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Mental State Examination
Mental State Examination
Mental State Examination
Examination
B. Facial appearance:
mood: anxious, depressed, happiness.
medical conditions with psychiatric importance: thyrotoxicosis,
Downs syndrome, renal failure and cushing syndrome.
C. General appearance:
A.self care and grooming; hair, nail: may be neglected in schizophrenic,
depressed and addicts.
clothing; colour, appropriateness with age and sex.
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.
II. Emotion
Emotion: is a complex phenomenon involving reactions in 3
distinct components;
o Feeling experienced by the subject (e.g joy, anger, sadness ).
o Behavioral (expressive) component.
o Autonomic and endocrine component.
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 a
thought or idea is finished; the patient feels that his mind has
gone blank.
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.
Circumstantiality: indirect speech that is delayed in
reaching the point but eventually gets from original point to
desired goal; characterized by over inclusion of details.
Loosening of associations: flow of thought in which ideas
shift from one subject to another in a completely unrelated
way. When severe, the speech is incoherent.
III. Thinking
cont.
C.Content of thought:
Obsession: persistence of an irresistible thoughts or
feelings that can not be eliminated from
consciousness by logical effort; associated with
anxiety.
Phobia: persistent, exaggerated, and pathological dread of
a specific stimulus or situation; results in a compelling desire
to avoid the feared stimulus.
Specific phobia: dread of a discrete object or situation.
C.Social phobia: dread of public humiliation, as in fear of public
speaking, performing or eating in public.
Agoraphobia: dread of open places.
III. Thinking
cont.
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
qualitative:
Dysarthria: disorder of articulation of speech.
A. 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.
V. Perception
Process by which a person interprets sensory stimuli.
Disorders of perception:
1. Hallucination: perception without existent external stimuls.
According to complexity:
Elementary (unformed) hallucination: e.g. whistles, flashes of light.
Complex (formed) hallucination: e.g. voices, faces, or scenes.
VI.
A. Consciousness
It is the awareness of self and environment.
Glasgow coma scale: used to evaluate the level of consciousness
from 3-14.
Eye opening
Spontaneous
To speech
To pain
None
Verbal response
4
Oriented
5
3
Confused
2
Words
1
Sounds
None
4
3
2
1
Motor response
Obeying orders 5
Localizing
Flexing
Extending
None
4
3
2
1
B. Orientation
Is the awareness of the oneself in relation to time, place and persons.
Disorientation may be:
o Organic mental disorders
o Psychogenic factors e.g. dissociative disorders and factitious disorder.
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.
C.Trance: focused attention and altered consciousness, usually seen in
hypnosis and ecstatic religious experiences.
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.
Disorders of memory
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.
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
o
o
o
Abstraction
Abstract thinking: ability of multi dimentional thinking with ability to use
metaphors and hypotheses appropriately.
Concrete thinking: limited use of metaphor without understanding
meanings; one-dimentional thought.
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 on
others, 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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