Miami Dade CollegeSchool of Nursing

Roxana Orta MSN, ARNP

The Mental Status Examination (MSE)

Mental StatusMental status is the total expression of a person’s emotional responses, mood, cognitive function, and personality.

It is closely linked to the individual’s executive functioning, i.e. motivation, initiative, goal formation, planning and performing, self-monitoring, and integration of feedback.

The Mental Status ExaminationThis is the primary type of examination used in psychiatry. Practitioners are expected to be expert observers, both of significant positive and negative findings on examinations. The MSE should be limited to what is observed.

Neuro Review

Frontal lobe Speech formation (Broca area)Emotions/affectDrive Awareness of selfShort-term memory Goal-oriented behavior

Neuro ReviewParietal lobe

Sensory perceptionSpatial sense and navigation

Neuro Review

Temporal lobe Perception and interpretation of sounds Wernicke’s area Integration of behavior, emotion, and personalityLong-term memory

Neuro ReviewLimbic system

Survival behaviors (mating, aggression, fear, affection)Reactions to emotions, and expression of affect is mediated by connections of the limbic system and the frontal lobe

Mental Status Examination The MSE is one component of an exam and may be viewed as the psychological equivalent of the physical exam

It is an important component to a neurological evaluation

Factors affecting the MSECulture and educational background of the patient

What is abnormal for a person with high intellectual ability may be normal for a person of less educationPatients with ESL may have difficulty with some components of the exam

Major Components of the MSE1. Appearance 2. Motor3. Speech4. Affect & mood5. Thought Content6. Thought Process7. Perception8. Intellect9. Insight

AppearanceAgeGenderRaceBody buildPostureEye contact

DressGroomingMannerAttentiveness to examinerEmotional facial expressionAlertness

MotorBehavior: Pleasant? Cooperative? Appropriate for the particular situation?

HesitancyAgitationAbnormal movementsGaitCatatonia

SpeechRate Rhythm VolumeAmount Articulation Spontaneity

Affect and MoodMood is usually defined as the sustained feeling tone that prevails over time for a patient.

- Mood: patient reports sadness, depression, hopelessness, worthlessness, and struggles with irritability and anger. She is fearful when experiencing hallucinations. She appears interested and attentive.

Affect is usually defined as the behavioral/observable manifestation of mood.

- Affect: patient’s affect seems incongruent with mood. She appears calm and less sad then what she reports. She smiles frequently and displays a generally pleasant attitude toward others.

Affect and Mood

Affect: How do they appear to you?StabilityRangeAppropriatenessIntensity

Mood: asks the patient directly how he/she feels

Thought

Usually, a description of a patient’s thoughts during the interview is subdivided into (at least) 2 categories: a description of the patient’s thought process, and the content of their thoughts

Thought Content

Suicidal ideationDeath wishesHomicidal ideationDepressive cognitionObsessionsRuminations

PhobiasParanoid ideationMagical ideationDelusionsOvervalued ideas

Description of what the patient is thinking about

Thought process

Describes the manner of organization and formulation of thought. Coherent thought is clear, easy to follow, and logical. A disorder of thinking tends to impair this coherence, and any disorder of thinking that affects language, communication or the content of thought is termed a formal thought disorder.

Thought Process

AssociationsCoherenceLogicStreamClang associations

PerseverationNeologism Thought blockingAttention

Description of the way in which the patient thinks

Disorders of Thought ProcessCircumstantial thought: a lack of goal directedness, incorporating tedious and unnecessary details, with difficulty in arriving at an end pointTangential thought: a digression from the subject, introducing thoughts that seem unrelated, oblique, and irrelevantThought blocking: a sudden cessation in the middle of a sentence at which point a patient cannot recover what has been said Loose associations: a jumping from one topic to another with no apparent connection between the topics. perseveration refers the patient's repeating the same response to a variety of questions and topics, with an inability to change his or her responses or to change the topic.

Disorders of Thought ProcessNeologisms: words that patients make up and are often a condensation of several words that are unintelligible to another person. Word salad: incomprehensible mixing of meaningless words and phrases. Clang associations: the connections between thoughts become tenuous, and the patient uses rhyming and punning.

PerceptionHallucinationsIllusionsDepersonalizationDerealizationdéjà vujamais vu

PerceptionHallucinations, which are perceptual experiences that have no external stimuli.Illusion, which is a false impression that results from a real stimulus. Depersonalization, which is a patients' feelings that he is not himself, that he is strange, or that there is something different about himself that he cannot account for.Delusions can be defined as false fixed beliefs that have no rational basis in reality, being deemed unacceptable by the patient's culture.

IntellectGlobal impression: average, above average, below average

Insight & JudgmentRefer to complex tasks that require a good deal of cognitive functioning (including conceptual thinking and abstract ability), though intact cognitive functioning alone is not adequate for good judgment and insight. For example, a patient’s ability to make a particular medical decision requires both insight into their specific malady, as well as the judgment to weigh alternatives in the service of arriving at an appropriate decision.

The Cognitive ExamCognition refers to the ability to use the higher cortical functions: thinking, logic, reasoning, and to communicate these thoughts to others.

1. Consciousness2. Orientation3. Attention and Concentration4. Memory5. Visuospatial ability6. Abstractions and conceptualization.

The Cognitive ExamConsciousness may range from normal alertness to stupor and coma. Orientation refers to the ability to understand one’s situation in space and time. Generally, orientation to place and time is tested.Attention and Concentration. Attention refers to the ability to focus and direct one’s cognitive in a physiologically aroused state. Concentration refers to the ability to maintain attention for a period.

The Cognitive Exam

Memory refer to the process of learning involving the registering of information, the storage of that information, and the ability to retrieve the information later.

The Cognitive ExamMemory is divided into registration, short-term memory, and long-term memory.

Registration refers to the ability to repeat information immediatelyShort-term memory refers to the storage of information beyond the immediate (registration) period, but prior to the consolidation of memory into long-term memory. Long-term memory is usually divided into procedural and declarative memory. Procedural memory refers to the ability to remember a specific set of skills. Declarative memory refers to the retention of data or facts, which can be verbal or nonverbal (i.e., sounds, images).

Visuospatial abilityConstructional Ability refers to the ability to recognize the relationship of different objects in the world.

The Folstein Mini Mental Status examination includes a constructional task in which a person is asked to draw intersecting pentagrams: a patient is expected both to draw the correct number of sides on both polygons as well as the two intersection points.

The Cognitive ExamAbstraction and Conceptualization refer to higher intellectual functions. Abstraction involves the ability to understand the meanings of words beyond the literal interpretation.

Questions?