1、MENTAL STATUS EXAMINATION,Outline,Operational definition Purposes Components Behavior Cognition Emotion Cognitive examination Mini Mental Status,MENTAL STATUS EXAMINATION: What is it?,ASSESSMENT of the: Behavior (see it all) Emotion (see some of it) Cognition (see none of it) Exhibited by the patien

2、t during the entire medical encounter,PURPOSES, Detect Describe Neuroanatomical localization Assess functional implications of Abnormalities/deficits in: Behavior Emotion Cognition,ABNORMALITIES & DEFICITS,Require diagnostic explanation May compromise capacity to coherently and reliably describe med

3、ical state to give informed consent to adhere to a therapeutic plan,MEDICAL ENCOUNTER,Comprehensive global assessment,BEHAVIOR Appearance Attitude Activity Speech Dress Grooming Hygiene,BEHAVIOR Appearance Attitude Activity Speech Dress Grooming Hygiene,COGNITION Thought content Thought progression

4、Insight/judgment,BEHAVIOR Appearance Attitude Activity Speech Dress Grooming Hygiene,COGNITION Thought content Coherence Goal directedness Insight/judgment Operations Arousal Attention Memory Emotion Language Reasoning,BEHAVIOR Appearance Attitude Activity Speech Dress Grooming Hygiene,EMOTION Affec

5、t Mood Suicide Homicide,COGNITION Thought content Coherence Goal directedness Insight/judgment Operations Arousal Attention Memory Emotion Language Reasoning,BEHAVIOR,Appearanceappears stated age, uses a cane to walk Attitudecooperative, hostile, detached Activitynormal, increased, agitated, subdued

6、 Speechnormal rate/rhythm, dysarthric Dresscasual, provocative, dirty Groomingdisheveled, meticulous Hygieneclean, malodorous,COGNITIVE EXAM (“Mental status”),REASONING LANGUAGE MEMORY ATTENTION AROUSAL,COGNITIVE EXAM (“Mental status”),REASONING LANGUAGE MEMORY ATTENTION AROUSAL,Must know education,

7、Can the patient hear?,MEMORY,Immediate memory = attention Recent memory (episodic) Recall of three words at 5 minutes Ensure that pt has registered the items “Repeat these words after me, I want you to remember them.” Remote memory (semantic & episodic) Tends to overlap with knowledge, most of what

8、we ask is overlearned Presidents, date of W.W.II, etc.,REASONING (Higher cognitive fx),Tests problem solving, abstract thinking Fund of knowledge - overlaps with remote memory How many weeks in a year? Name four presidents since 1940? What causes rust? Calculations Add, subtract, multiple, divide Se

9、quences 1, 2, 3, . 1, 4, 9, 16, . 2, 3, 5, 7, 11, .,REASONING (continued),Similarities Apple - orange Car - airplane Poem - novel Proverbs Dont cry over spilt milk A stitch in time saves nine People who live in glass houses shouldnt throw stones,BEHAVIOR Appearance Attitude Activity Speech Dress Gro

10、oming Hygiene,COGNITION Thought content Thought progression Insight/judgment Arousal Attention Memory Language Reasoning,EMOTION Affect Mood Suicide Homicide,EMOTION,AFFECT “Affect is to weather as mood is to climate” predominate sad, euphoric, angry, anxious intensityunmodulated rangenarrow, broad

11、congruenceincongruent with content MOODeuthymic, dysthymic, elated SUICIDEDo you ever wish you wont wake up? Does it ever seem that life isnt worth it? HOMICIDEIs there someone who deserves to be hurt?,MEDICAL ENCOUNTER,Comprehensive global assessment,Focused selected assessment,IN PRACTICE, MOST EN

12、COUNTERSARE FOCUSED,Accordingly the formal mental status exam is often limited to an assessment of COGNITION Further cognition is often assessed solely using: ORIENTATION,TO ORIENT,To understand ones relationship to the environment,Person Place Time Situation,“Oriented X 3” “O X3”,Person Place Time

13、Situation,“Oriented X 3” “O X3”,“Oriented X 4” “OX4”,Person Place Time Situation,“Oriented X 3” “O X3”,“Oriented X 4” “OX4”,ORIENTATION ASSESSES:, language perception reasoning remote memory recent memory,More precise More comprehensive Longer Statistical norms,Less precise Less comprehensive Shorte

14、r Examiner norms,Orientation,Full mental status,Mini Mental Status,Neuropsychological Testing,MINI MENTAL STATE EXAM,ADVANTAGES brief (10 min), systematic bedside instrument wide recognition among physicians since it is standardized, the score it yields is meaningful to physicians familiar with it D

15、ISADVANTAGES specific deficits may be ignored if the overall score is not low (less than 25 out of 30) the global score has no localizing valve repeated use with intact patients produces a mechanical transaction,Examiner uses paper and pencil Total of 30 points orientation (10) recent memory (3) att

16、ention (3) calculation, spell backward (5) name, read, repeat (4) write (1) constructional ability (1) ideomotor praxis (3) Not timed,What is the (year) (season) (date) (day) (month)? Where are we? (state) (county) (city) (hospital) (floor)(10) Ask pt to repeat three objects - give one per second. N

17、umber repeated first trial = score (3). Present till all repeated or 6 presentations. Serial 7s - 5 subtractions (93, 86, 79, 72, 65) (5). Score number of correct answers or spell “world” backward, score is number of letters in correct order. “dlorw” is 3 points.,Ask the patient to name a watch and

18、a pencil. (2) Ask the patient to say “No ifs, ands or buts” (1). Ask the patient to recall the three words (3). Ask the pt to read and follow the command: “Close your eyes”. Score (1 ) only if closes eyes. Ask the pt to write a sentence. It must have a subject and a verb and be sensible. Ignore gram

19、mar and punctuation (1).,Place a piece of paper where the patient can reach it with either hand. Ask him/her to: (1) pick it up, (2) fold it in half, (3) lay it on the floor. 1 pt for each step executed correctly (3). Ask the patient to copy a drawing of intersecting pentagons. All 10 angles must be present and two