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