MENTAL STATUS EXAM (CHAPTER 7)
APPEARANCE
What to Describe
• Height, weight, race, age, note whether pt. appears older or younger than age, other physical
characteristics
• Grooming and hygiene
• Clothing—style, fit, color, cleanliness, whether appropriate for setting, season, circumstance; note
anything bizarre or unusual
• Jewelry, makeup, hairstyle, condition of fingernails, etc.
• Tattoos, distinguishing marks
• Psychomotor activity, gestures, abnormal involuntary movements, stereotyped movements, tics, etc.
• Eye contact
• Social skills
ATTITUDE
Descriptors of Attitude and Demeanor
• Pleasant
• Cooperative
• Engaged/Attentive
• Seductive
• Flattering/Ingratiating
• Charming
• Eager to please
• Assertive
• Friendly/Warm
• Pleasant
• Cooperative
• Engaged/Attentive
• Seductive
• Flattering/Ingratiating
• Charming
• Eager to please
• Assertive
• Friendly/Warm
Behaviors Observed
• Aggression
• Withdrawal
• Crying
• Pacing
• Signs/symptoms of anxiety
• Self-destructive behaviors
• Cataplexy/Posturing/Echopraxia
• Psychomotor agitation/retardation
• Abnormal movements
• Pseudoparkinsonism
• Tardive dyskinesia
• Akathisia
Level of Consciousness and Orientation
, LOC
• Alert
• Drowsy
• Lethargic
• Stuporous
• Vigilant
Orientation
• Person
• Place
• Time
• Situation
*****Mood
• Subjective—must be elicited from pt
• Should be described with a quote from pt.
• Can be “hidden”
• Generally, more consistent and sustained than affect
• Patients with “alexithymia” may have great difficulty putting their feelings into words
Affect
The outward expression of one’s feeling state—usually best seen in facial expression
Objective--cannot be elicited by direct questioning
Fluctuations are normal but can be extreme as in a rapidly shifting affect with wide variations (labile
affect).
Affect should be congruent with mood and with thought content
Describe:
o quality—sad, irritated, anxious, angry, euphoric, happy
o reactivity—reactive or non-reactive(flat affected)
o range--broad or restricted; even or labile
o intensity—blunted, heightened, dramatic
o Congruence/lack of congruence with mood & thought content
Speech and Language
• Describe rate, rhythm, volume, fluency, quality and quantity of speech
• Deficits in fluency can include stuttering, expressive aphasias and hesitancy
• Prosody—refers to variations in the rate, rhythm and pitch in speech
• musicality, intonation, phrasing and intervals
• Lack of prosody is manifested in a monotonous sound without inflections
• Quality—includes descriptions of loudness, pitch, accents and dialects, articulation and
phonation
• pressured speech
• slurring
• Quantity—overabundant, hyperverbal, copious, loquacious or taciturn, minimally responsive, mute,
paucity of speech
• Note whether speech is spontaneous or has to be elicited.
• Is there any latency in response time?
Thought Process
Characteristics of Normal Thought Process
• Logical
• Coherent
• Goal-directed
• Spontaneous
• Descriptive
• Relevant
• Informative
APPEARANCE
What to Describe
• Height, weight, race, age, note whether pt. appears older or younger than age, other physical
characteristics
• Grooming and hygiene
• Clothing—style, fit, color, cleanliness, whether appropriate for setting, season, circumstance; note
anything bizarre or unusual
• Jewelry, makeup, hairstyle, condition of fingernails, etc.
• Tattoos, distinguishing marks
• Psychomotor activity, gestures, abnormal involuntary movements, stereotyped movements, tics, etc.
• Eye contact
• Social skills
ATTITUDE
Descriptors of Attitude and Demeanor
• Pleasant
• Cooperative
• Engaged/Attentive
• Seductive
• Flattering/Ingratiating
• Charming
• Eager to please
• Assertive
• Friendly/Warm
• Pleasant
• Cooperative
• Engaged/Attentive
• Seductive
• Flattering/Ingratiating
• Charming
• Eager to please
• Assertive
• Friendly/Warm
Behaviors Observed
• Aggression
• Withdrawal
• Crying
• Pacing
• Signs/symptoms of anxiety
• Self-destructive behaviors
• Cataplexy/Posturing/Echopraxia
• Psychomotor agitation/retardation
• Abnormal movements
• Pseudoparkinsonism
• Tardive dyskinesia
• Akathisia
Level of Consciousness and Orientation
, LOC
• Alert
• Drowsy
• Lethargic
• Stuporous
• Vigilant
Orientation
• Person
• Place
• Time
• Situation
*****Mood
• Subjective—must be elicited from pt
• Should be described with a quote from pt.
• Can be “hidden”
• Generally, more consistent and sustained than affect
• Patients with “alexithymia” may have great difficulty putting their feelings into words
Affect
The outward expression of one’s feeling state—usually best seen in facial expression
Objective--cannot be elicited by direct questioning
Fluctuations are normal but can be extreme as in a rapidly shifting affect with wide variations (labile
affect).
Affect should be congruent with mood and with thought content
Describe:
o quality—sad, irritated, anxious, angry, euphoric, happy
o reactivity—reactive or non-reactive(flat affected)
o range--broad or restricted; even or labile
o intensity—blunted, heightened, dramatic
o Congruence/lack of congruence with mood & thought content
Speech and Language
• Describe rate, rhythm, volume, fluency, quality and quantity of speech
• Deficits in fluency can include stuttering, expressive aphasias and hesitancy
• Prosody—refers to variations in the rate, rhythm and pitch in speech
• musicality, intonation, phrasing and intervals
• Lack of prosody is manifested in a monotonous sound without inflections
• Quality—includes descriptions of loudness, pitch, accents and dialects, articulation and
phonation
• pressured speech
• slurring
• Quantity—overabundant, hyperverbal, copious, loquacious or taciturn, minimally responsive, mute,
paucity of speech
• Note whether speech is spontaneous or has to be elicited.
• Is there any latency in response time?
Thought Process
Characteristics of Normal Thought Process
• Logical
• Coherent
• Goal-directed
• Spontaneous
• Descriptive
• Relevant
• Informative
