diagnosis
 
 
 
The Comprehensive Mental Status Examination
 
 
A Comprehensive Mental Status Examination, one utilized by psychiatrists, evaluates the following areas of functioning:
 
  1. Appearance: Their dress, personal hygiene, and grooming. (Is their clothing consistent with the season?  Are they wearing underwear over their clothes instead of under them?  Do they appear to be bathing regularly?)  
  2.  
  3. Demeanor and Posture: Their behavior and attitude as it relates to the interviewer and the circumstances.  
  4.  
  5. Movement and Behavior: What are gait (walking), posture, coordination, eye contact, and facial expressions like?  Do they demonstrate any unusual behaviors?  
  6.  
  7. Mood: This is their subjective report of their emotional state or the tone of their answers to questions.  Mood might be thought of as emotional climate.  
  8.  
  9. Affect: This is their display of observable emotions and emotional reactions.  Are their emotions blunted or restricted? Are there excessive displays of emotion that are inconsistent with their mood or thinking?  If mood was considered to be climate, affect would be weather.  
  10.  
  11. Speech: The volume, rate (speed), rhythm and inflection of their speech.  How long are their answers?  How organized are their statements?  Are these statements appropriate?  Are they clear and easily understood?  
  12.  
  13. Thought Content and Perceptions: This may be reflected in their speech or behavior.  Are they experiencing delusions, hallucinations, obsessional thoughts, or suicidal ideation (thoughts about suicide)?  These may involve passive suicidal ideation or active suicidal ideation.  Do they demonstrate disassociation (disconnecting memories or other mental processes from conscious awareness). Dissociation may include feelings of unreality, depersonalization, and other confusion related to identity.  
  14.  
  15. Thought Process: This is the logical connection between thoughts and how relevant they are  to the theme of a conversation. Details that are irrelevant or repetitious, thought blocking (thinking that is interrupted), tangential or loosely associated thoughts, and flight of ideas are examples of disordered thought process.  
  16.  
  17. Orientation: This involves knowing the who, when, where, why and circumstances related to their situation.  Orientation includes knowing who they are, the day of the week, the time of day, the season, the year and even the century.  They should be able to relate precisely where they are, why they are there, and describe the circumstances that brought them there.  
  18.  
  19. Cognition: Cognition is knowledge, the patient's fund of knowledge (general information), immediate recall, short and long-term memory, calculations, and abstract thinking.  General information might involve naming the previous five presidents, regional football teams, or any other information that one might expect the patient to know.  They should be expected to name familiar objects, write and read (and understand) complete sentences.  They may be asked to perform a simple task, copy a clock face or geometrical image.  Calculations reflect their ability to perform arithmetic by subtracting seven from a number repeatedly (this is known as serial sevens, or serial threes, if they have difficulty with subtracting seven).*  Abstract thinking is usually assessed by asking them to interpret proverbs such as:  A bird in hand is better than two in the tree.  A rolling stone gathers no moss.  People who live in glass houses shouldn't throw stones.  
  20.  
  21. Insight: Do they recognize that a problem exists?  Do they understand its nature and severity?  Do they possess the ability to consider potential solutions?  
  22.  
  23. Judgment: Do they demonstrate an ability to solve simple problems; for example, what they might do if they found a purse, smelled smoke in the hallway of their apartment, or found that they were out of medication.
  24.  
 
  1. *Any assessment of cognitive functioning must involve a consideration of the patient's IQ and the extent of their formal educations.
  2.  
  3.  
  4.  
(Sources: The author's knowledge base, unless otherwise noted.)
______________________________________________________________________________
 
Related Articles:
 
Diagnosis
_______________________________________________________________________________