The Psychiatric Mental Status Examination Observe The Psychiatric
The Psychiatric Mental Status Examination
Observe
The Psychiatric History n n n n Chief complaint History of Present Illness Past History Medications Family History Social History Review of Systems
Overview n n n General Emotion Thought Cognition Judgment and Insight Reliability
General
General Description n n Appearance Motor Behavior Speech Attitudes
General Description n Appearance n n n Prominent features "such that a portrait…” Eye contact Dress and grooming Age/appearance
General Description n Motor Behavior n n n n Gait Freedom of movement Firmness and strength of handshake Any involuntary or abnormal movements Pace of movements Purposefulness of movements Degrees of agitation
General Description n Speech n n n Rate Spontaneity Intonation Volume Defects
General Description n Attitudes n n n How the patient related "degree of cooperativeness“ Evaluator’s attitude
Emotion
Emotions n n Mood Affect
Mood n n Definition Patient report versus inference
Mood n n n Euthymic Angry Euphoric Apathetic Dysphoric Apprehensive
Emotion n Affect n Definition
Affect n n n Appropriateness Intensity Mobility Range Reactivity
Thought
Thought n n Process Content
Thought n Process n n Manner of organ. /form. thought. Stream of Thought Goal directedness/Continuity Other Abnormalities of Thought Process
Thought n Process n Connectedness/Organization Circumstantiality n Tangentiality n Loose Association n Word Salad n
“And now I’m here” “I was home” Start Finish “I felt some chest pain” “So I told my son” “And he called an ambulance”
“I was home” Start “I felt some chest pain” “So I told my son” “My son, maybe you know him” “He’s a doctor too” “He always worries so much” “And now I’m here” Finish “What was my point? Oh, yeah”
“I had five boys…” “Do you have children” “I was home” Start “I felt some chest pain” “So I told my son” “If only he’d settle down and “My son, have some He’s children” really great” “And now I’m here” Finish
Thought Process n Other n n n Clanging Echolalia Neologisms Perseveration Thought blocking
Thought n Content n n n Perceptual disturbances Delusions Other
The cognitive exam n n n Consciousness Orientation Concentration and attention Calculations Memory Intelligence
Insight and Judgment
Insight
Insight n Patient’s capacity to n n n Acknowledge/Appreciate illness Associated implications Consequences
Insight n n n Drugs/alcohol Dementia/cognitive problems Psychosis Severe mood problems Somatoform disorders
Judgment
Judgement n The process of n n n Consideration Formulation Leading to a n n Decision Action
Judgement n Requires n n n Insight Cognitive functioning Other abstract abilities Conceptualization Forward thinking Appreciation of what “rational people” would do.
Reliability
Reliability n n Intellect honesty and motivations psychosis/organic defects magnification/understatement
Examples
- Slides: 41