MENTAL STATUS EXAMINATION

MENTAL STATUS EXAMINATION

• Definition: Process of clinical examination in psychiatry, wherein the clinician records the psychiatric signs and symptoms.
• Ie., assessing the mental functioning status.

Methods/Areas of assessment:

1. General appearance and behavior.
2. Speech
3. Mood and affect.
4. Perception.
5. Thought (Cognition)
6. Higher mental functions.

General appearance and behavior:

• The appearance of the patient assessed. 
• Any gross abnormalities (Dressing, grooming, etc.,).

Speech:

• Assessed by rate, tone, volume, the spontaneity of speech.

Mood and affect:

• Describes emotions or emotional state.
• Affect – Cross-sectional emotional state.
• Mood – Sustained or longitudinal emotional state.
• Emotional state defined by 3 more subfactors:
• Quality, Fluctuations & Appropriateness, and congruency.
• Quality – 
• Predominant affective (or mood) state.
• This can be a euphoric mood (elevation of mood) & depressed mood.
• Fluctuations – 
• Refers to the changes in mood/affect.
• This can be labile mood (emotional liability) & Affective flattening (No mood changes irrespective of the situation).
• Appropriateness and congruency:
• Appropriateness of emotion described in relation to the situation.
• Congruency described in relation to the thought content of the person.
• Other emotional variations:
• Alexithymia – Lack of words to describe emotions.
• Anhedonia – refers to the loss of capacity to experience a pleasure.

Perception:

• Receiving of information using one of the sensory modalities (i.e. auditory, visual, tactile, olfactory, and gustatory).

Abnormalities of perception:

• Illusions – False perception of a real object.
• Hallucinations – False perception in the absence of any object or stimulus.
• Specific hallucination types:
• Hypnagogic hallucination (During sleep)
• Hypnopompic hallucinations (As we awaken from sleep)
• Reflex hallucinations (Synesthesia) – Feature of cannabis and LSD (and other hallucinogens) intoxication.
• Functional hallucinations.
• Auditory hallucinations – Most common in psychiatric disorders.
• Visual hallucinations – Most common hallucinations in organic psychiatric disorders (temporal lobe epilepsy).

Thought (Cognition):

• Cognition – Mental process of acquiring knowledge.
• Includes thoughts, experiences & sensations.

Thoughts – Variations:

• Stream (flow of thought), a form of thought & content of thought.

FLOW (STREAM) OF THOUGHT:

• Refers to speed of thoughts following.
• Disorders include,
• Flight of ideas (rapid flow of thoughts without connection).
• Inhibition of thinking (very slow thought process).

FORM OF THOUGHT:

• Refers to the “organization” of thought or “association” between consecutive thoughts.
• Formal thought disorders:
• Derailment – Disturbed association between two successive thoughts.
• Loosening of association – Single thought yet the connection between their components is lost.
• Incoherence – Total lack of organization & incomprehensible thought.
• Circumstantiality – Speaking with the inclusion of unnecessary details to reach the final statement (beating around the bush).
• Tangentiality – Answer related to question in some distant way; the goal of thought never reached.
• Neologism – Coining of a new word without any derivation of the word – Highly suggestive of schizophrenia.
• Word approximations (metonyms) – Old words are used in a new or unconventional way.
• Perseveration – Repetition of the same response, beyond the point of relevance; Always in response to a question & is not spontaneous.

CONTENT OF THOUGHT:

• This refers to the content of the thought process (what a person is actually thinking about).

Disorders associated:

• Delusion – Defined as a false, unshakeable belief that cannot be explained on the basis of a person’s social and cultural background.
• Types of delusion:
• Delusion of persecution – The most common type.
• Delusion of reference.
• Delusion of grandeur or grandiosity.
• Delusion of love (erotomania, fantasy lover syndrome)
• Nihilistic delusion (delusion of negation, Cotard’s syndrome).
• Delusion of infidelity (delusion of jealousy/morbid jealousy or Othello syndrome).
• Delusion of guilt
• Bizarre Vs Nonbizarre delusions.

POSSESSION OF THOUGHT:

• Owning the thought process & non-influential nature.

Disorders: 

• Experiencing tampered & influenced thought process.
• Obsessions: Repetitive thoughts against the person’s will.
• Thought alienation: Controlled/influenced thought process either by thought insertion, thought withdrawal & thought broadcast.

HIGHER MENTAL FUNCTIONS:

• Assessment includes,
• Attention
• Concentration
• Memory judgment
• Abstract thinking 
• Insight

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