Mental status examination
INTRODUCTION
The
mental status examination is the part of the clinical assessment that describes
the sum total of the examiner's observations and impressions of the psychiatric
patient at the time of the interview. Whereas the patient's history remains
stable, the patient's mental status can change from day to day or hour to hour.
The mental status examination is the description of the patient's appearance,
speech, actions, and thoughts during the interview. Even when a patient is
mute, is incoherent, or refuses to answer questions, the clinician can obtain a
wealth of information through careful observation. MSE, is developed from the work of the philosopher and
psychiatrist Karl Jaspers.
DEFINITION;
The mental status examination is a
structured assessment of the patient's behavioral and cognitive functioning.
The mental status
examination (MSE) is a cross-sectional, systemic
Documentation of the quality of mental
functioning at the time of interview.
The mental
status examination is the part of the clinical assessment that describes the
sum total of the examiner's observations and impressions of the psychiatric
patient at the time of the interview.
PURPOSE
ü
To
obtain a comprehensive cross-sectional description of the patient's mental
state
ü
It
helps for coherent treatment planning.
ü
To
obtain evidence of symptoms and signs of mental disorders, including danger to
self and others, that are present at the time of the interview.
APPLICATIONS:
Ø It is a key part of the
initial psychiatric assessment in an out-patient or psychiatric hospital setting.
Ø It is a systematic
collection of data based on observation of the patient's behavior while the
patient is in the clinician's view during the interview.
Ø . It is carried out
in the manner of an informal enquiry, using a combination of open and closed
questions, supplemented by structured tests to assess cognition.
Ø The MSE can also be
considered part of the comprehensive physical examination performed by physicians and nurses although it may be performed in
a cursory and abbreviated way in non-mental-health settings.
Ø Information is usually
recorded as free-form text using the standard headings,
Ø MSE checklists are
available for use in emergency situations, for example by paramedics or emergency department staff.
Ø The information obtained
in the MSE is used, together with the biographical and social information of
the psychiatric history, to generate a diagnosis, a psychiatric formulation and
a treatment plan
COMPONENTS
1. General
appearance and Behavior
2. Psycho
motor activity
3. Speech
4. Mood
and Affect
5. Thought
6. Perception
7. Cognitive
functions
Ø Orientation
Ø Memory
Ø Attention
Ø Concentration
Ø Intelligence
Ø Abstract
thinking
8.Judgment
9.Insight
1.GENERAL
APPERANCE& BEHAVIOR
The patient's appearance and overall
physical impression, as reflected by posture, poise, clothing, and grooming. If
the patient appears particularly bizarre, the clinician may ask,
Has anyone ever commented on how you
look?
How would you describe how you look?
Can you help me understand some of the choices
you make in how you look?
Examples of items in the appearance
category include body type, posture,
Ø Approximate height, weight
Ø Looks comfortable/uncomfortable
Ø Dressing(adequate, approximate, any peculiarities)
poise, grooming, hair, and nails. Common terms
used to describe appearance are healthy, sickly, ill at ease, poised, old
looking, young looking, disheveled, childlike, and bizarre. Signs of anxiety
are noted: moist hands, perspiring forehead, tense posture, wide eyes.
Ø Attitude Toward Examiner
The patient's attitude toward the
examiner can be described as cooperative, friendly, attentive, interested,
frank, seductive, defensive, contemptuous, perplexed, apathetic, hostile,
playful, ingratiating, evasive, or guarded; any number of other adjectives can
be used. Record the level of rapport established.
The patient’s
attitude is reflected on his non-verbal and behavior (eye contact, posture…)
Ø Comprehension:
intact/impaired(partially/fully)
Ø Rapport:
whether a working and empathic relationship can be established with the
patient, should be mentioned.
2.
Psychomotor Activity;
Here is described both the
quantitative and qualitative aspects of the patient's motor behavior. Included
are
ü Motor activity Increased or decreased
ü Excitement/stupor
ü Abnormal involuntary movements like tics, tremors,
akathisia, restlessness/ill at ease
ü Compulsive acts, rituals or habits(e.g.; nail biting)
·
Checking rituals: in which the
patient may repeatedly check the front door is closed or electrical switches
are in the ‘off’ position.
·
Cleaning rituals
·
Dressing rituals
·
Dipsomania; a compulsion to drink
alcohol
·
Polydipsia; a compulsion to drink
water
·
Kleptomania; a compulsion to steal
·
Trichotillomania; a compulsion to
pull out ones hair
ü Catatonic signs
Mannerisms, tics, gestures,
twitches, stereotyped behavior, echopraxia, hyperactivity, agitation,
combativeness, flexibility, rigidity, gait, and agility. Describe restlessness,
wringing of hands, pacing, and other physical manifestations. Note psychomotor
retardation or generalized slowing of body movements. Describe any aimless,
purposeless activity.
3.Speech
Characteristics
Rate
and quantity
ü This part of the report describes the physical
characteristics of speech. Speech can be described in terms of its quantity,
rate of production, and quality
ü Whether speech is
present or absent(mutism)
ü The patient may be described as talkative, garrulous,
voluble, taciturn, unspontaneous, or normally responsive to cues from the
interviewer.
Flow and rhythm speech;
ü Speech can be rapid or slow, pressured, hesitant, emotional,
dramatic, monotonous, loud, whispered, slurred, staccato, or mumbled. Speech
impairments, such as stuttering, are included in this section.
ü Any unusual rhythms (termed dysprosody) or accent should be
noted. The patient's speech may be spontaneous.
o
Circumstantiantiality
o
Tangentiality
o
Verbigeration
o
Stereotypies
o
Flight of ideas
o
Clang associations
o
Neologism
o
Echolalia
Volume
and tone of speech:
Increased /decreased(its appropriateness),
Low/high/normal pitch
4.Mood
and Affect
Mood
Mood is defined as a pervasive and
sustained emotion that colors the person's perception of the world.
Observe the patients’
mood during the interview and also ask how they are
feeling:
(1) Objectively
(affect): your impression (appropriate/inappropriate) – depressed,
Elated, euthymic, blunted or flattened, anxious.
(2) subjectively: how
the patient reports prevailing mood – depressed, elated.
The psychiatrist is interested in
whether the patient remarks voluntarily about feelings or whether it is
necessary to ask the patient how he or she feels.
ü Statements about the patient's mood should include depth,
intensity, duration, and fluctuations.
ü Common adjectives used to describe mood include depressed,
despairing, irritable, anxious, angry, expansive, euphoric, empty, guilty,
hopeless, futile, self-contemptuous, frightened, and perplexed.
ü Mood can be labile, fluctuating or alternating rapidly
between extremes (e.g., laughing loudly and expansively one moment, tearful and
despairing the next).
E.g.; dysphoric mood is an unpleasant mood
Elation is an elevated mood or exaggerated feeling of well being
NB: Can record
biological features of depression here if not in the history.
Suicidal ideas? (See assessing suicide
risk.)
Affect
Affect can be defined as the
patient's present emotional responsiveness, inferred from the patient's facial
expression, including the amount and the range of expressive behavior.
Ø Affect may or may not be congruent with mood.
Ø Affect can be described as within normal range, constricted,
blunted, or flat.
Ø In the normal range of affect can be variation in facial
expression, tone of voice, use of hands, and body movements.
Ø When affect is constricted, the range and intensity of
expression are reduced.
Ø In blunted affect, emotional expression is further reduced.
To diagnose flat affect, virtually no signs of affective expression should be
present; the patient's voice should be monotonous and the face should be
immobile.
Ø Note the patient's difficulty in initiating, sustaining, or
terminating an emotional response.
Appropriateness
of Affect
Ø The psychiatrist can consider the appropriateness of the
patient's emotional responses in the context of the subject the patient is
discussing.
Ø Delusional patients who are describing a delusion of
persecution should be angry or frightened about the experiences they believe
are happening to them.
Ø Anger or fear in this context is an appropriate expression. Psychiatrist’s
use the term inappropriate affect for a quality of response found in some
schizophrenia patients, in which the patient's affect is incongruent with what
the patient is saying (e.g., flattened affect when speaking about murderous
impulses).
Ø
5.Thought
Content and Mental Trends
Thought can be divided into process
(or form) and content. Process refers to the way in which a person puts
together ideas and associations, the form in which a person thinks. Process or
form of thought can be logical and coherent or completely illogical and even
incomprehensible
Content refers to what a person is
actually thinking about: ideas, beliefs, preoccupations, obsessions.
1) Formal thought disorder (abnormal
thought form):
.
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Ø Blocking is interruption of the train of thought before an
idea has been completed; the patient may indicate an inability to recall what
was being said or intended to be said.
Ø Circumstantiality indicates the loss of capacity for
goal-directed thinking; in the process of explaining an idea, the patient
brings in many irrelevant details and parenthetical comments but eventually
does get back to the original point.
Ø Tangentiality is a
disturbance in which the patient loses the thread of the conversation, pursues
divergent thoughts stimulated by various external or internal irrelevant
stimuli, and never returns to the original point.
(2) Abnormal thought tempo:
Acceleration
(pressured thought, flight of ideas – may exist without pressure of
Speech) or
retardation.
(3) Abnormal thought
possession:
The patient
experiences thought being controlled by an external agent –
Thought withdrawal,
insertion, broadcasting (feeling that one’s thoughts are
Being picked up by
others).
(4) Abnormal thought content:
Preoccupations/overvalued
ideas (these are strongly held and dominate and are
not always illogical
or culturally inappropriate).
Obsessions,
compulsions, ruminations. Beck’s cognitive triad – negative views of
self, the world and
the future.
Delusions
A delusion is a false
belief, unshakeable held, which is outside the individual’s normal social and
cultural belief system.
Types of delusion:
ü .
Grandiose – believe they have a special ability or mission.
ü .
Poverty – believe they have been rendered penniless.
ü .
Guilt – believe they have committed a crime and deserve punishment.
ü .
Nihilistic – believe they are worthless or non-existent.
ü .
Hypochondriacal – believe they have a physical illness.
ü .
Persecutory – believe that people are conspiring against them.
ü .
Reference – believe they are being referred to by magazines/television.
ü .
Jealousy – believe their partner is being unfaithful despite lack of evidence.
ü .
Amorous – believe another person is in love with them.
ü .
Infestation – believe they are infested with insects or parasites.
ü .
Passivity experiences – believe they are being made to do something, or to
feel emotions, or are being
controlled from the outside;
Delusions may be mood
congruent, e.g. grandiose, and persecutory in elated mood
States;
hypochondriacal, poverty-stricken, guilty, and nihilistic in depressed
Mood states.
Delusions may also be
classified as primary or secondary:
ü Primary delusions arise ‘out of the blue’
without any identifiable precedent.
ü Secondary
delusions arise out of an underlying mood, psychotic phenomenon or defect in
cognition and are understandable in the context. It arises out of an attempt to
understand the primary morbid experience
6.Perception
Perceptual disturbances, such as
hallucinations and illusions, can be experienced in reference to the self or
the environment.
The sensory system involved (e.g.,
auditory, visual, taste, olfactory, or tactile) and the content of the illusion
or the hallucinatory experience should be described.
HALLUCINATIONS:
Sensory distortions – increase in sound or
colour sensitivity.
Illusions – a
misinterpretation of normal stimuli.
Whether visual,
auditory, or in other sensory fields;
• Depersonalization - change in
self-awareness such that the person feels unreal,
detached from his or her body,
and/or unable to feel emotion
• De realization - feeling that
the world/outer environment is unreal
Hallucinations – false perceptions in the absence of
any stimulus; perceived
To be coming from
outside the person.
(1) Auditory:
ü Second-person
voices directly addressing the patient (e.g. ‘you are
ü useless’)
ü Third-person
– two or more voices discussing the patient (e.g. ‘he’s very
powerful’)
ü Thought
echo – voices echo thoughts before or after they happen
ü Third-person
commentary – voices comment on action (e.g. ‘he’s going out of the door now’)
Ask about timing,
triggers, number of voices, first or second person –
e.g. the voice may be
saying ‘I am useless’, ‘you are useless’ or ‘he is useless’.
Do they recognize the voice?
(2) Visual
(3) Olfactory: usually an unpleasant smell
(4) Gustatory: commonly a feeling that something tastes differently
and this is
interpreted as being
the result of poisoning
(5) Somatic sensations: e.g. sensation of insects
under skin or movement of
joints
Hallucinations may be
perceived by people when they are falling asleep (hypnagogic)
or waking up (hypnopompic)
– these are normal.
Pseudo hallucinations
are vague, lack clarity and recognized as coming from
one’s own mind.
The circumstances of the occurrence of any
hallucinatory experience are important;
ü hypnagogic
hallucinations (occurring as a person falls
asleep)
ü hypnopompic hallucinations (occurring as a person awakens) have
much less serious significance than other types of hallucinations.
ü Hallucinations can
also occur in particular times of stress for individual patients. Feelings of
depersonalization and derealization (extreme feelings of detachment from the
self or the environment) are other examples of perceptual disturbance.
ü Formication, the feeling of bugs crawling on or under the
skin, is seen in cocainism.
Examples of questions used to elicit
the experience of hallucinations include the following:
ü Have you ever heard voices or other sounds that no one else
could hear or when no one else was around?
ü Have you experienced any strange sensations in your body
that others do not seem to see?
A young man with schizophrenia heard
an insistent voice repeatedly telling him to stop his antipsychotic medication.
After resisting the command for many weeks, the patient felt that he could no
longer fight the voice, and he discontinued treatment. Two months later, he was
hospitalized involuntarily and near cardiovascular collapse. He later said that
once he stopped the medication, the voice further insisted that he should stop
eating and drinking to purify himself.
7.
COGNITIVE FUNCTION
The sensorium and cognition portion
of the mental status examination seeks to assess brain function, including
intelligence, capacity for abstract thought, and level of insight and judgment.
a)
Consciousness
Ø Disturbances of consciousness usually indicate organic brain
impairment.
Ø Clouding of consciousness is an overall reduced awareness of
the environment.
Ø A patient may be unable to sustain attention to environmental
stimuli or to maintain goal-directed thinking or behavior.
Ø Clouding or obtunding of consciousness is frequently not a
fixed mental state.
Ø A patient typically exhibits fluctuations in the level of
awareness of the surrounding environment.
Ø The patient who has an altered state of consciousness often
shows some impairment of orientation as well, although the reverse is not
necessarily true.
Ø Some terms used to describe the patient's level of
consciousness are clouding, somnolence, stupor, coma, lethargy, or alert.
b)
Orientation
Ø Disorders of orientation are traditionally separated
according to time, place, and person.
Ø Any impairment usually appears in this order (i.e., sense of
time is impaired before sense of place); similarly, as the patient improves,
the impairment clears in the reverse order.
Ø The psychiatrist must determine whether a patient can give
the approximate date and time of day.
Ø In addition, if hospitalized, does the patient know how long
he or she has been there?
Ø Does the patient seem to be oriented to the present?
Ø In questions about orientation to place, patients should be
able to state the name and the location of the hospital correctly and to behave
as though they know where they are.
Ø In assessing orientation for person, the psychiatrist asks
patients whether they know the names of the people around them and whether they
understand their roles in relationship to them.
Ø Do they know who the examiner is?
Ø Only in the most severe instances do patients not know who
they themselves are.
c)
MEMORY
Memory functions have traditionally
been divided into four areas:
1.
Remote memory,
2.
Recent past memory,
3.
Recent memory,
4.
Immediate retention
5.
Recall.
Ø Recent
memory can be checked by asking patients
about their appetite and then about what they had for breakfast or for dinner
the previous evening.
Ø Patients can be asked at this point if they recall the
interviewer's name. Asking patients to repeat six digits forward and then
backward is a test of immediate retention.
Ø Remote memory can be tested by asking patients for
information about their childhood that can be verified later.
Ø Asking patients to recall important news events from the
past few months checks recent past memory.
Ø Often in cognitive disorders, recent or short-term memory is
impaired first, and remote or long-term memory is impaired later.
Ø If there is impairment, what efforts are made to cope with
it or to conceal it?
Ø Is denial, confabulation, or circumstantiality used to
conceal a deficit? Reactions to the loss of memory can give important clues to
underlying disorders and coping mechanisms.
Ø For instance, a patient who appears to have memory
impairment but, in fact, is depressed is more likely to be concerned about
memory loss than is someone with memory loss secondary to dementia.
Ø The clinician must also determine whether a catastrophic
reaction is present (anxious crying when unable to remember).
A 40-year-old chronically alcoholic
man, whose memory on the mental status examination was markedly impaired,
frantically demanded to be released from the hospital, saying that his wife had
just been in an automobile accident and that he had to rush to another hospital
to see her. He said it with sincere conviction and appropriate fearful concern;
for the patient, at least, the story was real. In fact, his wife had been dead
for 15 years. The patient told the same story over and over again, always with
evident conviction, despite that staff member confronted him with the reality
that his wife had been dead for years. The patient was never influenced by
their assertions, because he could not register new memories. Although his past
memory was patchy at best, he could repeatedly recall the story of his wife's
emergency.
Summary of Memory Tests
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Confabulation (unconsciously making
up false answers when memory is impaired) is most closely associated with
cognitive disorders.
D)Concentration
and Attention
A patient's concentration can be
impaired for many reasons. A cognitive disorder, anxiety, depression, and
internal stimuli, such as auditory hallucinations, can all contribute to
impaired concentration.
Subtracting serial 7s from 100 is a
simple task that requires intact concentration and cognitive capacities.
Could the patient subtract 7 from 100 and keep
subtracting 7s? If the patient could not subtract 7s, could 3s be subtracted?
Were easier tasks accomplished: 4 × 9, 5 × 4?
The examiner must always assess whether
anxiety, some disturbance of mood or consciousness, or a learning deficit
(dyscalculia) is responsible for the difficulty.
Attention is assessed by
calculations or by asking the patient to spell the word world (or others)
backward.
The patient can also be asked to
name five things that start with a particular letter.
DIGIT SPAN TEST:
Digit-span task is used to measure working memory's number
storage capacity. Participants are presented with a series of digits (e.g., '8,
3, 4') and must immediately repeat them back. If they do this successfully,
they are given a longer list (e.g., '9, 2, 4, 0'). The length of the longest
list a person can remember is that person's digit span. While the participant
is asked to enter the digits in the given order in the forward digit-span task,
in the backward digit-span task the participant needs to reverse the order of
the numbers.
·
Up to seven number to be test.
Reading
and Writing
The psychiatrist should ask the
patient to read a sentence. The patient should also be asked to write a simple
but complete sentence.
Visuospatial
Ability
The patient should be asked to copy
a figure, such as a clock face or interlocking pentagons.
Abstract
Thought
It is characterized by the ability
to
1.
Assume a mental set voluntarily
2.
Shift voluntarily from one aspect of
situation to another
3.
Keep in mind simultaneously the
various aspects of a situation
4.
Grasp the essentials of a whole( eg.
situation or concept)
5.
To break a whole into its parts
Abstract
thinking testing assesses patient’s concept formation. The method s used are
v Proverb testing
v Similarities and differences
v Pick odd one out
Ø Abstract thinking is the ability to deal with concepts.
Patients can have disturbances in the manner in which they conceptualize or
handle ideas. Can the patient explain similarities, such as those between an
apple and a pear or between truth and beauty?
Ø Are the meanings of simple proverbs, such as A rolling stone
gathers no moss understood?
Ø Answers can be concrete (giving specific examples to
illustrate the meaning) or overly abstract (giving too generalized an
explanation).
Ø The appropriateness of answers and the manner in which they
are given should be noted.
Ø In a catastrophic reaction, brain-damaged patients become
extremely emotional and cannot think abstractly.
Ø When asked to explain the proverb People in glass houses
should not throw stones a schizophrenic patient replied, that’s easy, you can
break the glass.
Information
and Intelligence
If a possible cognitive impairment
is suspected, does the patient have trouble with mental tasks, such as counting
the change from $10 after a purchase of $6.37? If this task is too difficult,
are easy problems (such as how many nickels are in $1.35) solved?
The patient's intelligence is related to
vocabulary and general fund of knowledge (e.g., the distance from New York to
Paris, presidents of the United States).
The patient's educational level
(both formal and self-education) and socioeconomic status must be taken into
account.
Handling difficult or sophisticated concepts
can reflect intelligence, even in the absence of formal education or an
extensive fund of information.
Ultimately, the psychiatrist
estimates the patient's intellectual capability and capacity to function at the
level of basic endowment.
Impulsivity
Ø Is the patient capable of controlling sexual, aggressive,
and other impulses?
Ø An assessment of impulse control is critical in ascertaining
the patient's awareness of socially appropriate behavior and is a measure of
the patient's potential danger to self and others.
Ø Patients may be unable to control impulses secondary to
cognitive and psychotic disorders or because of chronic character logical
defects, as observed in the personality disorders.
Ø Impulse control can be estimated from information in the
patient's recent history and from behavior observed during the interview.
Judgment
and Insight
Judgment;
Judgment is the ability to assess a situation correctly and act
appropriately within the situation.
1. Personal judgment:
2.
Social judgment is observed during the
hospital stay and during the interview session. it includes evaluation of
person judgment.
v During the course of history taking, the psychiatrist should
be able to assess many aspects of the patient's capability for social judgment.
3.Test judgment is assessed by asking the patient what he
would do in certain situations.
v Does the patient understand the likely outcome of his or her
behavior, and is he or she influenced by this understanding?
v Can the patient predict what he or she would do in imaginary
situations (e.g., smelling smoke in a crowded movie theater)?
v When asked what she would do if she found a stamped
addressed envelope on the street, the patient replied, Well, I would open it of
course and read what it said. Maybe there would be money in it.
Insight
Insight is a patient's degree of
awareness and understanding about being ill. Patients may exhibit complete
denial of their illness or may show some awareness that they are ill but place
the blame on others, on external factors, or even on organic factors. They may
acknowledge that they have an illness but ascribe it to something unknown or
mysterious in themselves.
An 18-year-old man went to an
emergency room with the belief that he was controlled by a computer on an
Enterprise-like starship, an elaboration from the television series Star Trek.
He was convinced that all his thoughts, actions, and feelings were being
programmed onboard the starship, which was located light years away and,
therefore, could never be detected by anyone else.
Ø Intellectual insight is present when patients can admit that
they are ill and acknowledge that their failures to adapt are partly because of
their own irrational feelings.
Ø Patients' inability to apply their knowledge to alter future
experiences, however, is the major limitation to intellectual insight.
Ø True emotional insight is present when patients' awareness
of their own motives and deep feelings leads to a change in their personality
or behavior patterns.
A summary of six levels of insight
follows:
- Complete denial of illness
- Slight awareness of being sick and needing help, but
denying it at the same time
- Awareness of being sick but blaming it on others, on
external factors, or on organic factors
- Awareness that illness is caused by something unknown
in the patient
- Intellectual insight: admission that the patient is ill
and that symptoms or failures in social adjustment are caused by the
patient's own particular irrational feelings or disturbances without
applying this knowledge to future experiences
- True emotional insight: emotional awareness of the
motives and feelings within the patient and the important persons in his
or her life, which can lead to basic changes in behavior
Used to Test Cognitive Functions
in the Sensorium
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The
Mini-Mental State Examination (MMSE)
The MMSE is a brief
instrument designed to assess cognitive functions. It is widely used as a
screening test that can be applied during a patient’s clinical examination, and
as a test to track the changes in a patient’s cognitive state. It assesses
orientation, memory, calculations, writing and reading capacity, language, and
visuospatial ability. The patient is measured quantitatively on these functions
out of a perfect score of 30
What is today’s day? date?
month? year? season?
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5
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Where are we – country? County?
City? Hospital? Ward/clinic?’
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5
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‘I
am going to name three objects. I want you to
repeat
them after me and then remember them, because I will ask you to
name
these objects in a few minutes – APPLE, BOOK, COAT’. Give one point
for each one that they can
repeat immediately
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3
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Subtract
7 from 100. Keep subtracting 7 from
each
answer until I tell you to stop.’ Maximum 5 answers.
or
‘Spell WORLD backwards.’ Score
1 point for each correctly placed letter
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5
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Ask the patient to repeat the
objects named above.
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3
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Ø
Naming – Show the patient a pen and a watch, ask
to name them.
Ø
. Repetition – Ask the patient to repeat ‘No ifs,
ands or buts’.
Ø
. Three-stage command – Ask the patient to take a
piece of paper in the right hand, fold it in half and put it on the table.
Ø
. Reading – Ask the patient to read and obey a
command written on paper,
Ø
e.g. ‘Close your eyes’.
Ø
. Writing – ‘Write a sentence.’ The sentence
should have a verb and a subject.
Ø
‘Go away’ is not allowed!
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2
1
3
1
1
1
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Format of MMSE
Interlocking
pentagons used for the last question
The MMSE test includes simple questions and problems in a number
of areas: the time and place of the test, repeating lists of words, arithmetic
such as the serial sevens, language use and comprehension, and
basic motor skills. For example, one question, derived from the older Bender-Gestalt
Test, asks to copy a drawing of two pentagons
(shown on the right).
Although consistent application of identical questions increases
the reliability of comparisons made using the scale, the test is sometimes
customized (for example, for use on patients that are blind or partially immobilized. Also, some have
questioned the use of the test on the deaf.
However, the number of points assigned per category is usually consistent:
SCORING
AND IMPLICATIONS
Any score greater than
or equal to 27 points (out of 30) indicates a normal cognition.
Below this, scores can indicate severe (≤9
points), moderate (10-18 points) or mild (19-24 points) cognitive impairment.
[The raw score may also need to be corrected for
educational attainment and age.
That is, a maximal
score of 30 points can never rule out dementia.
Low to very low scores correlate closely with
the presence of dementia, although other mental disorders can also lead to abnormal findings on
MMSE testing.
The presence of purely physical problems can
also interfere with interpretation if not properly noted; for example, a
patient may be physically unable to hear or read instructions properly, or may
have a motor deficit that affects writing and drawing skills.
CONCLUSION
The mental
status examination is the part of the clinical assessment that describes the
sum total of the examiner's observations and impressions of the psychiatric
patient at the time of the interview. Whereas the patient's history remains
stable, the patient's mental status can change from day to day or hour to hour.
The mental status examination is the description of the patient's appearance,
speech, actions, and thoughts during the interview. Even when a patient is
mute, is incoherent, or refuses to answer questions, the clinician can obtain a
wealth of information through careful observation.
BIBLOGRAPY
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