Mental status examination

Definition

Mental status examination is an assessment of patient’s level of cognitive (knowledge related) ability appearance, emotional mood, and speech and thought pattern at the time of evaluation.

Purposes

Assess the presence and extent of a person’s mental impairment.

To suggest specific areas for further testing or specific types of required tests.

To monitor or document changes in a patient’s conditions.

Factors affecting interpretation of findingsAny known illness or health problem.Current medication whose side effect may cause confusion or depression.

The usual education and behavioural level.

Responses to personal history questions, indicating current stress, social interaction patterns, sleep habits drug and alcohol use.

Precautions

A mental status examination cannot be given in a patient who cannot pay attention to the examiner, for example as a result of being in coma or unconsciousness or is completely unable to speak (aphasic) or is not fluent in the language of examination

IDENTIFICATION DATA:

Name:Age: Sex:Diagnosis: Date and time of MSEVenue: Language of interview

1.GENERAL APPEARANCEGrooming and dressPosture and gait Physical characteristics Eye contact Motor behaviour Specific mannerisms Attitude towards the examiner: Handedness:Manner of relating: Rapport:

2. EMOTIONS (MOOD AND AFFECT)

MoodAffect

3.SPEECH

RatePitch volume and clarity Specific abnormalities

4.PERCEPTUAL DISTURBANCE:

Hallucination and illusion.AuditoryVisual Tactile

5.THOUGHT

Thought processRate and flow of ideasRacing thoughtsRetarded or slowed thoughtsCircumstantialityBlockingPerseveration:

AssociationLoose association: Flight of ideas: TangentialityClangingNeologismsWord salad

Thought contentObsessionsphobiasdelusions

Sensorium and cognitionAlertness and level of consciousness: Orientation: Time: Q] What is the time now? Q] Today’s date?Place: Q] Where are you now?Person: Q] Who am I?

Memory:

Immediate memory.Recent memoryRecent past memoryRemote memory:

Attention and concentration: 100 – 7, 40 – 3, 20 – 1Can you tell me the digits which I say

forward and backwards? 25, 28, 41, 52,

AbstractabilityGeneral InformationIntelligence

7.Impulse ControlQ] What will you do if your son shouts at you?

8.JudgmentTest judgment: Q] What will you do if you see a child

standing near the well?Personal Judgment: Q] What is your plan after discharge? Social judgment:

9.Insight Level of insight