1、MENTAL STATUS EXAMINATIONOutline Operational definition Purposes Components Behavior Cognition Emotion Cognitive examination Mini Mental StatusMENTAL 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 patient during th
2、e entire medical encounterPURPOSES Detect Describe Neuroanatomical localization Assess functional implications ofAbnormalities/deficits in:Behavior Emotion CognitionABNORMALITIES&DEFICITSRequire diagnostic explanationMay compromise capacity to coherently and reliably describe medical state to give i
3、nformed consent to adhere to a therapeutic planMEDICALENCOUNTERComprehensiveglobal assessmentBEHAVIORAppearanceAttitudeActivitySpeechDressGroomingHygieneBEHAVIORAppearanceAttitudeActivitySpeechDressGroomingHygieneCOGNITIONThought contentThought progressionInsight/judgmentBEHAVIORAppearanceAttitudeAc
4、tivitySpeechDressGroomingHygieneCOGNITIONThought contentCoherenceGoal directednessInsight/judgmentOperationsArousalAttentionMemoryEmotionLanguageReasoningBEHAVIORAppearanceAttitudeActivitySpeechDressGroomingHygieneEMOTIONAffectMoodSuicideHomicideCOGNITIONThought contentCoherenceGoal directednessInsi
5、ght/judgmentOperationsArousalAttentionMemoryEmotionLanguageReasoningBEHAVIORAppearanceappears stated age,uses a cane to walkAttitudecooperative,hostile,detachedActivitynormal,increased,agitated,subduedSpeechnormal rate/rhythm,dysarthricDresscasual,provocative,dirtyGroomingdisheveled,meticulousHygien
6、eclean,malodorousCOGNITIVE EXAM (“Mental status”)REASONINGLANGUAGEMEMORYATTENTIONAROUSALCOGNITIVE EXAM (“Mental status”)REASONINGLANGUAGEMEMORYATTENTIONAROUSALMust know educationCan thepatienthear?MEMORYImmediate memory=attentionRecent memory(episodic)Recall of three words at 5 minutesEnsure that pt
7、 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 we ask is overlearnedPresidents,date of W.W.II,etc.REASONING(Higher cognitive fx)Tests problem solving,abstract thinkingFund of knowledge-ov
8、erlaps with remote memoryHow many weeks in a year?Name four presidents since 1940?What causes rust?CalculationsAdd,subtract,multiple,divideSequences1,2,3,.1,4,9,16,.2,3,5,7,11,.REASONING(continued)SimilaritiesApple-orangeCar-airplanePoem-novelProverbsDont cry over spilt milkA stitch in time saves ni
9、nePeople who live in glass houses shouldnt throw stonesBEHAVIORAppearanceAttitudeActivitySpeechDressGroomingHygieneCOGNITIONThought contentThought progressionInsight/judgmentArousalAttentionMemoryLanguageReasoningEMOTIONAffectMoodSuicideHomicideEMOTIONAFFECT “Affect is to weather as mood is to clima
10、te”predominate sad,euphoric,angry,anxious intensityunmodulated rangenarrow,broad congruenceincongruent with contentMOODeuthymic,dysthymic,elatedSUICIDEDo you ever wish you wont wake up?Does it ever seem that life isnt worth it?HOMICIDEIs there someone who deserves to be hurt?MEDICALENCOUNTERComprehe
11、nsiveglobal assessmentFocusedselected assessmentIN PRACTICE,MOST ENCOUNTERSARE FOCUSED Accordingly the formal mental status exam is often limited to an assessment of COGNITION Further cognition is often assessed solely using:ORIENTATIONTO ORIENTTo understand onesrelationship to theenvironmentPersonP
12、laceTimeSituation“Oriented X 3”“O X3”PersonPlaceTimeSituation“Oriented X 3”“O X3”“Oriented X 4”“OX4”PersonPlaceTimeSituation“Oriented X 3”“O X3”“Oriented X 4”“OX4”ORIENTATION ASSESSES:language perception reasoning remote memory recent memoryMore preciseMore comprehensiveLonger Statistical normsLess
13、preciseLess comprehensiveShorterExaminer normsOrientationFull mentalstatusMini Mental StatusNeuropsychologicalTestingMINI MENTAL STATE EXAMADVANTAGES brief (10 min),systematic bedside instrument wide recognition among physicians since it is standardized,the score it yields is meaningful to physician
14、s familiar with itDISADVANTAGES 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
15、 memory(3)attention(3)calculation,spell backward(5)name,read,repeat (4)write (1)constructional ability (1)ideomotor praxis(3)Not timedWhat 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.Number repeated
16、first trial=score(3).Present till allrepeated or 6 presentations.Serial 7s-5 subtractions(93,86,79,72,65)(5).Scorenumber of correct answers or spell“world”backward,score is number of letters in correct order.“dlorw”is3 points.Ask the patient to name a watch and a pencil.(2)Ask the patient to say“No
17、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 asubject and a verb and be sensible.Ignore grammar and punctuation(1).Place a piece of paper where the
18、 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 intersectingpentagons.All 10 angles must be present and twomust intersect to create a 4 sided figure.Ignoretremo
19、r and rotation(1).Normals can be expected to score 25However,even with 25,if 0/3 or 1/3 for recentmemory or problems with naming,repeating,writing or reading suggest focal deficits.It is most sensitive to disturbances which broadly effect function,it may miss subtle,focal problems.You may not always do a MMS:Too little timePatient becomes agitated at challengeHowever,even without an MMSInteracting with the patient and obtaining a history have provided information to write up a mental status examLesson:YOU DO NOT HAVE TO DO AN MMS TO THOROUGHLY EXAM A PT
