Mental Status Examination

Marcos C.S. Ong, M.D., FPNA

I. Consciousness

• Alert
• Awake, aware, interacting, and responsive to stimuli
• Lethargic
• Arousable but cannot maintain arousal
• Stuporous
• Arousable with intense stimulation
• Comatose
• Not rousable even with intense stimuli
• Fluctuating
• Mental state varies during the course of the day
II. Attention and Vigilance

• Attention • Assessment
• The capacity to focus on • Digit span
a single stimulus • Forward and reverse
• Measures attention of < 10
• Vigilance sec duration
• The ability to focus • Auditory Vigilance
attention over an • Measures concentration of
extended period approx. 1 minute duration
III. Behavior

• Appearance and grooming

• Motor activity
• Increased motor activity
• agitated depression, mania, ADHD, delirium
• Reduced motor activity
• Depression, catatonia, frontal lobe syndromes, Parkinsonian state, delirium
• Tics
• Blinking and grimacing
• Repetitive acts
III. Behavior

• Facial expression
• Depression and Parkinson’s disease
• Mood and affect
• Affect is the immediate overt expression of an emotional state
• Mood is the sustained or underlying emotion
• Interview behavior
IV. Language, thought and memory
• Handedness
• Language comprehension
• Aphasia
• Motor vs. sensory
IV. Language, thought and memory
• Spontaneous speech
• Changes in rate of speech
• Complete muteness
• Dysarthria
• difficulty in articulation, intonation and phonation
• Dysprosody
• Loss of melodic aspect of speech
• Associated with right hemisphere lesions
• Inability to encode emotion into speech
IV. Language, thought and memory
• Writing
• Associated with frontal lesions
• Agraphia
• Inability to write dictated material
• Caused by posterior perisylvian lesions
• Dysgraphia
• Faulty production of letters and words
IV. Language, thought and memory
• Thought disorders
• May affect content or form
• Formal thought disorders
• Reduced content or poverty of ideas
• Circumstantiality
• Trouble reaching the point
• Derailment
• Shift in thinking
IV. Language, thought and memory
• Tangentiality
• Shifts in topic
• Blocking
• Sudden cessation of speech attributed to losing one’s thought
• Flight of ideas
• Includes accelerated speech and rapid shifts in topic
• Clang association
• A form of derailment in which patient changes topic because of
the sound
• Confabulation
• Apparent fabrication of facts or events to fill gaps in memory
IV. Language, thought and memory
• Neologisms
• Word inventions or distortions
• Echolalia
• Echoing of the words or phrases of others
• Perseveration
• Persistent repetition of words and phrases
• Word salad
• A form of disorganized speech in which syntax is lost
IV. Language, thought and memory
• Disorders of thought content
• Illusion
• A misperception of a real external stimulus
• Delusion
• A fixed false belief based on an incorrect interpretation fo reality
IV. Language, thought and memory
• Hallucinations
• Auditory
• Visual
• Olfactory
• Seen in complex partial seizures
• Gustatory
• Tactile
• Assaultive thoughts
• Homicidal thoughts
IV. Language, thought and memory
• Feelings of hopelessness
• Feelings of worthlessness
• Anhedonia
• Inability to derive pleasure from ordinarily pleasurable activities
• Feelings of guilt
• Suicidal thoughts
IV. Language, thought and memory
• Obsessions
• Phobias
• Sexual concerns
• Somatic preoccupation
• Religiosity
IV. Language, thought and memory
• Memory
• Sensorium
• Orientation
• Memory testing
• Orientation for time, place, situation and person
• Short term memory testing
• Recall
• Remote memory testing
V. Constructional ability, calculation
and learned material
• Constructional ability
• Ability to copy or draw 2-3 dimensional shapes or designs
• Calculation
• Simple mental arithmetic
• Serial subtraction
• Learned material
• Store of knowledge or general information
VI. Abstract thinking, conceptual
ability, judgement and insight
• Measures the highest cortical function
• Executive ability
• Abstract thinking
• Similarities
• Proverb interpretation
• Conceptual ability
VI. Abstract thinking, conceptual
ability, judgment and insight
• Judgment
• Patient’s understanding of what he has done or will do in various situations
• Insight
• Patient’s awareness of the significance of her symptoms and illness