Week 3: The Mental Status Exam

 

Appearance & Behavior

-description of client's clothes and self-care

-striking characteristics (scars, tattoos, etc should be noted)

-whether the client looks older/younger than stated age

-eye contact

-peculiar mannerisms

-whether client appears to be responding to internal stimuli

-motor behavior-restless, agitated, subdued, shaking, tremulous, rigid, pacing, withdrawn

-attitude toward the interview

 

 

Speech Characteristics & Thought Processes

-speech rate, volume, tone of voice

-describe thought process

" Pressured speech (increased rate of speech)

" Tangential thought (some connections between preceding thought and next statement)

" Circumstantial thought (same as above but returns to original topic)

" Loosening of associations (thoughts appear unconnected at times)

" Word salad (extreme loosening of associations)

" Flight of ideas (tangential thought or loosening of associations and pressured speech)

" Though blocking (stop in mid-sentence and never return to original idea)

" Illogical thought (displays illogical conclusions)

 

 

Thought Content

-ruminations (preoccupation with worries and feelings of guilt; thinking process does not appear strange to the client and they do not attempt to stop; too caught up in the process)

-obsessions (specific thought repeated over and over; client find this odd and painful; frequently attempt to stop the process)

-delusions (strongly held beliefs that are not correct or held to be true by vast majority of client's culture)

-presence of suicidal or homicidal ideation (presence of suicidal/homicidal wishes, plans, and degree of intent to follow the plans in an immediate sense)

 

 

Perception

-refers to the presence or absence of hallucinations or illusions

-visual, auditory, tactile

 

 

Mood & Affect

-mood-a self-report symptom of how he or she has been feeling recently; persistent

-affect-a physical sign of the client's mood (demonstrated by facial expressions and other nonverbal expressions); transient

-terms used to describe affect: normal (broad) affect with full range of expression; restricted affect (some decrease in facial animation); blunted affect (a fairly striking decrease in facial expression); flat affect (no sign of spontaneous facial activity); buoyant affect; angry affect; suspicious affect; frightened affect; flirtatious affect; silly affect; threatening affect; labile affect; edgy affect

 

 

Sensorium, Cognitive Functioning, & Insight

-basic level of functioning with regard to the level of consciousness, intellectual functioning, insight, and motivation

-always note whether the client exhibited a normal level of consciousness (awake, alert)

-Informal cognitive exam: performed throughout the interview in an non-invasive way (notes concentration and memory throughout the process of questioning)

-Formal cognitive exam: can range form a brief survey pf orientation, digit spans, and short-term memory, to a much more comprehensive exam lasting about 20 minutes or so