Chapter 5: Mental Status Assessment

Mental Status

A person’s emotional and cognitive function

ABCT

Appearance, behavior, cognitive functions, and thought processes/perception

Appearance

Posture, body movements, dress, grooming/hygiene, and pupils

Behavior

Level of consciousness, facial expression, speech, and mood/affect

Cognitive Functions

Orientation, attention span, memory, and new learning

Thought Processes

Thought content and judgement

Mini Mental Status Examination

Written examination that collects objective data about a patient’s memory, orientation, reading, writing, coping, visuospatial orientation, and ability to follow command (MMSE)

Delirium

Acute confusion or perceptual disturbance usually accompanying an illness, causes fluctuations in consciousness and is usually resolved with illness

Dementia

Gradual, progressive memory loss and confusion, patient is fully conscious and awake, not reversible

PINCH ME

Used for understanding delirium, pain, infection, constipation/urinary retention, hydration, medications/substances, and environmental triggers

Mental Disorder

Clinically significant behavioral, emotional, or cognitive syndrome that is associated with significant distress or disability involving social, occupational, or key activities

Organic Disorder

Mental disorder caused by a brain disease of known, specific cause (delirium, dementia, intoxication)

Psychiatric Disorder

Mental disorder with no established organic etiology (anxiety)

Consciousness

Being aware of one’s own existence, feelings, and thoughts, most important for mental status

Mood

Prolonged, durable display of feelings that color the whole emotional life

Affect

Temporary expression of feelings or state of mind

Orientation

Awareness of the objective world in relation to the self, including person, place, and time

Abstract Reasoning

Pondering a deeper meaning beyond the concrete and literal

Thought Process

The way a person thinks

Thought Content

What a person thinks

Full Mental Status Exam

Perform when you discover any abnormality in affect/behavior, patient’s initial screening suggests anxiety/depression, family members are concerned, report of relevant organic behavior symptoms, brain lesions, or aphasia

Anxiety/Hyperthyroidism Posture

Tense, frowning, darting eyes, and restless pacing

Depression Posture

Slumped, slow walk, and dragging feet

Anxiety Body Movements

Resless, fidgety movement or hyperkinetic appearance

Depression/Dementia Body Movements

Apathy and psychomotor slowing

Schizophrenia Body Movements

Abnormal posturing and bizarre gestures

Schizophrenia Dress

Eccentric dress combination and bizarre makeup

Stroke Hygiene

Unilateral grooming neglect

Depression/Alzheimers Hygiene

Inappropriate dress, poor hygiene, and lack of concern with appearance

OCD Hygiene

Meticulously dressed/groomed appearance and fastidious manner

GAD-7

Screening for generalized anxiety disorder, a score of > 8 requires further evaluation

Patient Health Questionnaire 2

Brief screening questions for depression, includes “over the past 2 weeks have you felt down, depressed, or hopeless” and “over the past 2 weeks have you felt little pleasure or interest in doing things”, score of 2+ indicates full PHQ-9 (PHQ-2)

Ask Suicide Screening Questions

Suicide screening for those 8 and older, answer yes to any question indicates further evaluation (ASQ)

Montreal Cognitive Assessment

Assessment tool for mental status, more sensitive to mild cognitive impairment compared to MMSE, a score less than 26 is indicative

Mini Cog

Assessment tool for dementia, have a patient remember 3 words and draw a clock, a score < 3 is indicative

Dystonia

Abnormal voice volume and pitch

Dysarthria

Distorted speech

Aphasia

Inability to speak/write coherently or understand speech/writing

Alert

Patient is awake or readily aroused, oriented, fully aware of all stimuli, and conducts meaningful interactions

Lethargic

Patient is not fully alert, drifts off to sleep when not stimulated, can be aroused with normal voice, responds but thinking is slow, looses train of thought, and have decreased spontaneous movements

Obtunded

Patient sleeps most of the time, is difficult to arouse (requires shouting/shaking), acts confused, uses monosyllables, mumbles, and requires constant stimulation

Stupor

Patient is spontaneously unconscious, responds only to consistent and vigorous shaking or pain, has appropriate motor responses, and reflexes persist

Coma

Patient is completely unconscious with no response to stimuli

Global Aphasia

Spontaneous speech is absent/reduced, comprehension is absent/reduced, repetition, writing, and reading are impaired, usually caused by large lesions, have a poor prognosis

Broca’s Aphasia

Person can understand language but cannot use it effectively, characterized by non-fluent, dysarthic, and effortful speech, usually due to lesion in anterior language area

Wernicke’s Aphasia

Person can hear sounds but cannot relate them to previous experiences, speech is fluent, effortless, and well articulated but has paraphasis and neologisms, caused by a lesion in posterior language area

Flat Affect

Lack of emotional response, no expression of feeling, monotonous voice, and immobile face

Depersonalization

Loss of identity, feels estranged, perplexed about meaning of existence

Lability

Rapid shift of emotions

Panic Attack

Defined period of intense fear, anxiety, and dread with signs of dyspnea, choking, chest pain, tachycardia, palpitations, nausea, and sweating, usually lasts 10 min

Agoraphobia

Irrational fear of being out in the open or in a place from which escape is difficult

Blocking

Sudden interruption in train of thought, unable to complete sentence

Confabulation

Fabricates events to fill gaps in memory

Neologism

Coining a new word that has no real meaning

Circumstantiality

Talks with excessive and unnecessary detail, relays reaching point

Loosening Associations

Shifting from one topic to an unrelated topic, is unaware that they are unrelated

Flight of Ideas

Abrupt change, rapid skipping from topic to topic, usually have associations or are a play on words

Word Salad

Incoherent mix of words, phrases, and sentences

Perseveration

Persistent repeating of verbal or motor response

Echolalia

Imitation often with mumbling, mocking, or mechanical voice

Clanging

Word choice is based on sound and not meaning

Hypochondriasis

Morbid worrying about health

Hallucination

Sensory perception for which there are no external stimuli

Illusion

Misperception of an actual existing stimulus

Oppositional Defiance Disorder

Disruptive set of behaviors characterized by negative aggressive, angry, and irritable mood