Mental Status Examination

1. Affect and Mood

Definition of “Affect” :

 Observable emosional expression ; how the Client present to others.

 Range Full/Broad vs Blunted/Flat
 Full range of expression. Considerer Typical or normal
 Blunted/Flat : Dull range of expression. Associated symptom of depression, brain injury, trauma.
 Congruent vs Incongruent.
 Congruent : appropriate emotional expression to the content being discussed. Considered
authentic, genuine, “integrated”.
 Incongruent : inappropriate emotional expression to the content being discussed. Considerd
inauthentic, “superficial”.

Definition of Mood.

 Subjective emotional state (rather than expression)

 Range ; Depressed/ Dysphoric -> Euthymic -> Elate / Euphoric
 Euthymic : Normal or typical mood. Upbeat, “happy’
 Depressed : Down, “blue” mood. Often with decreased energy. Irritability or anxiety, occurs in
some people. Common to depression, anxiety, depressed states of bipolar disorder
 Elated/Euphoric : “ Up” mood, “on top of the world “. Often with increased energy. Common to
manic stated of bipolar disorder.
 Lability
 Labile Mood : Capricious, unstable, quickly changing moox. Common to rapid cycling forms of
bipolar disorder in adults, and mood disorders in young children.
 Associated symptoms : anhedonia, vegetative sign of depression.
 Anhedonia : Lack of interest and withdrawal from regular and pleasurable activities that one use
to enjoy. An associated symptom of depression.
 Vegetative symptoms : Biologically based dysregulations in brain chemistry (e.g., serotonin).
Sleep and appetite changes are most pronounced. Common to depression

Review

Affect : Mood

 Full/Broad - Euthymic
 Blunted/Flat - Depressed/Dysphoric
 Congruent - Elate / Euphoric
 Incongruent - Labil
- Anhedonia
- Vegetative symptom

2. Thought Process :
 Definition of “Thought Process” :
  How a person makes sense of the world, and makes connections between content.
 Form of thought :
 Attention
 Speed of thought

Form of thought
Logical  Circumstantial  Tangential  Loose association  Flight of ideas
 Logical : clear, direct connections between content. One idea flows direct into another.
 Circumstantial ; disgressions to unnecessary detail in tought and speech before communicating the
central idea.
 Tangential ; Oblique, disgressive, irrelevant speech. The central idea is not communicated.
 Loose association : Little or vague connection is made between concepts; contiuous tangential
“rabbit –holing.” Can be a symptom of schizophrenia.
 Flight ideas : Multiple thought and ideas are generated spontaneously, without obvious connection.
Often occurs in manic stated; associated with bipolasr disorder.

Attention :
 Distractible : Focus can shift quickly into the external environment. This awareness interrupts the
present dialogue. Associated symptom of anxiety, attention – deficit (ADHD)
 Preoccupied : Inattentive to the external environment, internally focused, seems to be thinking
deeply. Can be associateanxietyd with depression, psychosis (schizophrenia) , schizoid personality
 Rumination : Preoccupation with a single idea or theme. Associated with anxiety, obsessive – e
compulsive disorder ; can lead to delusional thought. In autism, this is “Perseveration”
Speed Of Thought :.
 Latent : A prolonged period of time between a thought and its verbal expression. Associated with
depression, anxiety, schizophrenia.
 Racing thoughts : Multiple thought occurring in a seamless fashion. Often in list form. These thought
have a pressured quality. Associated with anxiety, manic states ( bipolar)

3. Memory
 Definition of “Memory” : Storage and recall of both current information (working memory) an past
information.
 Amnesia (antegrade, retrograde) : memory loss for event after the onset of amnesia. Associated with
brain injury, demensia, substance abuse. Assess confabulation (attempt to justify false response).
 Amnesia retrograde : Memory loss for events before the onset of amnesia. Associated with brain
injury , demensia, substance abuse. Assess confabulation (attempt to justify false response).
 Mini Mental state Exam examples
 Consciousness (dissociation, regression)
 Dissociation : Altered consciousness, a trance – like state, disconnected from emotions. Often occurs
in response to painfull emosional content. Associated symptom of trauma.
 Regression : Return to a childlikeare state. The person is unconscious and unaware of their
regression (if they are aware, it is usually a symptom of manipulation)
 Not explored, but important to assessing
Consciousness : orientation
 Time
  Place
 Person
 Situation
 “Intact” memory (appropriate short – and long – term storage and recall; notmal /typical)

4. Motor :
 Definition : Level of energy in body mechanics and movement.
 Motor spectrum

Psychomotor Relaxed, Restless, agitated

retardation/ normal hypernviron
catatonic hypoactive, ment active
apathetic
 Relaxed /normal : within typical range of motor movement.
 Psychomotor retardation / hypoactive : Decreasad activity, slow response to enviro nment.
Sluggish. Associated with depression, brain injury.
 Catatonic : severe immobility, associated with schizophrenia.
 Restless / hyperactive : A compelling need to be in constant movement. Difficult to sit still.
Symptom of anxiety, ADHD, Trauma
 Agitated : Severe anxiety and/or irritation. Can precipitate anger outbursts or panic attacks.
Pacing can occur.
 Stereotyp.y : continuous mechanical repetition or speech or physical activity, such as flapping
hands and rockimg
 Odd/eccentric (stereptypy)
 Not covered but important to knows :
Odd / eccentric Tic-like movement
 Clearing throat
 Licking lips
 Rolling shoulder
 Scrunching nose
 Sucking and protruding tongue (tardive dyskinesia)
 Not covered but important to know:
Apathetic
 Laissez-faire attitude occompanied by lack of motor impetus and dulled emotional tone.
 Associated with depression, brain injury, antisocial behavior and conduct problems.
 .Popularly attributed to adolescents

5. Speech :

 Definition of “Speech”:The content and delivery of verbal communication

Rate and rhythm (regular, pressured)

 Rate and rhythm (regular, pressured) :

Description : controlled, even paced verbal communication. Can interweave with another
person’s dialogue
  Pressured

Description : uncontrollable, accelerated, excessive talking. Rapid rate and rhythm, difficult to
interrupt. The person feels they cannot talk fast enough. Common ro anxiety, manic states.

 Content (laconic)

 Description : Terse, brief response provided without elaboration. No unprompted information is

given. “Poverty of speech” Assoxiated with avoidance, opposition/defiance

 Organization (disorganized)

 Description : Disconnected, unintelligible speech. Associated with dementia, delirium, schizophrenia.

Substance abuse.

 Odd / eccentric (Coprolalia, echolalia)

 Coprolalia

 Description : Involuntary use of vulgar or obscene language, found in Tourette’s syndrome. Also
consist of grunts and paralanguage ("hmmm”, “huh”, “ah”, “ grrr”. “shhh”, ect)

 Echolalia.

 Description : Repeating or mirroring the speech ot another person. For example, repeating back a
question instead of answering the question. Associated with autism spectrum.

 Not covered but important to know :

 Stuttering

 Neologisme

6. Interpersonal :

 Description of “Interpersonal” :

 Relationally – driven behavior

 Contempt :

Description : a passive – aggressive style of relating to others. Rolling eyes,

imitating vocal tone in a mocking manner.

According to Gottman, this is the greatest predictor of divorce

 Defensive :
 Description : reacting to the input of others in a hostile manner.

The person usually fell threatened and under attack.

 Dismissive :

Description : reacting to th e input of others by disregarding, rejecting, and thinking no more about
it, the doesn’t necessary feel threatened, but thinks they know better.

 Guarded :

Description : overly careful about sharing information with others, usually from lack of trust. Closed,
secrective. Infrequent self – disclosure. Associated with trauma, paranoia.

 Hypervigilant :

Description : excessive attention to external environment, stemming from heightened anxiety and
fear. An associated symptom of trauma.

 Oppositional/defiant :

Description : Intentional attempts to elicit a power struggle or argument with another person
(particularly in authority). Can involve baiting other (direct) or ignoring them (indirect).

 Suggestible :

Description : Uncritical acceptance and compliance with another person’s proposal or

recommendation. Easily influenced.

 Not covered, but important :

 Aloof : disengagement due to ego centrism

 Avoidant : disengagement due to anxiety and desire to escape contact

 Cooperative : normal / typcal relational behavior.

7. Intra-personal

 Definition of “Intra personal” :

 Internally driven behavior.

 Ego congruence :

 Ego syntonic
 Description : The individual considers their behavior to be consistent with their core
personality. This can result in externalizing blame to other for problematic behavior.

 Ego dystonic

Description : The individual does not consider their behavior to be consistent with their core
personality.

 Ego centrism

 Conceited :

Description : Egocentric, self-important, arrogant, proud. Often hides deeper seated anxieties and
feeling of inadequacy. Associated with nwrcissitic personality.

Grandiose/ expansive :

Description : Ego inflation. Belief that a person can accomplish anything, even outrageous task.
Associated with manic states in bipolar disorder.

Ego strength

Intropunitive :

Description : Self-derision, punishing self for unwanted events (even if they are not responsiblr). Turning
anger inward. Associated with depression.

Spiltting (dichotomous thinking)

Description : dichotomous thinking. Perceiving event is most likely to occur. Faulty logic. Associated with
depression, histrionic personality.

Catastrophizing :

Description : Daramatically predicting that the worst event is most likely to occur. Faulty logic. Associated
with depression, histrionic personality.

Definition of “Psychosis” : Belief and percepsual experiences that are idiosyncratic, not experienced by
others, and outside the realm of realistic possibility.

Includes : Delusions, hallucinations.

 Definition of “Delusion” :
 - A fixed belief that is experienced as odd, strange, or eccentric by other and outside the realm of
realistic possibility. Associated most commonly with schizophrenia.

 Definition of “Hallusination” :

- A sensory percepsion that is not experienced by others.

- Associated with schizophrenia, bipolar disorder, depression, delirium, and substance abuse.

 Sleep related (normal/typical)

- Hypnagogic : when falling sleep

- Hypnopompic : when awakening from sleep

 Delusions explored :

- Bizarre

- Control

- Grandeur

- Infidelity

- Persecution

- Reference

- Erotomanic

 Hallucinations : responding to internal stimuli

 Not covered, but important : Types of hallucinations

- Auditory (hearing)

- Visual (vision)

- Olfactory (smell)

- Gustatory (taste)

- Tactile (touch)

 Genuine hallucinations are typically frightening to the individual (pseudo-hallucinations are not). The
latter is associated with malingering, personality disorders, substance abuse.

 As an aside, be attentive to any report of olfactory or gustatory hallucinations – these can be

symptoms of stroke or brain tumors
 - “Smoke” example

 Not covered, but important : Appearance

Grooming
(unkempt* well groomed immaculate)
Dresser
(underdressed appropriate overdressed)

Overview
 Example of what to write if no psychotic symptom are apparent :
- Client’s appearance dress. Client denied symptoms of psychosis (hallucinations, delusions)
 Psychosis : Bizarre Delusion
Description : A fixed belief outside the realm of realitistic possibility. This belief is stange, odd,
eccentric to others.
 Psychosis : Control Delusion
Description : An individual’s fixed belief that their will/thought/feeling are being control by someone
or something else.
 Psychosis : Grandeur Delusion
Description : An individual’s fixed belief in their elevated importance, power, “specialness”
 Psychosis : Infidelity Delision
Description : An individual’s fixed belief that their partner or lover is being unfaithful to their
relationship.
 Psychosis : Persecution Delusion
Description : An individual’s fixed belief that they are being harassed or persecuted by others.
 Psychosis : Reference Delusion.
Description : An individual’s fixed belief that unrelated events in the external environment are
special messages that have a direct, personal significance and relevance to them.
 Psychosis ; Erotomanic Delusion
Description An individual’s fixed belief that someone else is in love with them or wants to have
sexual intercourse with them. To be classified a “delusion” this has to be unrequited.
 Psychosis : Responding to Internal Stimuli
Description : An individual seems to be attentively listening and responding to sights and sounds in
their external environment that other do not see or hear.
 :