Pemeriksaan Status

Mental
Oleh:
Ns. Gst. Kade Adi Widyas Pranata, S.Kep., M.S.
 Defining Mental Status
• Mental status  a person’s emotional (feeling)
and cognitive (knowing) function
• Mental health  a state of well-being in which
every individual:
 realizes his or her own potential,
 can cope with normal stresses of life,
 can work productively and fruitfully, and
 able to make a contribution to community
 Relative and ongoing
 Defining Mental Status
• Mental disorder:
 Apparent when a person’s response is much greater than
the expected reaction to a traumatic life event
 Clinically significant behavioral, emotional, or cognitive
syndrome that is associated with significant distress (a
painful symptom) or disability (impaired functioning)
involving social, occupational, or key activities
 Include:
• Organic disorders  caused by brain disease of known specific
organic cause (e.g., delirium, dementia, alcohol and drug
intoxication, and withdrawal)
• Psychiatric mental disorder  in which an organic etiology has not
yet been established (e.g., anxiety disorder or schizophrenia)
 Mental Status  inferred through assessment
No Individual’s Key Point
behaviors
1 Consciousness Being aware of one’s own existence, feelings, and
thoughts and of the environment
2 Language Using the voice to communicate one’s thoughts and
feelings
3 Mood and Affect  a temporary expression of feelings or state
Affect of mind
Mood  a prolonged display of feelings that color the
whole emotional life (more durable)
4 Orientation The awareness of the objective world in relation to
the self (Person, place, and time)
5 Attention The power of concentration, the ability to focus on
one specific thing without being distracted by many
environmental stimuli
 Mental Status  inferred through assessment
No Individual’s Key Point
behaviors
6 Memory The ability to lay down and store experiences and
perceptions for later recall
Recent memory  evokes day-to-day events
Remote memory  brings up years’ worth of
experiences
7 Abstract Pondering a deeper meaning beyond the concrete
reasoning and literal
8 Thought The way a person thinks; the logical train of thought
process
9 Thought What the person thinks - specific ideas, beliefs, and
content the use of words
10 Perceptions An awareness of objects through the five senses
Components of The Mental Status Examination

A
Appearance B Behavior

C
T
Thought processes
Cognitive Function
& Perception
Parameters Normal Abnormal findings
1. Appearance
a. Posture Erect and Anxiety: sitting on edge of chair or curled in bed, tense
position is muscles, frowning, darting and watchful eyes, restless
relaxed pacing
Depression: sitting slumped in chair, slow walk, dragging
feet
b. Body Voluntary, Anxiety: Restless, fidgety or hyperkinetic appearance
Movements deliberate, Depression and dementia: Apathy & psychomotor slowing
coordinated, Schizophrenia: abnormal posturing and bizarre gestures
smooth and even

c. Dress Appropriate for Organic brain syndrome: Inappropriate dress

setting, season, Schizophrenia or manic syndrome: Eccentric dress
age, gender, combination and bizarre make up
social group
d. Grooming Clean and well Strokes: Unilateral neglect
and hygiene groomed Depression and severe Alzheimer disease: inappropriate
dress, poor hygiene, and lack of concern with appearance
Obsessive compulsive disorders: Meticulously dressed and
groomed appearance and fastidious manner
Parameters Normal
2. Behavior
a. Level of Awake, alert, and aware of
Consciou stimuli from the environment
sness and within the self, respond
appropriately and reasonably
soon to stimuli
b. Facial Appropriate to the situation
Expression and changes appropriately
with the topic
c. Speech Laryngeal sounds effortlessly;
The pace is moderate, and
stream of talking is fluent;
Articulation is clear and
understandable; Word choice
is effortless and appropriate to
educational level, complete
sentences
d. Mood Appropriate to the person’s
and affect place and condition and
change appropriately with
topics
Abnormal findings
Lethargic (or Somnolent), Obtunded, Stupor
or Semi-Coma, Coma, Delirium (Acute
Confusional State)
Parkinsonism and depression: Flat, masklike
expression
Dysphonia: disorder of voice
Dysarthria: disorder of articulation
Aphasia: disorder of language
comprehension and production secondary to
brain damage
Depression: Slow, monotonous speech
Manic Syndrome: rapid-fire, pressured, and
loud talking
Flat affect: lack of emotional response, no
expression of feelings, voice monotonous
Euphoria: excessive well-being, unusually
cheerful or elated
Parameters Normal Abnormal findings
3. Cognitive Functions
a. Orientation Fully oriented by time, place Delirium and dementia: disorientation from
and person time  place  person

b. Attention Fully concentrate, can Confusion, negativism

Span complete a thought without Digression from initial thought
wandering Anxious, fatigued: attention span impaired
c. Recent Fully remember recent event Delirium, dementia, amnestic syndrome or
memory in the last 24-hour or a Korsakoff syndrome in Chronic Alcoholism:
passed week recent memory deficit
d. Remote Fully remember verifiable Alzheimer dementia or any disease that
memory past event (e.g., past health, damages the cerebral cortex: lost remote
first job, birthday and memory
anniversary dates, and
historical events)
e. New People < 60 is an accurate Alzheimer dementia: score zero- or one-word
learning – the three- or four-word recall recall
four unrelated after a 5-. 10-, and 30- Anxiety (inattention and distractibility) and
words test minute delay depression (lack of effort mobilized to
remember): impaired new learning ability
Parameters Normal Abnormal findings
4. Thought Processes and Perceptions
a. Thought The way a person thinks Illogical, unrealistic thought processes
processes should be logical, goal Blocking
directed, coherent, and Flight of ideas
relevant, complete a
thought
b. Thought What the person says Phobia
content should be consistent and Obsession, Compulsion
logical Hypochondriasis
c. Consistently aware of Hallucination  visual, auditory
Perceptions reality, congruent with (psychiatric and organic brain disease),
examiner tactile (alcohol withdrawal), olfactory,
gustatory
Illusion
 Supplemental Mental Status Examination
The Mini Mental Sate Examination (MMSE)
•Is a simplified scored form of the cognitive functions of the mental status
examination
•Is used with caution with people with low education
•It requires paper and pencil; the person must be able to write and have no
vision impairment
•It concentrates only on cognitive functioning, not on mood or thought
processes  good screening tool to detect dementia and delirium, and to
differentiate from pyschiatric mental illness
Score
•24 – 30  normal/ no cognitive impairment
•18 – 23  mild cognitive impairment
•8 – 17  moderate cognitive impairment
•0 – 7  severe cognitive impairment
 Developmental Competence
Infant and Children
•Emotional and cognitive functioning mature progressively from
simple reflex behavior into complex logical and abstract thought
•Consciousness gradually develops along with language by 18 to 24
months
•Language as a social tool communication occurs around 4 – 5 years of
age
•Attention gradually increases in span through preschool years
•Thought process become more logical, systematic, able to reason and
understand  around age 7
•Abstract thinking, the ability to consider a hypothetical situation 
ages 12 – 15 years
 Developmental Competence
Infant and Children
•The Denver II screening test 
•Designed to detect developmental delays in infants and preschoolers within
four functions: gross motor, language, fine motor-adaptive, and personal-
social skills
•Helps to identify young children who may be slow in development in
behavioral, language, cognitive, and psychosocial areas
•Childhood mental disorders
•ADHD (Attention-Deficit/Hyperactivity Disoder)
•ASD (Autism Sydrome Disorder)
•ODD (Oppositional Defiant Disorder
•Anxiety
•Depression
•Eating disorder  anorexia nervosa, bulimia nervosa, binge eating
 Childhood Mental Disorders

ADHD ODD

Autism spectrum
disorder
Eating disorders
 Characteristic of Eating Problems

Anorexia Nervosa Bulimia nervosa

Binge eating disorder

 Developmental Competence
The Aging Adult
•The aging process leaves the parameters of mental status mostly intact
•No decrease in general knowledge and little or no loss in vocabulary
•Response time is slower than in youth  take longer to process information
and react to it  affects new learning
•Recent memory which requires some processing is somewhat decreased
•Remote memory is not affected
•Changes in sensory perception can affect mental status
Vision loss  apathy, social isolation, and depression
Hearing loss  problem with normal conversation  frustration, suspicion,
social isolation and confused
•The grief and despair because of loss of loved one, job status and prestige,
income, energic and resilient body, chronic disease  disorientation,
disability, or depression
•Common disorder in Aging Adult: confusion, delirium, dementia
 Developmental Competence for Aging Adult
No Objective data Findings
1 Behavior  level The Glasgow Coma Scale is quantitative tool give the
of consciousness numeric value to the person’s response in eye opening,
best verbal response, and best motor response

2 Cognitive Experience social isolation, loss of structure without

functions  job, or short-term memory loss
orientation
3 New learning An age-related decline occurs in performance in the
Four Unrelated Words Test
4 Supplemental • Newly develop, reliable, quick, and easily available
Mental Status instrument to screen for cognitive impairment.
Examnination  • Consist of 3 item recall test and a clock drawing test
The Mini-Cog • Test the person’s executive function, including the
ability to plan, manage time, organize activities, and
managing working memory.
Abnormal Findings
 Level of Consciousness
No Level of Keypoint
Consciousness
1 Alert Awake; oriented, fully aware of internal-external stimuli;
conducts meaningful interpersonal interactions
2 Lethargic Not fully alert; drifts off to sleep when not stimulated;
(somnolent) can be aroused to name when called in normal voice but
looks drowsy
3 Obtunded Sleep most of the time; difficult to arouse (transitional
state between lethargy and stupor)
4 Stupor or Semi Spontaneously unconscious; responds only to persistent
Coma and vigorous shake or pain
5 Coma Completely unconscious; no response to pain or any
external or internal stimuli
6 Delirium Clouding of consciousness (dulled cognition, impaired
alertness); inattentive; incoherent conversation;
disoriented; impaired recent memory
No Mood and affect Key point
1 Flat affect Lack of emotional response
2 Depression Sad, gloomy, dejected
3 Depersonalization Loss of identify, feels estranged
4 Elation Joy and optimism, overconfidence
5 Euphoria Excessive well-being, unusually cheerful
6 Anxiety Worried, uneasy, apprehensive from anticipatio n
7 Fear Worried, uneasy, apprehensive, external danger is
known and identified
8 Irritability Annoyed, easily provoked, impatient
9 Rage Furious, loss of control, expressed violent behavior
10 Ambivalence The existence of opposing emotions toward an
idea, object, person
11 Lability Rapid shift of emotions
12 Inappropriate Affect clearly discordant with content of person’s
affect speech
No Anxiety disorders Key point
1 Panic attack Defined period of intense fear, anxiety, and dread
accompanied by signs of dyspnea, choking, chest pain
2 Specific phobia A pattern of debilitating fear when faced with a particular
object or situation
3 Generalized A pattern of excessive worrying and morbid fear about
anxiety disorders anticipated “disasters” in the job, personal relationships,
(GAD) health, or finances
4 Agoraphobia An irrational fear of being out in the open or in a place
from which escape is difficult
5 Social anxiety A persistent and irrational fear of speaking or performing
disorders (Social in public in which the person anticipates being judged or
phobia) criticized, feeling/ looking foolish
6 Obsessive A pattern of recurrent obsessions (intrusive,
compulsive uncontrollable thoughts) and compulsions (repetitive
disorder (OCD) ritualistic actions) done to decrease anxiety
7 Posttraumatic Follow a traumatic event outside the range of human
stress disorder experience involving actual or threatened death
 Delirium, Dementia, and Depression
Delirium Dementia Depression
Onset Sudden, over hour Slowly, over Gradual,
to days months exacerbation
during crisis or
stress
Contributing Hypoglychemia, Alzheimer, Lifelong history,
factors fever, vascular disease, losses, loneliness,
dehydration, chronic crises, declining
Change in alcoholism, head health, medical
environment (e.g., trauma conditions
hospitalization)
Cognition Impaired memory, Impaired Difficulty
judgment, memory, concentrating,
attention span, judgment, forgetfulness,
fluctuate through attention span, inattention
 Delirium, Dementia, and Depression
Delirium Dementia Depression

Level of Altered Not altered Not altered

consciousness
Activity level Can be Not altered Usually
increased or decreased,
reduced lethargy, fatigue
Emotional state Rapid swings, Flat; agitation Extreme
can be fearful, sadness, apathy,
anxious irritability
Speech Rapid, Incoherent, Slow, flat, low
inappropriate slow, repetitious
Prognosis Reversible Not reversible, Reversible
progressive
 Thought Process Abnormalities
No Type of process Key point

1 Blocking Sudden interruption in train of thought

2 Confabulation Fabricates events to fill in memory gaps
3 Neologism Coining a new word
4 Circumlocution Round-about expression
5 Circumstantiality Talks with excessive and unnecessary detail
6 Loosening Shifting from one topic to an unrelated topic;
associations unware that topics are unconnected
7 Flight idea Abrupt change, rapid skipping from topic to topic
8 Word salad Incoherent mixture of word, phrases, & sentences
9 Perseveration Persistent repeating of verbal or motor response
10 Echolalia Imitation, repeats others words or phrases
11 Clanging Word choice based on sound, not meaning
 Thought Content Abnormalities
No Type of content Keypoint
1 Phobia Strong, persistent, irrational fear of an
object or situation
2 Hypochondriasis Morbid worrying about his or her own
health; feels sick with no actual basis for
that assumption
3 Obsession Unwanted, persistent thoughts or
impulses
4 Compulsion Unwanted repetitive, purposeful act,
driven to do it
5 Delusions Firm, fixed, false beliefs, irrational;
person clings to delusion despite
objective evidence to contrary
 Perception Abnormalities

No Type of Key point

perception
1 Hallucination Sensory perceptions for which there are
no external stimuli; may strike any sense:
visual, auditory, tactile, olfactory,
gustatory
2 Illusion Misperception of an actual existing
stimulus, by any sense