this is a brief video on the mental status exam we're going to be talking about all the portions of the mental status exam that you can report in your notes for a psychiatric patient we're going to be breaking down the parts of the mental status exam into chunks and then at the end we'll show them all on the same slide let's get started first thing you want to ort is the appearance of the patient this is essentially the general appearance of a patient including that patient's apparent age their height weight and their manner of dress and grooming so some examples of what you might want to put under appearance are whether the patient looks disheveled if the patient has proper or poor hygiene if the patient appears older or younger than their stated age or if they appearer their stated age next you want to report the behavior this is an observation of specific abnormal movements as well as more General observations of the patient level of activity and arousal as well as patients eye contact and gate so quite a few things that might go under Behavior things you might want to include here are whether or not the patient was cooperative with the exam what kind of eye contact they had if they looked at you too much if they looked at you too little if they looked at you the proper amount if they were engaged in the conversation if they were wandering off if they were really into it or normal amount if they had repetitive movements like constantly tapping their hands uh or some other repetitive behavior that might indicate OCD would also go under the behavior component next you want to comment on the patient's motor function this is essentially a psychiatric disturbance that manifests in a change or deficiency in a patient's motor function some things to include here are psychomotor agitation psychomotor retardation any Tremors or restlessness um oftentimes restlessness is uh indicative of parkinsonism and it can also be a side effect of some antis psychotics so that would be important to note some patients that are on many anti psychotics might be moving slowly or talking slowly um and that would be that could be a manifestation of psychom motive retardation so there are manifestations of a patient psychiatric condition into their motor movements and those can be reported here lastly for this section you want to comment on the patients speech and by speech we mean how they talk rather than exactly what they are saying so you're concerned with the production of speech rather than the content of their speech so for instance you want to talk about how fast they talk if a patient's talking fast like I am right now you might want to say rapid speech if they talk slow that might be associated with psycho retardation you might say slow speech py retardation so the speed the rate the volume whether or not the volume of speech is consistent if they talk high all the time if they talk very softly all the time if they go high and low depending on what they're talking about pressured speech um can be indicative of mania fluent understandable speech would also be important to Note versus impoverished speech if they don't use many words if they reply to all your answers with no I don't know I'm not sure you are the psychiatrist I don't know um that would be impoverished speech you can comment on their tone which might give hints as to their mood or affect um and also if there's a delay or latency in their speech if you ask them a question and it takes them a few seconds to get talking or a few seconds to uh respond that might be a latency in speech next you want to report on the patient's mood this is in their own words you can often put it in quotes a description of the patient's internal emotional state so you might want to blatantly ask the patient how do you feel today or how would you describe your mood and they'll say something and you can put that down in quotes as their mood some examples of what the patient might say include happy sad okay good great or depressed um and those will often go in quotes ask the patient how's their mood and if they say good you put it in quotes as good next up is the affect which is a description of a patient's apparent emotion conveyed by their person's nonverbal behavior and also by using uh parameters of appropriateness intensity range reactivity and Mobility so this is using like the context clues of the conversation to make your judgment of what a patient's apparent emotional state is if they say they feel great do they actually look like they feel great if they say they're depressed do they actually look like they feel depressed so a patient's effect might be neutral it could be youth IC it could be dysphoric could be euphoric um you also so it could be any of these things listed here um you also want to comment on if a patient's so I'm going to talk about this bullet here you also want to report on if a patient's effect is congruent with their reported mood if a patient says they're happy but they're obviously not happy when they're talking to you they're looking down at their feet they're making poor eye contact and they look depressed you might want to say their their mood is happy and their effect is depressed non- congruent with reported mood um that would be appropriate you also want to report the rain of effect how do they look throughout the conversation if you're talking to this patient for 30 minutes or so and they look uh the same the whole time and they don't react to anything you're talking about and they kind of have that same effect the entire time they might have a blunted effect um and the range of effect can be described on a spectrum kind of listed um over the second bullet here on one end of the spectrum a patient might be flat or have a blunted effect and in this patient essentially nothing elicits a reactivity you can talk about something that's terrifying to them a previous trauma or something very exciting and they would not have a reaction they have the same face they have the same non-verbal Context Clues on the other hand of the spectrum a patient might have an expansive effect or a labile effect and this is a patient who's kind of out of control uh with their emotions it's almost like they they're not in control of their emotions they laugh at random times or they're overly happy at one moment and then very very sad at the other and it's almost like exaggerated it's the most comical um and some more normal effects in the middle would be a full effect or maybe even a restricted or constricted effect is kind of on the blunted side but more normal than a flat effect so that's a good Spectrum to know one other thing to comment on for affect is this word here appropriate or inappropriate if a patient for instance laughs uh when there's a very sad Topic at hand or laughs when talking about a pre trauma or is overly excited when talking about trauma or is overly sad when talking about what should be a joyous occasion you might describe that patient's effect as inappropriate it's out of context it doesn't match what you would expect it doesn't match what a normal person would do next session section is describing the patient's thought process this is description of the quantity Tempo and form of thought so some things to comment on here are if the patient has linear thought if they speak if they think logically if they're able to go through a conversation and be goal directed if they're organized in their thought if they make logical conclusions from one point to another that would be a linear logical and goal directed thought on the other hand if a patient has flight of ideas they might rapidly talk about something and immediately be distracted by another idea or immediately distracted by what they see or what they think of next or another story they come up with there in their head and those thoughts would be so rapid that it the the end product is almost incoherent they talk about a situation that they went home and talked to their mom and then they tell you a story about their mom who met her cousin and then they story about Mom's cousin and it kind of goes on and on and on that might be flight of ideas similarly tangential and circumferential I think I have definitions for those here tangential thought process is a thought process that goes off on a tangent and never returns to the matter at hand so patient is distracted and they keep telling stories and going on and on and uh getting distracted by different things going on a tangent and never coming back to the question that you asked on the other hand circumferential thought process goes off with extraneous details but does eventually come back to the matter at hand it does Circle back like the circumference of a circle and they do eventually answer your question so you ask a question about them going home to their mom they tell you a story about their mom their mom's cousin their mom's cousins cooking habits and how they like their mom's cousins cooking food uh but then they do answer the question about coming home to the mom and they do get back to what you were asking that would be circumferential versus tangential thought content on the other hand is a description of a patient's delusions overvalued ideas obsessions phobias and preoccupations what are they thinking this is the what they are thinking so you might want to write about comments endorsing or denying suicidal ideation homicidal ideation paranoid ideations ideas of reference that's when they think that a newscaster or a television reporter is specifically talking to them uh or any fixations or preoccupations that they might have if they fixate on a certain habit or if they fixate on a certain event in their life that could be reported in thought content as well but the big ones are definitely suicidal ideation homicidal ideation and paranoid ideations perceptual disturbances is next this is essentially hallucinations and interpretations of sensory information so it's a description of any disruption of their sensory information as we said auditory hallucinations visual hallucinations Illusions whether or not the patient responds to these stimuli a lot of times you might see patients that are kind of pacing the halls or talking to themselves or looking at their hands responding to internal stimuli uh that would be appropriate to report under perceptual disturbances next section you might want to comment on is the patient level of insight this is a description of patients understanding of his or her mental status evaluated by exploring their mental explanatory account of the problem and available treatment options so it's essentially how well do they know what's going on how well do they understand their mental illness you can use words like good Fair poor to describe their Insight um if they know they have psychoses and they know that their psychoses might be coming and they know how to cope with them that would be good Insight if the patient um knows that they're in a psych hospital for schizophrenia but they don't really think they have schizophrenia and they believe their delusions are real that would be very very poor Insight on the other hand is Judgment which is a patient's capacity to make sound reasoned and responsible decisions so essentially how well do they follow up with their treatments um a patient who has schizophrenia for instance and takes their medications is very compliant with them takes them at the same time every day as instructed would have good judgment patient who has poor Insight is more predisposed to have poor judgment if they don't think they have a problem um they might be less likely to act upon that problem and cooperate with the plan um if a patient reports that they were forced by their family to come in for their hallucinations or for their drug problem that would show poor judgment they themselves didn't bring themselves in um they're relying on their family um and they were kind of forced by their family that's poor judgment and lastly there's some other cognitive tests that you can add to the mental status exam the first one is a test of a patient's memory way to do this is to report three words to the patient to give them three words like dog bicycle and tree and then five minutes later ask the patient to repeat those three words to you and see if they remember them five minutes later so a good way to do this is to uh start with memory then do the two next sections that I'm going to talk about and then go back and ask the patient to remember those three words that you brought up to them um and you can report this as the patient remembering one of the three words two of of the three words or all three of the words um after a five minute time period you can also test a patient's concentration uh a couple ways to do this one of them is to do serial sevens which is when a patient starts with the number 100 and subtracts seven consecutively so you'd expect the patient to say 100 93 86 79 and kind of keep subtracting seven probably five or six times to see if they're able to concentrate on a task like that another would be to spell the word world backwards um also would require them to concentrate on a task to get through all five letters in the correct order lastly you want to test a patient's orientation to person place and time uh when you ask a patient about their person you can ask for their full name and their date of birth uh when you ask about the place you can ask for the state the town uh the current hospital that they're in the current location the building and floor perhaps if that's relevant whatever you uh Al patient would be expected to know uh would be reasonable to ask in terms of season excuse me in terms of time you can ask for the season the year the month those are usually easier than the day or the date um and uh that is also whatever would be um relevant or whatever would be important for a patient to know if they've been in the hospital for a very long time they might lose track of the day or the date um but they could still be oriented to month and season and after doing concentration and orientation would be a good time to go back and ask the patient about three words that you ask them to remember to finish up that memory portion of the exam and that's the entire mental Statics exam here's a summary of it all that might be helpful to keep with some examples of what to do uh when assessing the different sections of the mental status exam I hope this was helpful and thank you for listening