18. Mental Status Exam

elements of a mental status exam

abstract reasoning, appearance, attitude, behavior, mood/affect, speech, throught process, thought content, perceptions, cognition, insight, judgment

when should you choose complete a mental status exam?

if there is a reason to do so in the question stem (loose associations, not making sense in their speech, possible dementia, tangential thoughts)
- not age on it's own

abstract reasoning (MSE)

ask the client to interpret a proverb or identify a theme between 3 or 4 objects

appearance (MSE)

how does the client look? dressed with attention to detail? well groomed? age appropriate?

attitude (MSE)

Is the client cooperative? resistant? fearful?

behavior (MSE)

what is the client's activity level? are there tics or sterotyped movements? how alert is the client? what are their facial expressions? do they match what is discussed?

mood/affect (MSE)

what is the client's prevailing mood? observable mood liability? show a range of affect? appropriate to the content discussed?

speech (MSE)

is the client understandable? speech abnormalities? speech pressured?

thought process (MSE)

is the thought process circumstantial? tangential? flight of ideas? poverty of thought? perservations?

thought content (MSE)

does the client exhibit delusions? phobias? obsessions? preoccupied? suicidal thoughts? thoughts of harming others?

perceptions (MSE)

Are there any hallucinations or illusions?

cognition (MSE)

alert and oriented? demonstrate attention and concentration? is the client's memory intact?

insight (MSE)

does the client demonstrate understanding of her own symptoms or situation

judgment (MSE)

does the client demonstrate the ability to make sound, responsible decisions?

Mini Mental Status Exam (MMSE)

brief 40 point questionnaire used for cognitive impairment, particularly with alzheimers

A score below 21

Indicate increase odds of dementia

A score between 24-30

indicates no cognitive impairment.

A score between 18-23

indicates mild cognitive impairment.

A score between 1-17

indicates severe cognitive impairment