Comprehensive Mental Status Exam: Definitions, Brain Functions, and Altered Consciousness

What does mental status refer to?

A patient's level of awareness, cognition, and emotional functioning as assessed through observation and interaction.

What are the components of a mental status exam?

Orientation, attention, memory, mood, thought processes, perception, and judgment.

What is altered level of consciousness?

A clinical presentation that includes confusion, lethargy, stupor, or coma.

What does disorientation refer to in a mental status exam?

Disorientation can occur to person, place, time, or situation.

What are common signs of impaired attention or memory?

Forgetfulness and poor focus.

What are some abnormal behaviors or moods observed in mental status changes?

Agitation, withdrawal, and irritability.

What are some speech or thought disturbances observed in mental status changes?

Incoherence, slowed, or illogical speech

What are hallucinations and delusions?

Hallucinations involve seeing or hearing things that are not present, while delusions are false beliefs.

What can a change in mental status indicate?

It often signals acute medical or neurological dysfunction requiring prompt evaluation.

What is a mental health disorder?

A condition characterized by significant impairment in cognition, emotional regulation, and behavior, leading to distress or disability.

What are functional causes of changes in mental status?

Panic attacks, depressed mood in grief, post-traumatic stress disorder, personality disorder, and functional neurologic disorder

What are organic causes of changes in mental status?

Stroke, electrolyte abnormalities, delirium, traumatic brain injury, and alcohol or sedative drug withdrawal

What is the function of the frontal lobe?

It is responsible for personality characteristics, decision making, and the ability to form speech (Broca's area).

What does the parietal lobe do?

It helps identify objects and understand spatial relationships.

What is the primary function of the occipital lobe?

Vision.

What functions are associated with the temporal lobe?

Short-term memory, speech, musical rhythm, and some degree of smell recognition (Wernicke's area).

What is the role of the cerebellum?

It coordinates voluntary muscle movements and maintains posture, balance, and equilibrium.

What 3 parts of the brain play a role in intelligence?

Cerebellar-parietal, frontal and temporal

What are the categories of level of consciousness?

Alert, lethargic, obtunded, stuporous, and coma.

What characterizes an alert patient?

The patient is awake, aware, and responds fully and appropriately to stimuli.

What does it mean if a patient is lethargic?

They require loud, forceful speaking to provoke a response and may fall asleep after responding.

What does obtunded mean in terms of consciousness?

The patient opens their eyes with tactile stimulus and responds slowly, often appearing confused.

What is the state of a stuporous patient?

They are un-arousable except by painful stimuli and may lapse into unresponsive states.

What defines a comatose patient?

The patient is completely un-arousable, with closed eyes and no evident response to stimuli.

What are some acute life-threatening conditions that can alter consciousness?

UTI, hypoxia, pneumonia, hypoglycemia, sepsis, hypertensive encephalopathy, Wernicke's encephalopathy, overdose, CNS infections/trauma, intracranial hemorrhage, or epilepsy

What are the common conditions that can alter consciousness?

UTI, pneumonia, electrolyte abnormalities, medication adverse effects, medication withdrawals, psychiatric illness

What are other conditions that can alter consciousness?

Endocrine disease, stroke, CNS mass lesions, dementia

What are key components of a mental status exam?

Appearance and behavior, speech and language, mood, thoughts and perceptions, insight, judgment, and cognitive function

What should be observed in a patient's appearance and behavior?

Hygiene, grooming, facial expression, body language, and overall demeanor.

What does affect refer to in a mental status exam?

The observable behaviors that express subjective feelings or emotions through tone of voice, facial expression, and demeanor.

What are common symptoms of a paranoid patient?

Irritability, anger, suspiciousness, and evasiveness.

What does 'dulled' or constricted affect indicate in depression?

It is seen in combination with apathy.

What is the role of language in mental health assessment?

It is a system for expressing, receiving, and comprehending words. Essential for assessing mental function.

What aspects of speech should be assessed?

Quantity, rate and volume, articulation, fluency, and presence of circumlocutions or paraphasias.

What is dysphonia?

Impaired volume, quality, or pitch of the voice.

What is dysarthria?

Trouble with articulation of words.

What are circumlocutions in speech?

When a patient cannot think of a word and describes it instead.

What are paraphasias?

Malformation, incorrect use, or invention of words in speech.

How is mood defined in a mental health context?

As the pervasive and sustained emotion that colors a person's perception of the world.

How does mood differ from affect?

Affect is objective (observable), while mood is subjective (self-reported).

What should you ask to assess for suicidal thoughts?

Questions about feelings of discouragement, thoughts of death, and plans for suicide.

What is the difference between thought process and thought content?

Thought process refers to the logic and organization of thoughts, while thought content is what the patient thinks about.

What are hallucinations?

Perception-like experiences that seem real but lack external stimulation.

When are hallucinations not considered hallucinations?

If they are associated with dreaming, falling asleep and/or awakening.

What are illusions?

Misinterpretations of real external stimuli.

What does insight refer to in mental health assessment?

Awareness that symptoms or disturbed behaviors are normal or abnormal.

What factors can influence a patient's judgment?

Anxiety, mood disorders, intelligence, education, income, and cultural values.

What is orientation in cognitive assessment?

Awareness of personal identity, place, and time.

What is attention in cognitive assessment?

The ability to focus or concentrate over time

What types of memory are assessed in cognitive evaluation?

Remote (long-term) and recent (short-term) memory.

What is the purpose of assessing new learning ability?

To test registration and immediate recall of information.

What does assessing higher cognitive function involve?

Evaluating information and vocabulary, calculating ability, abstract thinking, and constructional ability.

What characterizes dementia?

An acquired condition that is characterized by a decline in at least two cognitive domains severe enough to affect social or occupational functioning.

What is delirium?

A multifactorial syndrome, an acute state of confusion marked by sudden onset, fluctuating course, and inattention.

What cranial nerve is responsible for smell?

Cranial Nerve I (Olfactory), a sensory nerve

How is the olfactory nerve tested?

By having the patient sniff substances while one nostril is occluded.

What can cause loss of smell?

Loss of smell can occur due to sinus congestion, Covid virus, head trauma, smoking, aging, cocaine use, and Parkinson Disease.

What is the function of CN II (Optic)?

CN II is responsible for vision and is a sensory nerve.

How should visual acuity and visual fields be tested?

Visual acuity and visual fields should be tested approximately 14 inches away.

What is involved in pupillary constriction to light?

Pupillary constriction to light involves both the optic nerve (CN II) and the oculomotor nerve (CN III).

What is the purpose of a fundoscopic exam?

The fundoscopic exam assesses the health of the retina and optic nerve.

What should the examiner instruct the patient to do during a fundoscopic exam?

The examiner should instruct the patient to focus on a distant object and continue to do so.

What characteristics of the optic disc should be reported during a fundoscopic exam?

The optic disc should have sharp margins and be yellowish in color, with a cup to disc ratio of about 0.5.

What is the role of CN III (Oculomotor)?

CN III is a motor nerve that supplies extraocular movements and plays a role in pupillary constriction.

What muscles are supplied by CN III?

Superior rectus, inferior rectus, inferior oblique and medial rectus

How is CN III tested?

CN III is tested by having the patient follow a finger in the six cardinal directions.

What is the function of CN IV (Trochlear)?

CN IV is a motor nerve that supplies the superior oblique eye muscles.

What is the function of CN V (Trigeminal)?

CN V is both a motor nerve for muscles of mastication and a sensory nerve for the face, sinuses, and teeth.

How is the motor function of CN V assessed?

Motor function is assessed by palpating the temporal and masseter muscles and asking the patient to clench their teeth.

How is the sensory function of CN V assessed?

Via light touch and pain. If sensory loss is suspected, test temperature sensation.

What are the 3 segments of the trigeminal nerve?

V1 - ophthalmic division, V2 - maxillary division, V3 - mandibular division

What is the function of CN VI (Abducens)?

CN VI is a motor nerve that supplies the lateral rectus eye muscles.

What is the function of CN VII (Facial)?

CN VII is a motor and sensory nerve that controls facial muscles and provides taste sensation from the anterior tongue.

How is CN VII assessed?

CN VII is assessed by inspecting the face for asymmetry and asking the patient to perform facial movements.

What is the function of CN VIII (Vestibulocochlear)?

CN VIII is a sensory nerve responsible for hearing.

How is hearing assessed for CN VIII?

Hearing is assessed using the rubbing fingers test and further evaluated with Rinne and Weber tests if hearing loss is present.

What are the 2 etiologies of hearing loss?

Conductive (from impaired "air through ear" transmission and sensorineural (from damage to cochlear branch or vertigo)

What is the function of CN IX (Glossopharyngeal)?

CN IX is a motor and sensory nerve that innervates muscles of the tongue and provides sensation to the posterior tongue and pharynx.

How is CN IX tested?

CN IX is tested by asking the patient to say 'aaah' and assessing soft palate elevation.

What is the function of CN X (Vagus)?

CN X is a motor and sensory nerve that innervates the heart, lungs, bronchi, and GI tract.

How is CN X assessed?

CN X is assessed by having the patient say 'ahhhh' and listening for voice quality and swallowing difficulties.

What is the function of CN XI (Spinal Accessory)?

CN XI is a motor nerve that innervates the sternocleidomastoid and trapezius muscles.

How is CN XI tested?

CN XI is tested by asking the patient to shrug shoulders and turn their head against resistance.

What is the function of CN XII (Hypoglossal)?

CN XII is a motor nerve that innervates the muscles of the tongue.

How is CN XII assessed?

CN XII is assessed by observing tongue movement and symmetry when protruded.

What is important when interpreting a cranial nerve exam?

It is important to know what is considered normal and to investigate any abnormal findings further.

What does normal cranial nerve documentation include?

Normal documentation includes intact smell, visual acuity, extraocular movements, facial movements, hearing, palatal elevation, and tongue symmetry.