The Mental Status Exam

Key Elements Observational components Observational components Components obtained via questioning Components obtained via questioning Formal cognitive examination Formal cognitive examination Elements Elements Useful standardized tests Useful standardized tests

Observational Components Appearance and behavior Appearance and behavior Mood and Affect Mood and Affect Speech Speech Thought processes Thought processes

Appearance and Behavior Level of consciousness Level of consciousness Ethnicity, gender, apparent age Ethnicity, gender, apparent age Hygiene and clothing Hygiene and clothing Motor activity, abnormal movements Motor activity, abnormal movements Facial expressions Facial expressions Relationship to interviewer Relationship to interviewer

Mood and Affect Type Type Anger Anger Anxiety Anxiety Depression Depression Euphoria Euphoria Lability Lability Appropriateness Appropriateness Intensity Intensity

Speech Rate Rate Rhythm Rhythm Pressured Pressured Latencies, thought blocking Latencies, thought blocking Circumstantial Circumstantial Extraneous sounds, verbal tics Extraneous sounds, verbal tics Use of language Use of language Neologisms Neologisms

Thought Processes Associations Associations Loose Loose Flight of ideas Flight of ideas Tangentiality Tangentiality Blocking Blocking Incoherence Incoherence Perseveration Perseveration

Components Obtained via Questioning Thought content Thought content Cognition Cognition

Thought Content Delusions Delusions Paranoid Paranoid Grandiose Grandiose Somatic Somatic Thought broadcasting Thought broadcasting Thought control Thought control Mood congruent vs. mood incongruent Mood congruent vs. mood incongruent

Thought Content Hallucinations Hallucinations Auditory Auditory Visual Visual Tactile Tactile Olfactory Olfactory Anxiety symptoms Anxiety symptoms Suicidal ideation Suicidal ideation Homicidal ideation/thoughts of violence Homicidal ideation/thoughts of violence

Cognition Attention and concentration Attention and concentration Orientation Orientation Language Language Memory Memory Immediate, recent, remote Immediate, recent, remote Verbal and visual Verbal and visual Abstraction Abstraction Insight Insight Judgment Judgment Reading and writing Reading and writing

Standardized Cognitive Tests

Brief, easy to use, known comparators Brief, easy to use, known comparators Limitations Limitations Miss subtle deficits Miss subtle deficits Examples Examples MMSE MMSE SLUMS SLUMS Cognistat Cognistat Others Others