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1. Mental Status Examination
Prepared by: Neda’a Al Shatnawi
Heem

2. Mental Status Examination
Prepared by: Neda’a Al Shatnawi
Heem

3. Assessment
•The patient interview is usually the principal source of data, but it is not
the only source. Information can be gathered from friends, family,
physical examinations, laboratory tests, psychological studies, staff
observations, standardized interviews, and brain-imaging techniques.
•بال mental examination بنعمل overall assessment لل pt عن طريق ال interview وين ال p r o b l e m عندو وشو
ا4شياء اللي صارلها damage وممكن تكون physically أو emotionally أو intellectually الها عAق ة بال
perception وال congestion واهم اشي ال s o c i a l وال occupational Fنو شرط اساسي لتشخيص كل اOمراض
النفسية إنو يكون في impairment بال function تبعهم
•و4زم تعرفو انو ما بكون ال p t هو ال o n l y s o u r c e ) ممكن نجمع اZعلومات من ال friends وال family وكمان من خAل
ال physical examination وال lab test وال psychological studies ومن ال stuff
وال standardized interviews وال brain imaging techniques
•بال psych بكون في مرجع محد د لكل مرض يعني عشان أحط diagnosis لل pt 4زم يكون في عندي criteria لكل
ا4مراض النفسية وبمشي عليها وأحدد بالزبط شو ال disease اللي عندو
س% ي د ا ت ا ل anxiety وال grief مش مط ل و ب ة م ن ا
Me
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4. An Outline of the Psychiatric Assessment
I. HISTORY
A. Identifying information
B. Chief complaint
C. History of present illness
D. Past psychiatric and developmental
history
E. Family psychiatric and medical
history
F. Medical history and physical
examination
II. MENTAL STATUS EXAMINATION
A. Behavior (Behaving)
B. Sensorium—basic cognition, awareness
(Sensing)
C. Emotion (Feeling)
D. Thought (Thinking)
E. Perception (Perceiving)
هاي السAيدات
عبارة عن outline
لل psychiatric
assessment
اقرأوهم ورح نشرح
منهم لقدام شوي
ال history بال psych مختلف عن اللي متعودين عليه ..
وبدوام ال clinical رح ينشرحلنا بالتفصيل

5. THE MENTAL STATUS EXAMINATION
•The mental status examination (MSE) describes the patient’s behavior,
sensorium, emotions, thought, and perception.
•psychiatric history is a subjective account given by the patient about
past events that have not been witnessed by the therapist.
•MSE is an objective report of the patient’s current mental state as
observed by the therapist.
•هون في مAحظة مهمة وهي إنو ال MSE not collateral information
يعني مافي معلومة بتسد أو بتعوض عن معلومة ثانية، كل dimension Aزم أقيمو وأحط عليه notes
• ال mental status examination بعبر عن ال pt behavior و s e n s o r i u m و emotions و thoughts و perception
•ال psychiatric history عبارة عن subjective account بنوخدها من ال p t عن كل ال events اللي صا رت معو زمان )قبل ما يقابل ال therapist (
•اما ال MSE فهي عبارة عن objective report عن ال pt’s current mental status اللي جمعه ا ال therapist نفسو
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6. •There are two elements of the MSE: informal and formal.
•Clinicians gather the informal MSE while taking a history; for most
patients, these observations may be sufficient to get an accurate
picture of the psychological status
• Formal MSE the clinician adds a series of standardized questions
that assess memory, thought processes, attention span, and so on,
that important for those patients with suspected cognitive or perceptual
abnormalities as found in neurocognitive, psychotic, and substance
use disorders.
في 2 elements لل MSE
•ا4ول هو ال formal وهاد بكون في criteria محددة وبمشي عليها )زي النموذج اللي بالصفحة ورا(
•والثاني informal وهو ال a s s e s s m e n t اللي بنوخدو بشكل عام ) ال history) زي مثAً )متى دخلت
عاZستشفى؟ شو سبب دخولك آخر مرة؟ من Zا دخلت لهسا شو اتغير وشو صا ر و و و ..)اسئلة عشو ا ئ ي ة(
Heem

7. Mental Status
Examination Form
مثال على ال formal MSE
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8. •A. Behavior (Behaving)
1. Appearance
2. Activity (including impulse control,
psychomotor activity)
3. Attitude (relating to the examiner, eye
contact)
4. Articulation (Speech)
B. Sensorium—basic cognition,
awareness (Sensing)
1. Consciousness
2. Orientation (person, place, time,
situation)
3. Memory (registration, immediate,
recent, remote)
4. Attention/Concentration
C. Emotion (Feeling)
1. Affect (type and lability)
2. Mood (including suicidal/homicidal
ideation, plan, or intent)
3. Congruency (appropriateness to
expressed thought content and/or
mood)
هاي السAيدات بعد شوي رح نشرح عنهم بالتفصيل
Heem

9. •A. Behavior (Behaving)
1. Appearance
2. Activity (including impulse control,
psychomotor activity)
3. Attitude (relating to the examiner, eye
contact)
4. Articulation (Speech)
B. Sensorium—basic cognition,
awareness (Sensing)
1. Consciousness
2. Orientation (person, place, time,
situation)
3. Memory (registration, immediate,
recent, remote)
4. Attention/Concentration
C. Emotion (Feeling)
1. Affect (type and lability)
2. Mood (including suicidal/homicidal
ideation, plan, or intent)
3. Congruency (appropriateness to
expressed thought content and/or
mood)
ال palm reading عشان ننتبه اذا ال pt بيقضم اظافرو وممكن نصافح ال pt وننتبه
صا فح ب قوة و4 مصا فحتو ضعي ف ة و كم ا ن ممكن ن ن ت ب ه Z ل مس ا ي د ي ه ن ا عم و4 خشن
بننتبه لكل هاي الشغAت
بال appearance بدنا نشوف مظهر اPريض )ال physical
characteristics( ووضعيتو ) ممكن تحددلي شو ال disease
اللي عندو أو تبZ شو ال self esteem عندو وم%بسو )مث%ً
Aبس اشي مناسب للجو او مناسب لجنسو وA في اشي غريب(
`نو با لغا لب بصير في distortion بهاد ال part Aنو ال pt بصير
مهمل كثير بنفسو وخاصةً مرضى ال depression وال
schizophrenia ومرضى ال mania رح يكون مرتب وAبس بدلة و
و وكمان بنتبه على نظافة وترتيب لبسو Aنها نوع من انواع ال
communication اللي بتعطينا نظرة عن الشخص
Heem
-

10. •Activity:
•patient’s motor activity: gait, gestures,
mannerisms, impulse control,
stereotypies, and other muscular
movements such as tremors, twitches, or
tics.
•Psychomotor agitation, or simply
“agitation,” is repetitive, nonproductive
motor activity usually associated with
feelings of tension (e.g., pacing, fidgeting,
constantly standing and sitting).
• Psychomotor retardation describes
slowed movements, reactions, or speech.
•بعديها بدنا نقيّم ال activity نشوف ال g a i t وال gestures
•وال pts ممكن يكون عندهم agitation يعني اZريض h y p e r
بتحرك كثير وممكن يكون عندو special patterns ل
movement معينة زي ال m a n n e r i s m s اللي هي طقطقة
اOصابع أو أكل اOظافر أو تحريك الرجل

•وممكن يكون عندهم retardation يعني اZريض بكون h y p o
يعني ما عندو activity
•وممكن يكون عندهم normal physical activity
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11. •Catatonia is not responding to
environmental stimuli either with or
without associated activity
•Catatonic excitement is extreme
overactivity seemingly unrelated to
environmental stimuli.
•Catatonic negativism is an apparently
motiveless and extreme resistance to
all instructions or attempts to be moved
•ال catatonia وحدة من ا لوضعي ات ا ل لي ممكن تصي ر عند ا Zرضى
النفسي? وهي التخشب وهي نوع من انواع ال schizophrenia
•ال catatonic excitement بكون في overactivity
بس ما الو عAق ة بأي محفز خارجي
•ال catatonic negativism بكون في extreme resistance
لكل ال instructions ولكل محا وAت التحريك
Heem

12. •Negativism are:
(a) catatonic posturing, in which a bizarre
position is rigidly held for long periods.
(b) catatonic rigidity, in which the patient
resists all efforts to be moved.
(c) waxy flexibility, in which the patient
resists having his body moved, but ends up
with parts of his body being “molded” into
odd positions, as if they were pliable wax.
•Echopraxia: is the repetitive imitation of
another person’s movements.
• Stereotypy is an isolated, repetitive, and
purposeless movement. It appears most
often in catatonic and drug-induced
states.
•ال catatonia rigidity اZريض بكون متخشب ولو حاولت تغير وضعيتو
مارح تتغير بكون عندو high resistant شو ما احاول اعمل ما بتتغير
اما ال waxy flexibility بقدر اغير من وضعية ا1ريض
وبيوخد الوضعية الجديدة وبيثبت عليها مث?ً اذا بدي
اعمل للمريض intervention اقيس ضغطو ومديتلو ايدو
وخلصت ا ل intervention رح اLقي ا يدو ضلت ممدودة
•ال Echopraxia ال p t بيعمل imitation لحدا ثاني
يعني اZريض بضل يعيد حر ك ا تي
•ال stereotypy اZريض بكون يعيد حركات نمطية محددة
وهاي ا لحركات بتكون purposeless
وهي most common مع مرضى ال ASD )ال Autism(
Heem

13. •Attitude:
•Describes how the patient relates to the
examiner. Is eye contact established? Is
communication reciprocal? Descriptors
include indifferent, frank, friendly,
embarrassed, help seeking, evasive, afraid,
resentful, sullen, angry, irritable, assaultive,
erotic, negativistic, denudative, exhibitionistic,
dramatic, transparent, cooperative, hostile,
withdrawn, open, guarded, suspicious, angry,
evasive, sneering, interactive, averted gaze,
fleeting eye contact, sarcastic, and so on.
ال attitude هي وصف لشو ت ع ا م ل ا 1 ر يض م عك ا و م ع ا ل care give يعني عندو eye contact وL W ..
كان friendly وL aggressive وL cooperative وL suspicious)شك اك( وL خايف وL معصب او او ..
Heem

14. •Articulation (Manner of Speech):
•Describes the manner (volume, flow, rate, quality, coherence) but not
the content of speech. Speech can be rapid or slowed, hesitant, soft or
loud, pressured or casual, spontaneous or hesitant, clear or slurred
(i.e., dysarthria), monotonous, staccato, and pedantic or stilted
(formal)
وبال behavior Lزم ننتبه كمان لل manner of speech يعني نوصف ال v o l u m e وال fl o w
وال quality وال c o h e r e n c e يعني حكيو سر يع وL بطيء l o u d وL soft بيضغط على حالو
وهو بيحكي وبوضوح وL W على بغض النظر عن ال content اللي بيحكي فيه ال pt
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15. •Poverty of speech: is a striking lack of speech, so that replies to
questions are brief or monosyllabic; some questions are not answered
at all. Poverty of speech refers to an inadequate quantity.
•Mutism: is not speaking; it is a frequent feature of catatonia. With
mutism there is a tendency to substitute the use of related words
approximating the definitive term
•Pressured speech is rapid, virtually nonstop, often loud and emphatic,
seemingly driven, and usually hard to interrupt. It typically occurs in
mania and in some drug-induced states and in severe anxiety states.
•بال poverty of speech ال pt بكون عندو lack بال speech وردودو على اسئلتي مختصرة
وفي اسئلة ممكن يطنشها يعني ممكن تقعد تحكي معو نص ساعة وتطلع منها ب 4 وA 5 كلمات بس
•اما ال mutism اZريض بكون بحكيش باZرة وبكون الها سبب?
١. بكون في paralysis بال vocal cord بنسميها aphonia
٢. او بكون في damage بال speech center اPوجود بال brain وهاد بنسميه aphasia
•ال pressured speech بتكون بالغالب عند مرضى ال mania وهون اZريض بكون بحكي كثير وصوتو عالي
وبتحسو بدو يخلص الجملة عشان يحكي اللي بعدها بسبب تزاحم اAفكار
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16. •Sensorium:
Sensorium refers to basic cognition and awareness.
Consciousness: Descriptors of consciousness in declining order include
hyper alert, alert, lethargic, confused, stuporous, and comatose
•Clouding of consciousness: is when the patient is awake and
functioning, but has an incomplete or distorted awareness of the
environment.
•Stupor: is a state of foggy consciousness and nonalertness in which
the patient may respond to noxious stimuli, but otherwise be oblivious
to her environment.
•Coma: is the most impaired end on a continuum of consciousness.
Patients may be totally unresponsive to a (painful) stimulus, such as a
pinprick, or may twitch, but not display any further evidence of
awareness.
مش ك ث ي ر م ه م ا ل س% ي د )اAستاذ محمد صي احZ حك ا ل ن ا ه ا د مش من ضمن
ال assessment اللي مطالبZ فيها( بس شيكو عليه ل%حتياط
Heem

17. •Orientation
•As patients become progressively
disoriented, they are unable to indicate
the current time (and situation), then
their current location (place), and last,
their own name.
Lزم يكون oriented by 4
هم ال time وال p l a c e وال p e r s o n
والرابعة الجديدة هي ال insight to illness وهي ادراكو ووعيو للمرض
بمعنى هل ال pt عارف هو ليش موجود هون وL W
•اذا حك ا لي موجود عشان مشكلة نفسية وبيتعا لج منها )مش بالضرورة يحدد ا Zرض ب ا ل زبط( هون
بكون full insight to illness
•اذا حك ا لي موجود وبيتعالج عن مرض صحي physically زي السكري او الضغط
هون بكون partially insight
•اذا قعد يحكي حكي مش مفهوم وملهوش عAقة بمرض زي مثAً يحكيلك اهلي جابوني هون
عشا ن م ا اشا ر ك ه م ب ا ل و ر ث ة ا و عشا ن ا ل ع ي د ق رب و ب دهمش يشو ف و ني هون ب كون lack insight
Heem

18. •Memory
•memory is categorized as remote, recent, or immediate. Remote memory
refers to many years ago, recent memory to the past several days to months,
and immediate memory to the past several minutes.
•Amnesia is a pathological loss of memory.
• Anterograde amnesia is for events occurring after a significant point in time.
• Retrograde amnesia is for events occurring before a significant point in time.
•Confabulation is when a patient invents responses, facts, and events to
mask an organic impairment.
•وهسا نيجي لل m e m o r y بنقيمها با4عتماد على 3 types
1.ال immediate memory وهون بنقيم ا لذاكرة ا لقريبة )خAل ا ق ل من 24 ساعة او خAل دق ا ئق( زي مثAً شو أفطرت اليوم؟
2.ال recent memory بنقيم فيها الذاكرة بشكل ابعد شوي لحد 6 شهور وبنحاول نربطها بحدث مع? زي مثAً رمضان اZاضي وين
كنت بالبيت و4 باZستشفى؟ او العيد اZاضي شو عملت؟
3.ال remote memory بنقيم فيها الذاكرة البعيدة بتمتد لسنوات لل childhood زي مثAً تسأ لو مت ذكر شو اسم مدرستك ا 4ساسي ة ؟
•ممكن يصير في impairment بال memory بنسميها amnesia بتصير بسبب trauma معينة عملتلو loss بال memory
•اذا ال p t كان ناسي كلشي بعد الحادث )بتذكر كل حياتو لحد يوم الحادث( بنسميها Anterograde amnesia
•اذا ال pt كان ناسي كلشي قبل الحادث )بتذكر كل حياتو اللي بعد يوم الحادث( بنسميها Retrograde amnesia
•ال trauma ممكن تكون p h y s i c a l وممكن emotional
•Zا يصي ر في فقدان لجزء من ال m e m o r y واZريض يحاول يعبي
اOحداث والحكي من عندو )يفبرك( هاي بنسميها confabulation
Heem

19. •Attention and Concentration
•Attention is the ability to sustain a focus on one task or activity.
• Impairment of consciousness, orientation, memory, and attention
(COMA) suggests the presence of cognitive dysfunction due to an
organic (physical) condition
افضل طريقة عشان نقيم ال attention وال concentration هي ا ن ن ا نسأ ل ه م عن شغ ل ة حك ي ن ا ه ا ب ب د ا ي ة ا ل interview
مث?ً ببدايتها حكيتلو اسمي بنهايتها بسألو بتتذكر شو اسمي؟ او بتقدر بلحظتها تحكيلو عدلي من ١-٢٠ بالعكس
او حسب مستواه التعليمي ممكن تعطيه عملية حسابية
Heem

20. •Delirium: is a clouding of consciousness with disorientation and recent
memory loss (e.g., a concussion caused by physical injury to the brain
may result in a delirium), acute case and reversible.
•Dementia: is characterized by a loss of intellectual abilities, especially
memory, chronic irreversible case.
•Disorientation: is the inability to correctly identify the current time,
situation, place, and person (familiar and self).
•Distractibility is when a patient’s attention is frequently drawn to
unimportant or irrelevant external stimuli.
ال D e l i r i u m هي الهذيان وبالعادة بتترافق مع ال a l c o h o l i s m بصي ر في عندهم temporarily memory loss
وال D e l i r i u m اذا صا رت c h r o n i c بصي ر اسمها Dementia اللي هي خرف وهي i r r e v e r s i b l e
ال Disorientation بكون اPريض مش قادر يحدد ال B y 4 اللي حكين اهم ورا
وال Distractibility انو اPريض سريع التشتت )بتشتت بأي اشي(
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21. •Emotion:
•Mood and Affect. Mood is a pervasive and subjectively experienced
feeling state, whereas affect refers to instantaneous, observable
expressions of emotion.
•Moods are what people tell you they feel, and affects are what you see
them feeling.
•Moods are symptoms; affects are signs.
ال emotion بينقسم ل m o o d و affect ال m o o d بكون subjective من ال p t يعني symptoms
وال affect بكون objective من ال health care provider يعني s i g n s
زي مث?ً بتسأل ا1ريض كيف مزاجك اليوم؟ لو حكا لك "انا اليوم مبسوط" هاي m o o d
واذا انت شفتو بيضحك او مرتاح هاي affect
وال n o r m a l انو يكون في c o m p o r u n c y يعني يكون في توافق ب} ال m o o d وال affects
Heem

22. •Commonly described affects are:
•Broad affect is a normal range of affect.
•Flat, blunted, and constricted affects
describe (in decreasing order of severity)
•Restrictive affect is sometimes used when
someone seems to be deliberately
attenuating emotional expression.
في 3 انواع لل affect
1.ال board affect وهو ال n o r m a l r a n g e
2.ال flat affect بكون no emotions يعني مش و اضح شو شع و ر و م بسوط و 4 ز عAن و 4 و 4 …
3.ال restrictive
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23. •Inappropriate or incongruent affect is clearly discordant with the
expressed emotional state or discordant with the content of the
patient’s speech, e.g., a patient giggles while talking about his father’s
death.
•Labile affect shows a range of expression in excess of cultural norms,
with repeated, rapid, and abrupt shifts of emotion, as when a patient
cries one moment and laughs the next.
ال affect Lزم تكون appropriate مع ال situation يعني مث?ً مش معقول ال pt يحكيلي عن حالة وفاة وهو بيضحك
او احكيلو نكتة ويصير يعيط عليها
ال labile affect بكون في عندو repeated shift بال emotion يعني بت?قي ال pt شوي بضحك وشوي بعيط
عندو mood swings
Heem

24. Mood states include:
•Apprehensive mood involves worried expectation or anticipation.
•Dysphoria is any unpleasant mood, including irritable, apprehensive,
and dysthymic moods.
•Dysthymia is the mood of depression or pervasive sadness, including
a subjective sense of heaviness or feeling “weighted-down,” blue, or
down-in the dumps
•وال dysthymia بكون ال p t عندو d e p r e s s i o n وبحس بال s a d n e s s وبحس بالثقل h e a v i n e s s
•ال irritable يعني ال p t بكون tension و n e r v o u s
شا د على حا لو وبسهولة ممكن ينزعج ويعصب
•ال apprehensive ال pt بضل
worried قلقان من كلشي ممكن يصير معو
•وال d y s p h o r i a هي ال u n p l e a s a n t
mood يعني ال p t بكون منكد مش مبسوط
وعندو irritable mood
•ال alexithymia هاي ال emotional dryness
يعني ال pt ما عندو مشاعر
•بال a n h e d o n i a مافي اشي بفرح ال p t شو ما
تحكي لو او تعمللو ما بحس بال p l e a s a n t
•ال a n h e d o n i a مهمة 4نها وحدة من أهم ال negative symptoms لل schizophreniaHeem

25. •Irritable mood is a feeling of tension or nervousness; one feels prickly,
easily annoyed, provoked to anger, or frustrated.
•Alexithymia is a trait in which the patient has a constricted emotional
life, diminished ability to fantasize, and a virtual inability to articulate
emotions.
•Anhedonia exists when there is a pervasive inability to perceive and
experience pleasure in actions and events that are normally
pleasurable or satisfying for the individual or most individuals.
•ال euthymia هي ال normal range بكون ال
pt ما عندو dysphoria وA أي مشكلة بال mood
•ال ephoria هي الزهزهة وبالعادة بتكون عند
مرضى ال mania او بتكون side effect بعد
ما ال pt يوخد بعض انواع ال medication
•بال e x p a n s i v e m o o d ال p t ما بكون قادر
يعمل control Zشا عرو وببالغ بأهمية
ا4شخاص با4ضافة لل euphoric mood
•هاي stages لل elevated mood
mild .. moderate .. sever .. very severe
احفظوهم
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26. •Thought
•Thought Process (Form of Thought)
Word usage/ language
•Neologisms are self-invented words or phrases that are most often
seen in schizophrenia.
•Word salad is a group of words that are put together randomly with out
any logical connection.
•poverty of speech the patient utters only a few words or syllables, in
poverty of content of speech the patient’s words are sufficient and
individual sentences may even make sense, but the total
communication remains meaningless.
جزئية ال thought واللي بعدها مهمة كثير
بال neologism ال pt بحكي كلمة غريبة علينا احنا ما بنعرفها مش مارقة علينا أو بحكي
كلمة بنعرفها بس بتعنيلو اشي ثاني غير عن اQعنى اللي احنا بنعرفو
بال word salad بحكي كلمات بدون جمل يعني كلمات مختلفة randomly
مش م ف ه و م ة و مش ر ا ك ب ة ع ل ى ب عضه ا without any logical connection
ال poverty ال pt كلماتو قليلة معدودة
Heem

27. • Incoherent or incomprehensible speech is often referred to as verbigeration
and word salad.
Stream of thought
• Refers to the production and quantity of thoughts (e.g., overabundant,
slowed). Interruption of a train of speech before a thought has been
completed is called “thought blocking.”
•Flight of ideas (the ideas are associated but rapidly generated)
• ال flight of ideas بتترافق مع ال pressured speech اللي حكينا عنها قبل انو ال pt عندو افكار متطايرة وبحكي جمل كثيرة وسريعة
•ال incoherent speech هو الكJم الغير مترابط او الغير مفهوم بنحكيلو verbigeration او word salad
•ال steam of thought هو التيار الفكري يعني بيوصف كمية انتاج اRفكار
اما بتكون overabundant زيادة أو بتكون slowed قليلة
•وبال thought blocking بكون في interruption بالحكي قبل ما تنتهي الفكرة
بهاد السXيد اYستاذ محمد ركز بس على ال flight of ideas
Heem

28. •Looseness of associations: Thinking is characterized by speech in
which ideas shift from one unrelated subject to another, the individual
is unaware that the topics are unconnected.
•Tangentiality: is the person never really gets to the point of the
communication. Unrelated topics are introduced, and the focus of the
original discussion is lost.
•Circumstantiality is the individual delays in reaching the point of a
communication because of unnecessary and tedious details. The point
or goal is usually met but only with numerous interruptions by the
interviewer to keep the person on track of the topic being discussed.
•بال Looseness of associations ال p t بحكي جمل بدون افكار مترابطة بتكون unlerated وال p t بكونش واعي لشو بحكي
•بال tangentiality بس تسأل ال pt عن شغلة بضل يشرح ويحكي ويلف ويدور ويبعد عن اRشي ا\طلوب وبا^خر ما بجاوبك
يعني مافي conclusion او ما بيوصل لل point of communication
•بال circumstantiality ال pt بقعد يشرح بس آخر اشي بجاوبني يعني في conclusion
اذا انت ضل يت تعمللو interruption وضل يت ت ذ ك ر و ب ا ل point of communication
Heem

29. •Clanging association is choice of words is governed by sounds. Often
take the form of rhyming.
•Echolalia is a meaningless, persistent, verbal, repetition of words or
sounds heard by the patient
•Perseveration is repeats the same word or idea in response to
different questions.
•Mutism is an individual’s inability or refusal to speak.
•بال clanging ال pt بكون يحكي على نفس القافية )سجع(
•بال echolalia ال pt بعيد نفس كJمك يعني اذا سألتو شو اسمك برجع بحكيلك شو اسمك
•بال pereseveration الpt بعيد نفس اRجابة يعني شو ما تسألو بحكيلك نفس الكلمة
يعني تحكيلو مرحبا رح يحكيلك اهلe .. كيفك؟ .. اهلe …
•ال mutism حكينا عنها قبل انو ال pt بكونش قادر يحكي عندو aphonia او aphasia أو هو رافض يحكي
قبل حكينا انو ال echopraxia
هي Q ا ا ل pt يعيد نفس حركاتي
Heem

30. •Thought Content
•Illogical thinking involves conclusions that contain clear,
internal contradictions or are blatantly erroneous given the
initial premises.
•Magical thinking is the person believes that his or her
thoughts or behaviors have control over specific situations
or people
•ال magical thinking بتحس ال pt عايش بعالم موازي وبحكي شغJت ما بتتصدق
•ال Illogical thinking التفكير الغير منطقي عبارة عن تناقضات داخلية غير عن ا\عطيات
يعني بتحكيلو اشي وبيفهمو اشي ثاني
Heem

31. •Obsessions are unwanted and uncomfortable ideas, thoughts, images,
or impulses that persistently invade one’s consciousness.
•Compulsions are repeated, stereotyped, overtly senseless actions or
rituals, which are performed to prevent anxiety. Compulsions are
obsessions expressed in behavior. Obsessions are thoughts,
compulsions are deeds.
•ال OCD هو مرض الوسواس القهري
•ال obsessions هي انو ال pt يضل يكرر التفكير بنفس الشغلة بطريقة unwanted و uncomfortable زي
مثJً سكرت الباب وR ما سكرتو؟ غسلت ايدي وR ما غسلتها؟ ركزو انو هاي بس مجرد التفكير فيها
•وال compulsion هي تكرار اuفعال يعني يفكر ويروح يسكر الباب ويفتحو ويرجع يسكرو ويفتحو وهيك …
Heem

32. •Relationship to Reality
•Psychosis is a mental state in which the person is unable to
distinguish reality from fantasy.
• Overvalued ideas are unreasonable and persistent beliefs, held with
less delusional intensity, which are not generally held in the patient’s
subculture.
•Paranoia is not a symptom but a mental disorder characterized by
delusions of grandeur and persecution, suspiciousness, jealousy, and
resentment.
في مصطلح^ احنا Yزم نميز بيناتهم
اYول psychosis مرض نفسي والثاني Neurosis مرض عصبي
في فاصل بيناتهم وهو ال reality
اذا ال pt صا ر عندو lose contact مع ال reality بكون psychosis
اذا still contact مع ال reality بكون Neurosis
طيب كيف بدي أعرف ال p t صا ر عندو l o s e و4
still contact مع ال reality ؟
باختصار اذا كان في عند اZريض hallucination
أو d e l u s i o n بكون lose of contact
•بال overvalued ال pt بكون exaggeration لكلشي بالحياة يعني ببالغ وبفكر بكلشي
•ال paranoia هي جنون ا لعظمة بكون pt شايف حالو كثير وهاد وR يمكن نحكي انو neurosis هو اكيد p s y c h o s i s
Heem

33. •Delusions are false personal beliefs that are
inconsistent with the person’s intelligence or
cultural background. The individual continues
to have the belief in spite of obvious proof
that it is false or irrational.
•Delusion of reference: All events within the
environment are referred by the psychotic
person to him or herself
•Ideas of reference are less rigid than
delusions of reference. An example of an
idea of reference is irrationally assuming that,
when in the presence of others, one is the
object of their discussion or ridicule.
بالبداية Yزم نفهم انو ال delusion هو عبارة عن أفكار ثابتة خاطئة ما بتتغير غير مع ال medication )زي ا للي
بحكيلك بدهم يسمموني . . هو بكون مقتنع وما بصير تناقشو Yنك رح تعمل breakdown لل trust بينك وبينو (
ال delusion إلو انواع كثيرة
•ال delusion of reference بربط احداث عا\ية
كونية بنفسو يعني بحكيلك الحرب صارت عشاني
الدنيا شتت عشاني زعJن ..
ال Ideas of reference زي اللي كل ما يشوف ٢ بيحكو بشك
انهم بحكو عنو )مقتنع انو هو ال idea اللي الكل بحكي فيها(
•وظيفتك تعطيه بدائل زي مثJ ً خايف
يتسمم بدك تعطيه شغJت مسكرة
Heem
A

34. •Delusion of control or influence: The
individual believes certain objects or
persons have control over his or her
behavior
•Grandiose delusions: The individual has
an exaggerated feeling of importance,
power, knowledge, or identity
•ال delusion of control بصي ر يحك ي ل ك ا نو في اشي ع ا مل ع ل ي ه control ويتحكم بتصرفاتو وبأثر عليه
•ال grandiose delusion بتترافق مع ال paranoia جنون العظمة بس مع فكرة ثابتة
يعني ممكن يحكيلك انا سوبر ما او يحكيلك انا سمكة
Heem

35. •Jealouse delusions involve suspicions about a or about one’s sex
partner being unfaithful.
•Nihilistic delusion: The individual has a false idea that the self, a part
of the self, others, or the world is nonexistent
•Somatic delusion: The individual has a false idea about the functioning
of his or her body
•Persecutory delusions: The individual feels threatened and believes
that others intend to harm or persecute him or her in some way
•Religiosity is an excessive demonstration of or obsession with
religious ideas and behavior.
•ال jealous هي جنون غيرة وبتكون بe ال partners وممكن توصل معو يحبس الشخص الثاني من كثر الغيرة او يقتلو
•ال nihilistic بكون مقتنع إنو في organ او جزء من جسمو مش موجود )ما عندي قلب او ما عندي عيون(
•ال somatic بكون ال pt بحكي عن ال function يعني بكون مقتنع انو ال organ موجود بس
مش شغ ا ل )عندي عيون بس ما بشوف فيها(
•ال persecutory بكون ال pt مقتنع إنو في حدا بJحق فيه او في جهة بتطارد فيه بدهم يقتلوه وبضل يحس بالخوف وعدم اuمان
ال Religiosity بكون ال pt عندو تشدد بالدين زيادة زي اللي بصير عندهم
distortion زي اللي فجأة صار يلبس دشداشة ولحية طويلة وكل كXمهم بالدين
هاي ال most
common
Heem

36. •Thought broadcasting is the belief that one’s inner thoughts are no
longer private, have escaped from one’s mind, and have become
known to everyone.
•Thought insertions are ego-alien convictions that thoughts have been
placed into one’s mind, with the person believing his thoughts are not
his own.
•Thought withdrawal is a patient’s ego-dystonic belief that thoughts are
being taken, or stolen from her mind or brain, and that she has fewer
thoughts than before.
•بال thought broadcasting بكون ال pt مقتنع إنو اRفكار بتطلع منو لحالها بحكيلك كل افكاري بتتسرب
•بال thought insertion ال pt بكون مقتنع إنو في حدا بزرع اRفكار وا\علومات بذهنو
بال thought withdrawal بكون مقتنع انو الكل بسرق افكارو بحكيلك في حدا بسرق افكاري بطلعها
Heem

37. •Concept Formation (Abstractibility)
•A patients behavior during the interview usually provides enough data
to determine the ability to abstract.
•The ability to abstract - to think symbolically, to generalize, and to
conceptualize is frequently absent with a functioning IQ under 90 or
with schizophrenia.(concrete thinking)
•ال consept formation عشان تقيم مدى تفكير ال pt ممكن تعطيه مثل شعبي )زي مد لحافك على قد رجليك(
وتطلب منو يشرحلك اياه وتشوف هو فاهم ا\ضمون وR رح يشرحلك حرفي
•اغلب اللي عندهم ال IQ أقل من 90 ومرضى ال schizophrenia عندهم concrete thinking
•ال normal نكون abstract thinking
Heem

38. •Intelligence and Information:
•Includes examining the patient’s general fund of
information.
•Performing simple calculations involving money is
correlated with intelligence
•الذكاء او ا\عرفة العامة بنقدر نقيمها بس نسأل ال pt اسئلة ثقافة عامة
او اسئلة حسابية حسب ال educational level
Heem

39. •Insight refers to patients awareness and understanding of their chief
problem.
1.Acknowledges being ill
2.Acknowledges illness but attributes cause to bad food, climate,
overwork, virus, need for rest, etc.
3. Denies being ill at all
ال insight هدول شرحناهم ورا عند ال oriented by 4
Heem
B

40. •Judgment
•Abilities to exercise judgment in
dealing with social situations,
which includes acting
appropriately during the interview
and understanding the
consequences of their actions.
ال judgment هي ال social level انك تحط اQريض ب situation واطلب رأيو فيه عشان اشوف كيف بحكم عليها
زي مثXً اسأ لو لو شفت ا لغرفة ا للي جمبك بتنحرق شو بتعمل؟ او لقيت طفل مدعوس با لشارع شو بتعمل؟ . .
وحسب ردو بتعرف شو تقيمو
Heem

41. •Perception
•Assessing the five senses: hearing, seeing, touching, tasting, and
smelling.
•These abnormalities, which include hallucinations, illusions,
depersonalization, derealization, and déjà vu.
•Hallucinations: false sensory perceptions not associated with real
external stimuli.
•In general, only auditory and visual hallucinations occur in psychiatric
disorders, whereas these and olfactory, tactile, and other hallucinatory
phenomena occur in disorders caused by drug use or medical
conditions.
•بال perception بكون ضرب عندو اشي من الحواس الخمسة اذا مش كلهم
•ال hallucinations بشوف او بسمع او بشم او بتذوق شغJت اصJً مش موجودة زي مثJً بحكيلك سامع صوت حدا
مع انو الغرفة فاضية او شامم ريحة دم او شايف اسد بالغرفة او او
•ال illusion بشوف الشغJت اللي موجودة بالغرفة بطريقة ثانية .. مثJً بحكي عن البرداية شبح او عن الكرسي وحش
•الفرق بيناتهم هو ال external stimuli
ال auditory وال visual بالعادة بتصير بسبب ال psychiatric disorders
ال olfactory وال tactile بالعادة بتصير بسبب drug او medical condition
Heem

42. •Illusions are misperceptions of real
external stimuli.
•Hallucinosis: is a state in which the
patient realizes his hallucinations are
false.
نفس الحكي اللي ورا
Heem

43. • Auditory hallucinations: are false
perceptions of sound. Most
commonly they are of voices, but the
individual may report clicks, rushing
noises, music, and other noises.
Command hallucinations may place
the individual or others in a
potentially dangerous situation.
•Visual hallucinations: These
hallucinations are false visual
perceptions. They may consist of
formed images, such as of people, or
of unformed images, such as flashes
of light.
Gustatory hallucinations : This
type is a false perception of taste.
Most commonly, gustatory
hallucinations are described as
unpleasant tastes.
Olfactory hallucinations: are false
perceptions of smell
Tactile hallucinations: are false
perceptions of the sense of
touch, often of something on or
under the skin.
مثJً اذا قلك بشوف اشي ما حدا بشوفو .. مJئكة او جن او اشباح هاي hallucinating
بس ا ذ ا حك ي ت ل و ا وصف ل ي ا ل غ ر ف ة و ق ل ك عن ا ل ب ر د ا ي ة شبح ه ا ي illusion
هدول اقرأوهم بتركيز
وفرقو ان ال hallucinations باشياء مش موجودة باQرة
ال illusion شغXت موجودة بس هو بفهمها اشي ثاني
ال auditory بسمع شغ?ت مش م وجو د ة
ال visual بشرف شغ?ت مش موجودة
ال gustatory بستطعم شغ?ت u n p l e a s a n t
ال olfactory دايماً بشم شغ?ت مش موجودة
ال tactile بحس انو في حدا بلمسو او في اشي
زي حشر ات او نمل بمشي عليه
بال hallucinations
Heem

44. •Depersonalization is when a person perceives her body as unreal,
floating, dead, or changing in size. A person’s arm may feel like wood
or seem detached from her body.
•Derealization is when a person perceives his environment as unreal.
The individual feels removed from the world, as if he is viewing it on a
movie screen.
•Déjà vu literally “already seen” is a sense of familiarity when
confronted by a situation or event that has not been experienced
previously.
•بال depersonalization بكون في مشكلة بe الشخص ونفسو يعني مثJً لو اندق الباب بكون
مقتنع انو فش داعي يقوم من مكانو عيونو لحالها رح تروح تشوف مe عالباب
•بال derealization ال pt بكون مع نفسو يعني عايش بعالم موازي ومش معنا
•ال Deja vu الشخص بكون مقتنع إنو عايش شغJت متكررة بفكر انها صايرة معو من قبل
Heem

45. Sample Mental Status Exam Documentation
• The patient is well-groomed with appropriate and casual dress. Body habit is thin and
without dysmorphic features or abnormal movements. The patient appearance is
consistent with stated age. There is no psychomotor agitation (activity). Patient is
cooperative with the interview, is forthcoming with responses, and establishes good
eye contact (attitude). Speech is clearly articulated with a regular rate, rhythm and
volume. Patient is alert (consciousness) and fully oriented to person, place, situation,
and date/time, with intact memory and adequate attention throughout the session.
Patient registers and recalls 3/3 objects at 5 minutes. Patient is able to spell name
forward and backward without difficulty. Affect is comfortable and consistent
(congruent) with both thought content and a reported stable mood of 5/10, without
suicidal or homicidal ideation, plan, or intent. Thought process is without flight of
ideas, racing thoughts, or loosening of associations. Thought content is without
obvious delusions or obsessions. Patient correctly identifies the last three presidents
and performs simple change exactly to $3.68. Patient is able to provide an abstract
proverb interpretation. Three wishes expressed are (***). Intelligence is considered
normal based upon fund of knowledge, comprehension, and vocabulary. Insight is
minimal and judgment is grossly intact to real life and hypothetical situations. No
hallucinations or other perceptual abnormalities are evident.
•Note: The MSE summary paragraph is always written in the present tense. It is useful
to collect the data and report it using the same outline for organizing the mental status
exam

46. ↑
A

47. I