MENTAL STATE

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Mental StateExamination

By

Mohamed AbdelghaniAss. Lecturer Of Psychiatry

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I. Appearance and BehaviourA. Body built:

Height and weight;

Very tall: chromosomal abnormality.

Very thin: anorexia nervosa.

B. Facial appearance: mood: anxious, depressed, happiness.

medical conditions with psychiatric importance: thyrotoxicosis,

Downs syndrome, renal failure and cushing syndrome.

C. General appearance: self care and grooming; hair, nail: may be neglected in schizophrenic,

depressed and addicts.

clothing; colour, appropriateness with age and sex.

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I. Appearance and Behaviour Cont.D. Motor activity:

Decreased in depression, and Increased in mania and hypomania.

Catatonic stupor: markedly slowed motor activity, often to the

point of immobility.

Catatonic exitement: agitated, purposeless motor activity,uninfluenced by external stimuli.

Echopraxia: pathological imitation of movements of one person by

another.

Psychomotor agitation: excessive motor and cognitive activity,

usually non-productive and in response to inner tension.

Dystonia: slow sustained contractions of the trunk or limbs.

Aggression: forceful, goal-directed action that may be verbal or

physical; the motor counterpart of rage, anger and hostility.

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II. EmotionEmotion:is a complex phenomenon involving reactions in 3

distinct components;

o Feeling experienced by the subject (e.gjoy, anger, sadness ).

o Behavioral (expressive) component.

o Autonomic and endocrine component.

Mood:sustained emotional tone and the subjective

(experienced) aspect of emotion.

Affect:short-lived feeling state and used to describe the

objective (observable) aspect of emotion.Appropriate affect: condition in which the emotional tone is

in harmony with the accompanying idea, thought or speech.

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III. Thinking Goal-directed flow of ideas, symbols, and associations initiated

by a problem or task and leading toward a reality-oriented

conclusion.

Thought disorders may be classified according to stream, form,

and content of thought.A. Stream of thought:

Too rapid: flight of ideas (d.d loosening of association).

Too slow: various degrees of retardation up to mutism.

Interrupted: abrupt interruption in train of thought before athought or idea is finished; the patient feels that his mind has

gone blank.

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III. Thinking cont.B. Form of thought:

It refers to the manner in which thoughts, as reflected in

speech, are linked in language.

Neologism: new word created by a patient. Circumstanciality: indirect speech that is delayed in

reaching the point but eventually gets from original point to

desired goal; characterized by overinclusion of details.

Loosening of associations: flow of thought in which ideasshift from one subject to another in a completely unrelated

way. When severe, the speech is incoherent.

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III. Thinking cont.C. Content of thought:

Obsession: persistence of an irresistible thoughtsor feelings that can not be eliminated from

consciousness by logical effort; associated with

anxiety.

Phobia: persistent, exaggerated, and pathological dreadofa specific stimulus or situation; results in a compelling

desire to avoidthe feared stimulus.

Specific phobia: dread of a discrete object or situation.

Social phobia: dread of public humiliation, as in fear of public

speaking, performing or eating in public.

Agoraphobia: dread of open places.

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IV. Speech Ideas, thoughts, feelings are expressed through language.

Speech abnormalities:A. quantitative:

Amount of speech: increased, or decreased up to mutism.

Rate of speech

Pauses in speech

Loudness of voice

B. qualitative:

Dysarthria: disorder of articulation of speech.

Aphonia: loss of the ability to phonate. Stuttering: repitition of syllable; stut-tut-tuttering.

Echolalia: repitition of words or phrases heard.

Aphasia: inability of the formulation of speech.

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V. Perception Process by which a person interprets sensory stimuli.

Disorders of perception:1. Hallucination: perception without existent external stimuls.

According to complexi ty:

Elementary (unformed) hallucination: e.g. whistles, flashes of light.

Complex (formed) hallucination: e.g. voices, faces, or scenes. According to sensory modality:

Auditory

Visual

Olfactory.

Gustatory.

Tactile.

2. Illusion: misinterpretation of existent external stimulus.

Pathological as in delerim and normal phenomenon as in camouflage &fashion designers.

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VI. Cognitive and intellectual functionsA. Consciousness

It is the awareness of self and environment.

Glasgow coma scale: used to evaluate the level of consciousness

from 3-14.

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Eye opening Verbal response Motor response

Spontaneous 4

To speech 3

To pain 2

None 1

Oriented 5

Confused 4

Words 3

Sounds 2

None 1

Obeying orders 5

Localizing 4

Flexing 3

Extending 2

None 1


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B. Orientation Is the awareness of the oneself in relation to time, place and persons.

Disorientationmay be:

o Organic mental disorders

o Psychogenic factors e.g. dissociative disorders and factitious disorder.

In disorientation, sense of time is impaired before sense of place andthe patient improves in reverse order.

C. attention and concentration Attentionis the ability to focus on certain stimuli and concentrationis the

ability to sustain attention.

Disorders of attention:

Distractibility: inability to concentrate; state in which attention is drawn

to irrelevant external stimuli. Hypervigilance: excessive attention to all internal and external stimuli,

usually secondary to delusional or paranoid states.

Trance: focused attention and altered consciousness, usually seen inhypnosis and ecstatic religious experiences.

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D. Memory

Memory is the process of acquisition (registration), retention

(storage), and retrieval (reproduction) of information.

Levels of memory:

Immediate memory: retrieval of perceived material within seconds

or minutes. It is checked by asking patients to repeat 6 digits forward

and then backward. Recent memory: retrieval of events over past days or weeks. It is

checked by asking patients about their appetite and then about what

they had for breakfast or for dinner the previous evening.

Remote memory: retrieval of events in distant past. It is checked by

asking patients about informations from their childhood that can be

later verified.

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memoryDisorders of

1) Amnesia: partial or total inability to recall past experiences;

may be of organic or emotional origin.Anterograde: amnesia for events occuring after a point in time.

Retrograde: amnesia for events occuring before a point in time.

2) Hypermnesia: exaggerated degree of retention and recall.

3) Confabulation: unconscious filling of gaps in memory byimagined or untrue experiences that a person believes but that

have no basis in fact.

4) Dj vu: illusion of visual recognition in which a new situation

is incorrectly regarded as a repetition of a previous memory.

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D. Intelligence

Ability to understand, recall, mobilize, and constructively integrate previous

learning in meeting new situations.

Disturbances of intelligence:

Mental retardation: lack of intelligence sufficient to interfere with social

and voactional performance.

Degrees of mental retardation:

o

Mild (IQ of 50 to 70).o Moderate (IQ of 35 to 50).

o Severe (IQ of 20 to 35).

o Profound (IQ below 20).

E. Abstraction1.Abstract thinking: ability of multidimentional thinking with ability to use

metaphors and hypotheses appropriately.

2.Concrete thinking: limited use of metaphor without understanding

meanings; one-dimentional thought.

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VII. Insight Is the patients degree of awareness and understanding

about being ill.

Levels of insight:

i. no insight: complete denial of illness.

ii. partial insight: awareness of being sick but blaming it onothers, on external factors, or on organic factors.

iii. true emotional insight: emotional awareness of the

motives and feelings within the patient which can lead to

basic changes in behaviour.

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MENTAL STATE