Mental status examination

Mental status examination

Mental status examination is a structured way of observing and describing the patient's current state of mind. When reading a patient's mental state examination, you have to remember it refers to the day and time it was done. Mental status examination is the equivalent of the physical medical examination but focused mainly on the patient's mind. The patient's mind is under these 8 domains, that have to be commented and described:

• Appearance
• Speech
• Sensorium and cognition
• Perception
• Thinking
• Mood and affect
• Insight
• Alarm system

These 6 domains are fundamental for all medical doctors, all of you must know how to assess these domains.

Appearance

The first thing to do is describe from a general point of view how you see the patient in the room. Describe the personal identification, such as:

• Personal identification: general attitude toward the circumstance and the medical doctor.
• General behavior: how the patient behaves in the room. Examples: If the patient stands still and doesn't sit down, or if he/she is restless, agitated, walking around and not speaking to me. The general behavior of the patient is not suitable for the situation.
• Attitude toward the examiner: Is the patient cooperative, reticent, hostile, defensive, or evasive? In which way does she/he speak to you?
• Eye contact.
• General description: of his/her look, clothes; address if the patient is dressing in a way that doesn't fit with the circumstances (e.g., wearing a coat in summer or not wearing shoes).
• Behavior and psychomotor activity:
• Mimic and gesture
• Mannerism: an awkward/unnatural/strange behavior - Tics: rapid and involuntary movement
• Retardation or agitation
• Hyperactivity

Speech

• Spontaneity: Does the patient speak spontaneously or only if questioned?
• Reaction time: The latency between the question and the patient's response. The speech is not slow itself; the reaction time is slow.
• Productivity: Does the patient have logorrhea? Excess of productivity, difficult to stop speaking. Or on the other hand, does the patient use just a few words (the patient answers with just: yes, no, I don’t know)?
• Speed: Is the way of speech too fast or too slow?
• Volume: Is it loud or whispered?
• Vocabulary: Is the language appropriate to the level of education of the patient? Example: the patient has a high education but she/he is still using a low level of vocabulary. It could mean that at that moment there are some cognitive disturbances. On the other hand, if we are visiting a patient with a low level of education but the vocabulary...