If there is any concern regarding possible interest in committing suicide or homicide, the patient should be asked this directly, including a search for details e.
It is beyond the scope of this chapter to consider this broad topic; however, some recent efforts to simplify and systematize the cognitive portion of mental status testing will be of interest and use to the primary-care physician.
As they speak, for example, note if they are avoiding eye contact, acting nervous, playing with their hair, or tapping their foot repeatedly. For example, an apple and an orange good response is "fruit"; poor response is "round"a fly and a tree good response is "alive"; poor response is "nothing"or a train and a car good response is "modes of transportation".
An ideal test of attentiveness should assay concentration on a simple task, placing minimal demand on language function, motor response, or spatial conception. Word fluency is more specifically tested by having the patient generate as many words in a given category as he or she is able in a fixed time period.
Note if the patient is speaking at a fast pace or is talking very quietly, almost in a whisper. References Boller F, Grafman J.
Instances of unilateral spatial neglect usually imply a destructive lesion of the contralateral parietal lobe. It was once felt that the right hemisphere was dominant for spatial relationships, hence constructional abilities, but it is now clear that damage to either side of the brain can lead to disability in this faculty.
Thought perseveration refers to a pattern where a person keeps returning to the same limited set of ideas. The more seriously ill patient may exhibit overtly delusional thinking a fixed, false belief not held by his cultural peers and persisting in the face of objective contradictory evidencehallucinations false sensory perceptions without real stimulior illusions misperceptions of real stimuli.
Recording an accurate educational history is imperative. Alertness is a global observation of level of consciousness i. The assessment of spontaneous speech is performed as the patient supplies answers to open-ended questions. Ask patients their marital status. All of these things must be kept in mind at all times when completing the social history.
Both affect and mood can be described as dysphoric depression, anxiety, guilteuthymic normalor euphoric implying a pathologically elevated sense of well-being. A condition of inattentiveness, then, does little to differentiate between toxic and metabolic states, diffuse cortical dysfunction, or psychiatric dysfunction.
If patients exhibit decreased levels of consciousness note the stimulus required to arouse the patient.
Clinical Significance What one thinks of as the "standard neurologic examination" is largely devoted to the testing of thresholds of perception of the special senses and the integrity of the motor and extrapyramidal systems. It may convey a sense of hostility, anger, helplessness, pessimism, overdramatization, self-centeredness, or passivity.
Patients may exhibit marked tendencies toward somatization or may be troubled with intrusive thoughts and obsessive ideas. How the patient perceives and responds to stimuli is therefore a critical psychiatric assessment. Certain specific syndromes such as unilateral spatial neglect and the disinhibited behavior of the frontal lobe syndrome are readily appreciated through observation of behavior.
This part of the examination is based solely on observations made by the health care professional.
Coma is unarousable unresponsiveness. Is the patient responding in exaggerated fashion to actual events, or is there no discernible basis in reality for the patient's beliefs or behavior.
Schneiderian first rank symptoms are a set of delusions and hallucinations which have been said to be highly suggestive of a diagnosis of schizophrenia.
The intensity of the affect may be described as normal, blunted affectexaggeratedflat, heightened or overly dramatic. Mar 30, · The history and Mental Status Examination (MSE) are the most important diagnostic tools a psychiatrist has to obtain information to make an accurate diagnosis.
Although these important tools have been standardized in their own right, they remain primarily subjective measures that begin the moment the patient enters the office. Mental Status Examination: 52 Challenging Cases, DSM and ICD Interviews, Questionnaires and Cognitive Tests for Diagnosis and Treatment (Volume 1) Apr 2, by Wes Burgess.
Learning Objectives • Discuss the mental status examination • Articulate the purpose of a comprehensive mental status examination • Understand the parts of the mental status examination • Formulate the criteria for documentation of assessment data 2.
The Mental Status Examination The mental health status examination (MSE) forms one component of the assessment of an individual. It augments other assessment components such as the history of the presenting complaint and provides cues as to what more.
1 Case Management: The Mental Status Examination. Part 1: Introduction. The mental status examination (MSE) is based on your observations of the client.
It is not related to the facts of the client's situation, but to the way the person acts, how the person talks, and how the person. The mental status examination is a structured assessment of the patient's behavioral and cognitive functioning.
It includes descriptions of the patient's appearance and general behavior, level of consciousness and attentiveness, motor and speech activity, mood and affect, thought and perception, attitude and insight, the reaction evoked in the examiner, and, finally, higher cognitive abilities.Mental status examination 1