psychiatric disorders
Routine Psychiatric Assessment
Mental Status Examination
A How to Assess Mental Status uses observation and questions to evaluate several domains of mental function, including Speech Emotional expression Thinking and perception Cognitive functions Brief standardized screening questionnaires are available for assessing certain components of the mental status examination, including those specifically designed to assess orientation and memory. Such standardized assessments can be used during a routine office visit to help screen patients; such screening can help identify the most important symptoms and provide a baseline for measuring response to treatment. However, screening questionnaires cannot take the place of a broader, more detailed Examination of Mental Status . General appearanceshould be assessed for unspoken clues to underlying conditions. For example, patients’ appearance can help determine whether they Are unable to care for themselves (eg, they appear undernourished, disheveled, or dressed inappropriately for the weather or have significant body odor) Are unable or unwilling to comply with social norms (eg, they are garbed in socially inappropriate clothing) Have engaged in substance use or attempted self-harm (eg, they have an odor of alcohol, scars suggesting IV drug abuse or self-inflicted injury) can be assessed by noting spontaneity, syntax, rate, and volume. A patient with depression may speak slowly and softly, whereas a patient with mania may speak rapidly and loudly. Abnormalities such as dysarthrias and Aphasia may indicate a physical cause of mental status changes, such as head injury, stroke, brain tumor, or multiple sclerosis. Emotional expressioncan be assessed by asking patients to describe their feelings. The patient’s tone of voice, posture, hand gestures, and facial expressions are all considered. Mood (emotional state reported by the patient) and affect (patient's expression of emotional state as observed by the interviewer) should be assessed. Affect and its range (ie, full vs constricted) should be noted as well as the appropriateness of affect to thought content (eg, patient smiling while discussing a tragic event). Thinking and perceptioncan be assessed by noticing not only what is communicated but also how it is communicated. Abnormal content may take the form of the following: Delusional Disorder (false, fixed beliefs) Ideas of reference (notions that everyday occurrences have special meaning or significance personally intended for or directed to the patient) Obsessive-Compulsive Disorder (OCD) (recurrent, persistent, unwanted, and intrusive thoughts, urges, or images) The physician can assess whether ideas seem to be linked and goal-directed and whether transitions from one thought to the next are logical. Psychotic or manic patients may have disorganized thoughts or an abrupt flight of ideas. Cognitive functionsinclude the patient’s Level of alertness Attentiveness or concentration Orientation to person, place, and time Immediate, short-term, and long-term Memory Loss None Abstract reasoning Insight Judgment Abnormalities of cognition most often occur with Delirium or 