Of all portions of the mental status examination, the evaluation of a potential thought disorder is one of the most difficult and requires considerable experience. Phonemic errors are mistakes in pronunciation; semantic errors are errors in the meaning of words; neologisms are meaningless nonwords that have a specific meaning for the patient. Must be a dysfunction in the individual. Fund of Knowledge and Intelligence: computations; vocabulary; facts. Alertness and level of consciousness alert to coma. Constructional Ability and Praxis Apraxia is the inability, not due to weakness, to perform previously learned motor acts. This is a 30-point test with 10 points devoted to orientation, 3 to registration, 5 to calculation, 3 to short-term memory, 8 to language function, and 1 to constructional ability.
Patient care plans may have to be altered in order to properly care for patients with impaired mental status. Finish by documenting the patient's understanding of the treatment. What other questions do you have? The mental status exam is based upon your own observations of the client while he or she is in your office. This is a very common condition particularly among hospitalized patients notable for an acute, global change in mental status that can be the result of physiologic derangement anywhere within the body. The following format is generally accepted, with mild alterations made per individual attending. Past Psychiatric History Put in all contact the patient has had with therapists psychiatrists, psychologists, social workers, and counselors , inpatient units, and other outpatient experiences. Does he fidget or wring his hands? Cognition Level of consciousness Alert, drowsy, delirium, stupor.
Document when the last time used. Look for use of grooming that might be suggestive of a mood state or disorganization. Kansas - what a state! It is usually easy to detect the depressed patient; but what about the patient who has just the opposite symptoms? Other causes for the acute type are: fluid and electrolyte imbalance severe ones , heavy metal poisoning, chemical poisoning other than drugs already mentioned , and others. But now that you asked, my name is Bob. In fact, even if you had the experience and knowledge to generate diagnoses, this still may not be possible after a single patient encounter. A normal level of consciousness is one in which the patient is able to respond to stimuli at the same lower level of strength as most people who are functioning without neurologic abnormality.
No patient can fit your form exactly. One test often recommended is the ability to listen to digit spans of increasing length and repeal them back to the examiner. Do they know who you are? An ideal test of attentiveness should assay concentration on a simple task, placing minimal demand on language function, motor response, or spatial conception. These may offer clues to the underlying diagnosis — for example, do you feel dysphoric depressed patient , off balance and unable to follow the conversation schizophrenia , or frustrated personality disorder? Are their thoughts appropriately linked or simply all over the map? Recommend treatment for the patient. This disorder, seen in Korsakoffs psychosis, bilateral hippocampal infarction, and herpes simplex encephalitis, results in a dramatic loss of short-term retention and, in the extreme, a total inability to lay down any long-term memory traces. Information that you're noting comes from all portions of the patient's life.
Pinel's influential Treatise on Insanity helped disseminate the idea that some mental illnesses have a psychologic causation, while others are secondary to physical illnesses. It is so true that people are disturbing rather than disturbed. Delirium is an acute or subacute hours to days onset of a grossly abnormal mental state often exhibiting fluctuating consciousness, disorientation, heightened irritability, and hallucinations. His affect was labile, but appropriate to the content of his speech i. Memory dysfunction that worsens over a matter of months tends to be pathologic. Also list prior suicide attempts and methods. If not, how off base are they? Complete a mental status exam based on Janelle from the video.
The formulation of actual diagnoses, the final step in this process is, for the most part, beyond the scope of this discussion I've included two of the most commonly encountered ones at the end of this section as examples. Orientation to person is simply the ability to identify one's name and is the last element of orientation to be lost, usually only in very severe dementia or in psychotic states. Does patient answer questions directly, or are answers vague circumstantial , irrelevant tangential or drift away from the subject derailed? Record the patient's mental health history. Physical illness may certainly impair mental status. Do they tend to stray quickly to related topics? Make sure that the patient has as much privacy as the situation allows, minimize distractions, such as television or hallway conversations, and prepare yourself to focus entirely on what the patient is telling you. Intent refers to whether the patient is simply thinking about or even wishing her own death or has an intent to actively do something to bring it about. Note: consultation with a mental health clinician is mandatory for a patient being held under a legislative Act.
Include current symptoms and behavior. They are usually unable to define exactly what they are not afraid of, but it can become very strong and the patient has feelings of impending doom. If the mental status exam is presented in one separate group to the patient, the patient will usually become very anxious over the types of questions being asked. The more common of these are ideomotor apraxias wherein the patient can initiate movements and manipulation of objects but is unable to pretend a given action. The underlying assumption of the mental status exam, an assumption not always valid, is that speech is a reflection of thought. Give them a few seconds to commit the information to memory.
They are frequently confused, disoriented, agitated and uncooperative. Initial presentation of psychotic disorders as well as dementia can be mistaken for delirium and vice versa. Intellectual: Patient is oriented in three spheres, shows no impaired judgment, nor impaired memory. These have been termed transcortical aphasias. The person who is so absorbed with cleaning, that they take clean clothes out of the closet and wash then again. It's a good idea to preface your inquiry with a general comment about the fact you ask every patient these questions otherwise patients will often take offense at your asking them their name or where they are.
A patient who threatens to overdose on Prozac and ends up taking 10 pills in a gesture is less worrisome than a patient who is found with a loaded gun to her head, although both should be taken very seriously. Mental status exam in primary care: a review. Don't use diagnostic labels, just describe what you see. This is also an example of looseness of association and a possible idea of reference. Ask these questions tactfully, and if the patient acts or feels uncomfortable with these questions, it could be that there is a problem; it could be a significant finding. Technically part of the neurological exam, the mental status exam has both objective and subjective components.
He reported auditory hallucinations God had told him to quit his job and become a professional golfer and was preoccupied with his athletic and sexual accomplishments. Affect : observable emotion euthymic, neutral, euphoric, dysphoric, flat , the range full, constricted, blunted , whether it fits appropriate to stated mood or content, lability. Vocabulary, diction, and word usage are also very good indicators of global cognitive functioning, although you must adjust somewhat for educational background. If you can remember the mnemonic, you are on your way to a succinct yet thorough mental status exam. He exhibited loosening of associations and flight of ideas; he intermittently and unpredictably shifted the topic of conversation from golf, to the mating habits of geese, to the likelihood of extraterrestrial life.