Mental Status Examination

It is an assessment of the patient at the present time. Historical information should not be included.

A. General Appearance and Behavior
1. Grooming, level of hygiene, characteristics of clothing
2. Unusual physical characteristics or movements
3. Attitude – ability to interact with the interviewer
4. Psychomotor activity – note agitation, retardation, tense, lethargy
5. Degree of eye contact

Example:
The patient is a muscular young man appearing his stated age, wearing jeans, a white t-shirt and sneakers. He wears several rings on his fingers and bracelets on both wrists. There is an obvious healing cut on his upper lip which is slightly swollen. He is unshaven, but has an overall neat appearance and adequate hygiene. He sits with his arms crossed in a chair that swivels and uses his feet to swivel through roughly 90 degrees back and forth throughout the interview. He maintains good eye contact.

B. Affect
- is a person’s display of emotions or feelings
- External range of expression, described in terms of quality, range and appropriateness
- The nurse also assesses for consistency between the client’s mood, affect and situation

Types of Affect:
a. Flat affect
• showing no facial expression
b. Blunted or restricted affect
• displaying one type of expression, usually serious or somber.
c. Inappropriate affects
• unexpected responses to a situation
• displaying a facial expression that is incongruent with mood or situation, often silly or giddy regardless of circumstances.
d. Broad affect
• displaying afull range of emotional expressions
• generally appropriate
e. Labile
• multiple abrupt changes in affect.

C. Mood
- internal emotional tone of the patient
- is a subjective way a client explains feelings
- The client mood may be described as happy, sad, depressed, euphoric, anxious, euthymic or angry.
Example:
Subjectively he reports feeling angry and depressed because he is being kept on a locked ward. Objectively, he appears tense, angry and sad at different times. His emotional expression is liable, of full range and appropriate to content. His eyes filled with tears at times.

D. Thought Processes
- The way the person functions intellectually. The process or way of thinking or analysis of the world. The way of connecting or associating thoughts, the overall organization of thoughts.

1. Use of Language
 The quality and quantity of speech, tone, associations and fluency of speech should be noted.
Example:
He speaks spontaneously and very rapidly. Becoming pressured at times, but he is interruptible. Volume is occasionally loud. Rhythm and expressive intonation are normal. Speech is understandable, but some words are poorly articulated because of the high rate of speech production.

2. Common Thought Disorders:
a. Pressured Speech – rapid speech, typical of patient with manic disorder.
b. Poverty of Speech – minimal responses, such as answering just yes or no.
c. Blocking – sudden cessation of speech, often in the middle of a statement.
d. Flight of Ideas - accelerated thoughts that jumps from idea to idea, typical of manic discorder.
e. Loosening of associations – illogical shifting between unrelated topics.
f. Tangentiality – frequent digression until the initial reason for beginning a discussion is forgotten, wondering off the topic and never providing the information requested.
g. Circumstantiality – inclusion of unnecessary detail in a conversation, when the client answers a question but only after giving excessive unnecessary detail.
h. Echolalia – echoing of words and phrases, repeating the same words which were said by others.
i. Neologisms – invention of new words by the patient.
j. Perseveration – repetition of the same word in reply to different questions.
k. Ideas of reference – client’s inaccurate interpretation that general events are personally directed to him.