MENTAL STATUS’S

JOUR NA L R EV IEW
Berdasarkan American Academy of Family Physicians
University of Mississippi Medical Center

Pembimbing :
dr. Yulinar N. Siringoringo, Sp.KJ

Disusun oleh:
Desta Fransisca, S.Ked FAB 118 023
Risda Fajrianty Alwarisi S.Ked FAB 118 018
Febio Amino Leiden, S.Ked FAB 118 034
Feromiya Oksa, S.Ked FAB 118 014

KEPANITERAAN KLINIK
KSM ILMU KESEHATAN JIWA
RSJ KALAWA ATEI BUKIT RAWI
FAKULTAS KEDOKTERAN UPR
2019
• The mental status examination
– Useful tool  assist physicians  differentiating
neurologic and psychiatric disorders
– Observations made during a general patient
encounter or a more thorough evaluation by the
physician.
• Culture, native language, level of education, literacy,
and social factors such as sleep deprivation, hunger,
or other stressors  interpreting the examination

• The patient must be able to understand the questions

and communicate his or her answers, and the
physician must be able to interpret the examination
results.
• Begins with a general assessment
– Consciousness
– Appearance
– Activity
– Emotional state

• When a more thorough examination is indicated, it may be

separated into two general portions:
 observations made by the physician about the patient’s physical state
 a cognitive evaluation in which the patient’s neurologic and psychological functioning is
assessed.
THE COGNITIVE PORTION INVOLVES
ASSESSMENT OF 11 DIFFERENT FUNCTIONS:

• Attention • Praxis
• executive • Prosody
functioning • thought content
• Gnosia • thought processes
• Language • visuospatial
• Memory proficiency.
• Orientation
COMPONENTS OF
M E N TA L S TAT U S
E X A M I N AT I O N
 GENERAL
OBSERVATION
COMPONENT DEFINITION/CONTENT WHAT TO ASSESS SAMPLE QUESTION/TEST POTENTIAL DIAGNOSES IF ABNORMAL

Appearance Body habitus, eye contact, Appearance: attention to detail, attire,
and Behavior interpersonal style, style of distinguishing features, grooming,
dress hygiene
 
Behavior: candid, congenial,
cooperative, defensive, engaging,
guarded, hostile, irritable, open,
relaxed, resistant, shy, withdrawn Eye
contact: fleeting, good, none, sporadic
N/A Disheveled: depression, schizophrenia/psychotic
disorder, substance use
 
Irritable: anxiety
 
Paranoid: psychotic disorder
 
Poor eye contact: depression, psychotic disorder
Provocative: personality disorder or trait

Mood and Mood: subjective report of
Affect emotional state by patient
Affect: objective observation
of patient’s emotional state by
the physicia
Motor Facial expressions,
Activity movements, posture
Body movements/making contact
with others, facial expressions
Akathisia: excessive motor activity
 
Bradykinesia: psychomotor
retardation
 
Catatonia: immobility with muscular
rigidity or inflexibility
How is your mood? Mood disorder, schizophrenia, substance use
 
Have you felt sad/discouraged
lately?
Have you felt energized/out of
control lately?
N/A Akathisia: anxiety, drug overdose or withdrawal,
medication effect, mood disorder, parkinsonism,
post traumatic stress disorder, schizophrenia
 
Bradykinesia: depression, medication effect,
schizophrenia
 
Catatonia: schizophrenia/psychotic disorder,
severe depression
 COGNITIVE
FUNCTIONING
 COMPONENT DEFINITION/CONTENT WHAT TO ASSESS SAMPLE QUESTION/TESTS POTENTIAL DIAGNOSE IF ABNORMAL

ATTENTION Ability to focus - Count by sevens or fives Spell a word Attention-deficit/hyperactivity disorder,
based on internal or backwards delirium, dementia, mood disorder, psychotic
external priorities disorder

EXECUTIVE Ordering and Testing each Clock drawing test: ask patient to draw a Delirium, dementia, mood disorder,
FUNCTIONIN implementation of cognitive function clock with hands set to 11:10 Trail- psychotic disorder, stroke
G cognitive functions involved in making test: ask patient to alternate
necessary to engage completing a task numbers with letters in ascending order
in appropriate
behaviors

GNOSIA Ability to name - Show patient a common object and ask Advance dementia, stroke
objects and their if he or she can identify it and describe
function how it is used
LANGUAGE Verbal or written Appropriateness of N/A Rapid or pressured speech: mania  
communication conversation, rate of Slow or impoverished speech: delirium,
speech (> 100 depression, schizophrenia
words per minute is Inappropriate conversation: personality
normal; < 50 words disorder, schizophrenia
per minute is Inappropriate reading/writing level:
abnormal), reading dementia, depression, previous stroke
and writing
appropriate to
education level
 COMPONENT DEFINITION/CONTENT WHAT TO ASSESS SAMPLE QUESTION/TESTS POTENTIAL DIAGNOSE IF ABNORMAL

MEMORY Recall of past events Declarative: recall of When is your birthday? Short-term deficit: amotivation, attention-
recent and past What are your parents’ names? deficit/hyperactivity disorder, dementia,
events Procedural: Where were you born? inattention, substance use
ability to complete Where were you on September 11,  
learned tasks without 2001?
conscious thought Ask patient to repeat three words
immediately and again in five minutes
Ask patient to sign his/her name while
answering unrelated questions

ORIENTATION Ability of patient to Time, space, person What year/month/day/time is it? Amnesia, delirium, dementia, mania,
recognize his or her What city/building/floor/room are you previous stroke, severe depression
place in time and in?
space What is your name?
When were you born?

PRAXIS Ability to carry out praxia: inability to Could you show me how to use this delirium, dementia, intoxication, stroke
intentional motor acts carry out motor acts; hairbrush/hammer/pencil?
deficits may exist in
motor or sensory
systems,
comprehension, or
cooperatio
 Component Definition/content What to assess Sample questions/tests Potential diagnoses if
abnormal
Cognitive Ability to Repeat “Why are you here?” Autism spectrum
functioning with multiple inflections (e.g., happy, surprised, excited, disorder, developmental
recognize the - angry, sad) and ask patient to identify the emotion
(continued) emotional aspects delay, mood disorder,
Ask the patient to say the same sentence with each of the
Prosody schizophrenia
of language above emotional inflections

Thought content What the patient is Delusions, • Do you have thoughts or images in your head that you Delusions: fixed delusions,
thinking hallucinations, cannot get out? mania, psychotic
homicidality, • Do you have any irrational or excessive fears? disorder/psychotic
obsessions, phobias, • Do you think people are trying to hurt you in some depression Hallucinations:
suicidality way? delirium, dementia, mania,
• Are people talking behind your back? schizophrenia, severe
• Do you think people are stealing from you? Do you depression, substance use
feel life is not worth living? Homicidality: mood
• Do you see things that upset you? disorder, personality
• Do you ever see/hear/smell/taste/feel things that are disorder, psychotic disorder
not really there? Obsessions: obsessive-
• Have you ever heard or seen something other people compulsive disorder,
have not? posttraumatic stress
• Have you ever thought about hurting others or getting disorder, psychotic disorder
even with someone who wronged you? Phobias: anxiety disorder,
• Have you ever thought about hurting yourself? If so, posttraumatic stress
how would you do it? disorder Suicidality:
• Have you ever thought the world would be better off depression, posttraumatic
without you? stress disorder, substance
use
Component Definition/content What to assess Sample questions/tests Potential diagnoses if
abnormal
Thought Organization of Circumferential: patient Generally apparent throughout Anxiety, delirium,
processes thoughts in a goal- goes through multiple the encounter dementia, depression,
oriented pattern related thoughts before schizophrenia, substance
arriving at the answer to a use
question
Disorganized thoughts:
patient moves from one
topic to another without
organization or coherence
Tangential: patient listens
to question and begins
discussing related thoughts,
but never arrives at the
answer .

Visuospatial Ability to perceive - Ask patient to copy Delirium, dementia,

proficiency and manipulate intersecting pentagons or a stroke
objects and shapes three-dimensional cube on
in space paper Draw a triangle and
ask patient to draw the
same shape upside down
OTHER DIAGNOSTIC TESTING
• Abnormal results by the mental status examination  help
physicians determine the cause of cognitive problems.
• mental status examination results may not be sufficient to
narrow the differential diagnosis
• Therefore, testing is based on clinical judgment
• Initial laboratory studies to consider in patients
with an abnormal mental status examination
include :
Serum glucose
Blood urea nitrogen
Creatinine clearance
Urinalysis
Thyroid function
• Other tests 
Neuroimaging
Electroencephalography
Positron emission tomography,
Serum laboratory testing
Cerebrospinal fluid analysis
• Potentially nonpsychiatric symptoms or symptoms that
may be caused by a general medical condition
THANK YOU 