Mental status examination

for nursing students

1. MENTAL STATUS EXAMINATION Presented by Rahul Singh Gusain Msc nursing Ist year

2. INTRODUCTION Mental status examination is a description of the patient’s appearance, speech, actions & thoughts during the interview. It is a systematic format for recording finding about , thinking & behavior patient history remains stable, where the mental status can change daily or hours.

3. D efinition A mental status examination is an assessment of a patient’s level of cognitive (knowledge-related) ability, appearance, emotional mood, & speech , thought patterns at the time of evaluation.

4. P urpose To check the current status of client. To obtain a comprehensive cross sectional description of the patients mental state. To get biographical and historical information of client. To allow us to make a diagnosis To test the mental capacity.

5. Components of mental status examination General Behavior Psychomotor activity speech thought Mood Perception Cognitive function

6. Identification data Name Gender Age Date of admission Ward Religion Type of family education Marital status Diet Informant name

7. General appearance Conscious level- fully conscious/lethargic Physical feature- thin, good built Facial expression- dull, happy, excited Eye contact- maintained/ difficult/ not established Rapport- spontaneous/difficult/ not established Personal hygiene- adequate/ inadequate/overtly clean Posture-upright, rigid , slump

8. Motor disturbances Over-activity or hyper activity- pace, sit still Under activity- psychomotor retardation Compulsion Echopraxia -evidence of mimicking Range of motion

9. speech Intensity- loud, high Pitch- high, low Speed- slow , rapid, normal, not clear Pressure of speech- present/ absent Tone- normal variation/ monotonous Manner- normal/highly formal/ inappropriate Aphasia- formation of words, making of words Coherence- fully coherent/over elaborate, incoherent

10. Thought Form of thought Flight of ideas Associate of looseness Circumstanciality Tangentiality Neoligisms Concrete thinking Clang association Word salad Persecution Echolalia mutism

11. Content of thought Delusions -unrealistic ideas or beliefs content of any delusional system Persecutory, grandiose, reference, somatic & nihilistic. Thought broadcasting– thought being heard by others Thought insertion- thought being inserted into persons mind by others. Phobias - irrational fears.

12. Mood affect Mood- depressed, irritable, anxious, elated, euphoric, fearful, labile Affect -congruence with mood, blunted, flat, appropriate and inappropriate.

13. Perception Hallucination- unrealistic sensory perception Auditory Visual Tactile Olfactory gustatory

14. Illusion Misinterpretation of real stimuli Depersonalization - altered perception of self Derealization - altered perception of environment

15. Cognitive function Consciousness - alertness , attentive Orientation T ime- what is the time now? Place- which place is at you are? Person-who is with you?

16. Attention & concentration Attention- normally aroused/ aroused with difficulty Concentration- focus on subject subtract 7 from 100 7 from 93 3 from 20 keep going

17. Digit forward- 11,12,13… Digit backward-100,99,98… Name of month (backward) Name of days in week (backward)

18. memory To check the whether registration, retention, or recollection of material is involved. Immediate – repeat six forward & backward (normal response) test after 5 minutes 3-5 unrelated objects Recall

19. Recent Question -What did you had in breakfast? Remote memory- date of birth or age Number of children Names & number of family members Year of completing education

20. judgement Ability to solve problems & make decision Assessment area Personal – inquire about patient future plan Social - by observation in social situations Test- predictions of one’s own behavior in imaginary situations. fire problem Letter problem

21. intelligence Includes the areas of general information, comprehension, arithmetic & vocabulary Education status- literate/ illiterate General knowledge- Name of prime minister 5 river , cities or state Capital of countries

22. illiterate Seasons Crops of fruit in seasons Prices of food grains or food items. Price of land Vocabulary: common objects/ uncommon objects/parts of object Similarities – pen & pencil Differences-stone-potato -fly – butterfly -iron - silver

23. arithmetic Questions If 18 boys are divided into groups of 6, how many groups will be there be?

24. comprehension Questions What will you do when you feel cold? What will you do if it rains when you start to work? What will you do when you miss the bus when you are on a journey?

25. proverb Whether the patient understand the proverb like as: Slow & steady wins the race A barking dog never bites. As you sow , so shall you reap

26. insight Knowledge of self Complete denial of illness Slight awareness of being sick Awareness of being sick attribute it to external/ physical factor Awareness of being sick, but due to something unknown in himself Intellectual insight True emotional insight Grade 1-6

27. Physiological factor Bowel & bladder habits Sleep appetite

28. Psychological factor Stress Social relation occupation

29. General observation Patient’s generalize mental health status. Episodic disturbances Epilepsy Hysterical impulsive aggressive Distructive Conclusion Conclusion of mental examination of patient

30. Summary conclusion

31. B ibliogrphy Kaplan & sadock , clinical psychiatry, 6 th edition, wollter klwuier , page no. 14-20 Practical guide to mental health nursing , I st edition, jaypee page no. 6-10 Mary. c. townsend , psychiatric mental health nursing, concepts of care in evidence –based practice, jaypee , page no. 962-966 R.sreevani A guide to helath & psychiatric nursing second edition, jaypee .

32. Thank you