpful to specifically describe the patient's behavior for example pacing around the room sitting in a corner or

1:30 throwing objects when describing how readily they answer questions I use words like evasive if they are avoiding answering questions and guarded if they take long pauses or give brief responses as though they are withholding information if they answer questions quickly and fully I use the word forthcoming to describe the level of eye contact I describe it in simple terms such as avoiding eye contact intermittent eye contact or intense eye contact for speech I comment on spontaneity fluency speed volume amount and proy spontaneity refers to how much prompting a patient requires to speak and respond in a conversation fluency refers to how fluidly the patient pronounces words and sentences proy refers to the rhythm of a patient's

2:17 vocal tone throughout a phrase or sentence speed volume and amount are hopefully self-explanatory mood and affect are two different aspects of emotion expression mood refers to the patient's subjective report of their emotional state while affect refers to the doctor's objective observation of emotional state as seen in the patient's facial expression for mood I simply record whatever words the patient uses to describe their mood such as okay happy depressed anxious angry and so on for affect I comment on quality reactivity variability congruence and appropriateness quality describes the veilance of the expressed emotion ranging from tearful to expansive variability refers to how rapidly and

3:03 intensely affect changes ranging from Flat to labile reactivity refers to change in affect in response to stimuli such as brightening in response to a cheerful topic congruence and appropriateness refer to whether the patient's reported mood matches their affect and how appropriate the patient's affect is to the situation respectively for thought process I comment on both the direction of thoughts ranging from less to more linear and the flow of thoughts ranging from less to more logical For Thought content I ask and comment on a few important safety items including suicidal ideation homicidal ideation and hallucinations I also comment on whether I observed any apparent delusions or response to internal stimuli during the interview for cognition for a typical

3:49 interview I comment on alertness orientation and attention however for interviews involving altered mental status it is important to complete a more thorough cognitive exam finally insight and judgment refer to two different aspects of a patient decision-making ability Insight refers to how well the patient recognizes and understands their illness or situation while judgment refers to how well the patient makes decisions for each of these I use a scale ranging from poor to good that's the end of this talk I hope this is a useful organizational schema for the mental status exam and introduces you to much of the terminology used when describing and documenting the exam thank you