in this video we're going to be breaking down the core elements of the mental status exam the best way of thinking about the mental status exam is as psychiatry is equivalent of the physical exam just as you would use findings from the physical exam to argue for or against the presence of a specific disease like a heart murmur suggesting a valve problem you can use findings from the mental status exam to rule specific diagnoses in or out like monotone speech or flat facial expressions clueing you into a case of depression the mental status exam can be broken down into the following domains appearance behavior motor speech affect and mood thought process thought content perception orientation cognition insight and judgment a good way to remember these in order is to use the phrase a beautiful mental status always pleases customers provided of course it's justified some of these elements can be assessed without any active effort like being able to comment on someone's speech just by talking with them however other aspects will need to be specifically elicited such as someone's thought content we'll go over each of these elements now one by one appearance is what you see when looking at the patient which can contain some important diagnostic clues someone's apparent age can increase the likelihood of certain diagnoses such as adhd in children or dementia in older adults specific facial features can suggest certain diagnoses as well like a masked facey suggesting parkinson's disease or a flat nasal bridge suggesting down syndrome someone's level of grooming can also be telling as a lack of self-care can be found in a variety of psychiatric syndromes like schizophrenia or severe depression weight can also provide diagnostic clues especially when it comes to eating disorders the next domain is behavior which encompasses many aspects first you can evaluate the patient's level of alertness next cooperation rapport and eye contact can all provide information about the quality of the relationship you have with the patient the patient's overall level of activity can also provide clues as decreased activity can occur in states of depression known as psychomotor retardation while increased activity can be assigned a mania known as psychomotor agitation a basic neurological examination of movement and gait is often performed as part of the mental status exam as motor abnormalities can be observed either due to specific conditions like motor tics and tourette syndrome or waxy flexibility in catatonia or as a side effect of the medications used to treat them like extrapyramidal symptoms caused by antipsychotic drugs when evaluating speech listening to how the words are being said can be just as important as the words themselves take note of the patient's level of verbality are they talking more than normal or are they barely talking at all are they talking usually quickly or slowly does their speech feature prosidy or the melodic quality that normal speech has does their speech feel pressured like they can barely contain the words or are they having trouble getting words out in the first place are their words slurred and hard to understand or are they completely unable to speak abnormalities in speech can be a sign of a variety of mental conditions like absent pros at a suggesting depression or poor articulation suggesting alcohol intoxication the words affect and mood both refer to a patient's current emotional state a patient's mood reflects their internal emotional experience so you can assess mood by asking how are you feeling right now and reporting the patient's response verbatim such as good okay frustrated angry and so on in contrast affect is the patient's external emotional expression which can be evaluated semi-objectively by the interviewer affect is most often described by the words euthymic which is a normal well-balanced mood dysthymic a depressed or sullen mood and euphoric and intensely elevated mood however there are other affective states as well like irritability angriness playfulness and suspiciousness you can also make a note of the range of affect someone with a full ranger backfact will show a variety of facial expressions throughout the interview where someone with a restricted range would show only a narrow range of emotions a labile affect involves rapid shifts from extremes or emotions such as going from laughing to crying in a matter of seconds whereas a blunted or flat affect refers to a lack of emotional expression the next two items refer to someone's thoughts thought process involves the nature of the connections between one's thoughts most people have a linear and logical thought process meaning that they proceed from one topic to another in a natural and straightforward way that's easier for you as a listener to follow this isn't always the case with patients in psychiatry however as some mental disorders involve a degree of thought disorganization that makes it difficult to follow a train of thought when asked a question a patient may veer off into unrelated topics before eventually answering the question which is known as circumstantiality or may never answer the original question at all which is known as tangentiality in contrast to thought process thought content involves the specific ideas and beliefs that a patient has in mind specific areas of thought content which are relevant to psychiatry include suicidal ideation homicidal ideation preoccupations and delusions given that none of us have the ability to read minds thought content can only be assessed by asking the patient directly perception refers to the patient's ability to accurately take in information about the world around them the most commonly assessed perceptual abnormalities in psychiatry are hallucinations or false perceptions in the absence of any external stimuli such as hearing someone's voice saying things about you when no one else is in the room the specific form that hallucinations take on matters with auditory hallucinations being common in schizophrenia and visual hallucinations being more often related to non-psychiatric conditions like delirium viewers of this channel may remember orientation as one of the elements of the psychiatric interview however some sources consider this to be part of the mental status exam as well as a brief reminder this involves assessing the patient's current understanding of person place time and purpose cognition refers to the patient's general level of intellectual ability cognition is comprised by a variety of domains including memory attention knowledge and executive functioning there are also longer standardized cognitive tests such as the mocha or mmsc that can provide an even greater level of detail on the patient's current cognitive abilities finally insight and judgment are two related domains that involve the patient's ability to accurately understand their situation as well as to know how to act appropriately within it many mental disorders can directly impair insight including diseases like schizophrenia where delusions and hallucinations can lead the patient to believe things that are not consistent with reality insight and judgment are directly linked as it can be hard to make appropriate decisions if your understanding of the situation is lacking for example a drunk person who decides to drive is doing so as a result of alcohol impairing not only their insight but also their judgment and that's it those are all the core elements of a mental status exam by using the phrase a beautiful mental status always pleases customers provided of course it's justified you can make sure to hit all major parts of the exam when presenting the case to other clinicians or completing your documentation go ahead and give it a shot next time you're working with a patient who requires psychiatric evaluation and let me know how it goes in the comments until next time good luck in your studies you