The aim of the Mental Status Examination is to obtain a detailed profile of an individual's mental state. When coupled with their social, work and psychological history, the accumulated information allows the clinician to make an accurate diagnosis and plan the most effective treatment.
Examination of a person's mental state is a central feature of any initial assessment. It is important as it helps to rule out any specific dangers to the person or to others, as well as providing a broader profile. Mental Status Examinations tend to be conducted in as relaxed an atmosphere as possible. It takes the form of observation, conversation and certain modest task requirements. These include:
- Appearance. Observation of weight, deportment, skin texture, cleanliness, grooming and appropriateness of dress can all be made through simple observation.
- Attitude. The approach the person takes to being interviewed is a rather subjective form of assessment but it does provide valuable insights as to whether mood may change quickly, whether the person is cooperative, hostile, evasive or guarded. If Alzheimer's is suspected it is sometimes possible to determine the person's orientation to time and place, whether they are able to recall general knowledge (what year is it, what is a pen used for) and so on.
- Behavior. Depending on the nature and advanced status of a condition certain behaviors may help to verify what is suspected. For example, slowing down of thought may correspond with reduced movements. Difficulty following a line of thought or questioning may result in poor eye contact or unresponsiveness.
- Language. In Alzheimer's it is not uncommon for the patient to experience echolalia (repeating what someone else is saying) or palilalia (repeating their own words).
- Speech. The production of speech, as opposed to its content, may be assessed on the basis of features such as loudness, whether pressured or not, whether the person can produce a certain number of words in a given time frame, whether the person can repeat back short sentences.
- Mood. This is something the patient volunteers. Their mood may be angry, apathetic, sad, irritable, and so on. Mood fluctuations or low mood may be associated with the early stages of Alzheimer's if the person is becoming aware of memory problems or other difficulties.
- Affect. Affect is another term for emotion and this tends to be assessed by the clinician who will judge the appropriateness of emotion according to what is being discussed.
- Thought Content. This is a fairly broad category that helps the clinician determine whether any obvious thought processes are at work. For example, thoughts of a bizarre, paranoid or delusional nature. Also, whether the person is considering suicide, self harm or harm to others. In Alzheimer's, for example, thought content may seem quite coherent at times but not at others, or may switch to different topics.
- Insight & Judgment. It is quite likely that in the early stages of Alzheimer's the person will have insight into changes they are experiencing. They may be most aware of slips in memory but minor changes involving judgment may also be affected. Very often a relative will accompany the person to the clinical interview who may be able to shed some light into the variety of issues affecting the person.
- Cognition. The term cognition is something of a catch-all to describe the various functions of the brain that may be affected. These include such things as memory, alertness, orientation, attention, executive functions such as problem solving. Various tests may be used to help determine which cognitive processes are affected. The Mini-Mental State Examination (MMSE) is widely used in this capacity.
Published On: February 03, 2010