Comprehensive Mental Status Examination

ANSWERS

The Mental Status Exam (MSE) systematically describes a patient’s mental state during a psychiatric assessment. A skilled clinician can conduct a thorough mental status exam to help guide them to a diagnosis.

Behavior and Appearance

Movement and gait are two appearance descriptors.

Look for gait abnormalities, tics, psychomotor agitation or retardation, tremor (at rest or with movement), and signs of extrapyramidal symptoms caused by medications.

Appearance

Take note of your posture, clothing, grooming, and cleanliness.

Make a note of any signs of self-harm (cuts on the wrists/legs), significant weight loss or cachexia (think anorexia), or physical injury (think domestic abuse or involvement in violent situations)

Behaviors

Take note of any mannerisms, gestures, facial expressions, eye contact, ability to follow commands/requests, and compulsions.

Note whether the patient is cooperative, hostile, open, secretive, evasive, suspicious, apathetic, easily distracted, focused, or defensive in their demeanor.

Consciousness Level

Is the patient alert, vigilant, drowsy, lethargic, stuporous, asleep, comatose, confused, or fluctuating?

If there is cause for concern, you may need to conduct additional cognitive testing (see Cognition section below)

You might want to ask about orientation quickly:

“Can you tell me your full name?”

“What floor, building, city, county, and state are we on?”

“What is today’s full date (date, month, year, day of the week, and season)?”

Rapport

Is the relationship good, fair, or wrong?

Do you have a good connection/relationship with the patient?

Speech

The following descriptors can be used to describe speech:

Speech quantity

Talkative, spontaneous, expansive, speech paucity, speech poverty (i.e., very little is said)

Speech tempo

Fast, slow, regular, and under pressure

Speech volume (tone)

Loud, soft, monotone, strong, weak

Speech fluency and rhythm

Aphasic, slurred, clear, with appropriately placed inflections, hesitant, with good articulation

Latency in response

How long does the patient take to respond?

Emotion

Emotion is made up of mood and affect.

The mood is how the patient expresses themselves subjectively.

“How are you feeling?” or “How is your mood?” inquired the patient.

Affect is what you observe objectively.

Take note of the patient’s reaction to the current situation.

Other affect descriptors include:

Affect fluctuations: labile, even, expansive

Affective spectrum: broad, restricted

Affect intensity: blunted, flat, regular, hyper-energized

Affective state: depressed, angry, hostile, indifferent, euthymic, dysphoric, detached, elated, euphoric, anxious, animated, irritable

Congruency

Is there a link between mood and affect? Is there congruence between thought content and affect? (For example, they say they are sad but are laughing) (For example, they appear sad but say, “I feel happy.”)

Perception

Illusions are misperceptions of actual stimuli that are either a misunderstanding or a clear error in perception (e.g., the patient feels as though a clock has eyes, that wind blowing is whispered, or they see figures moving in the dark at night when leaves on a tree are blowing)

Illusions are not pathologic; most people can recall a time when they had a misperception or fleeting perception (for example, hearing one’s name called when no one else is home or believing someone is hiding in the dark at night).

Hallucinations are perceptions that occur when no sensory stimuli exist in any of the five senses (auditory, visual, gustatory, olfactory, and tactile). The two most frequently asked questions in psychiatry are:

Hearing hallucinations

Is the patient hearing one or more voices?

Is one of the voices male or female?

Are the voices of people they recognize, or are they new to them?

Are these simple statements or complicated sentences?

Do the voices converse with the patient or comment on his or her thoughts?

Command auditory hallucinations (voices instructing the patient to do things) are a common symptom of psychosis that necessitates inpatient hospitalization.

In non-organic (i.e., primary) psychiatric conditions, auditory hallucinations are the most common type of hallucination.

Hallucinations of sight

Visual hallucinations can be psychiatric or neurological, so understanding what is happening is critical.

Visual hallucinations should elicit a more thorough neurologic history and examination!

The most common single cause of visual hallucinations and illusions is migraine.

Visual phenonemona (seizure auras) can also be reported as visual hallucinations.

Individuals suffering from Lewy Body Dementia may experience visual hallucinations as part of their core symptoms.

Charles Bonnet Syndrome (CBS) is a common non-psychiatric condition that causes temporary visual hallucinations in people with severe vision loss (macular degeneration, glaucoma, and diabetic retinopathy).

Narcolepsy patients may also experience visual hallucinations.

One should also consider whether hallucinations are associated with any underlying delusions. Hallucinations can be mood-congruent (for example, a depressed patient hearing a voice chastising her for failing and urging her to commit suicide) or mood incongruent (for example, a depressed patient hearing a voice chastising her for failing and urging her to commit suicide) (e.g., a patient with schizophrenia who despite being quite paranoid hears voices that they find calm and soothing).

Some patients may experience depersonalization and derealization.

“Do you ever feel like you are not in your own body or looking in from the outside?” inquired the patient.

Derealization

The perception that one’s surroundings and events are detached from the person or that they are distorted, changed, or unreal.

Depersonalization

Perception of standing outside oneself as a detached observer of one’s surroundings, experiences, and events

QUESTION

Comprehensive Mental Status Examination

For this assignment, list the parts of a comprehensive mental status examination (MSE) for mental health patients. Give examples of each and describe the significance to the advanced practice nurse.

Formatted per current APA and 2-4 pages in length, excluding the title, abstract, and references page.

Minimum of 5 current (published within the last five years) scholarly journal articles or primary legal sources (statutes, court opinions).

• Comprehensive Mental Health Examination. For this assignment, list the parts of a comprehensive mental status examination (MSE) for mental health patients. Give examples of each and describe the significance to the advanced practice nurse.