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The Psychiatric Mental Status Examination

The Psychiatric Mental Status Examination. Observe. The Psychiatric History. Chief complaint History of Present Illness Past History Medications Family History Social History Review of Systems. Overview. General Emotion Thought Cognition Judgment and Insight Reliability. General.

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The Psychiatric Mental Status Examination

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  1. The Psychiatric Mental Status Examination

  2. Observe

  3. The Psychiatric History • Chief complaint • History of Present Illness • Past History • Medications • Family History • Social History • Review of Systems

  4. Overview • General • Emotion • Thought • Cognition • Judgment and Insight • Reliability

  5. General

  6. General Description • Appearance • Motor Behavior • Speech • Attitudes

  7. General Description • Appearance • Prominent features • "such that a portrait…” • Eye contact • Dress and grooming • Age/appearance

  8. General Description • Motor Behavior • Gait • Freedom of movement • Firmness and strength of handshake • Any involuntary or abnormal movements • Pace of movements • Purposefulness of movements • Degrees of agitation

  9. General Description • Speech • Rate • Spontaneity • Intonation • Volume • Defects

  10. General Description • Attitudes • How the patient related • "degree of cooperativeness“ • Evaluator’s attitude

  11. Emotion

  12. Emotions • Mood • Affect

  13. Mood • Definition • Patient report versus inference

  14. Mood • Euthymic • Angry • Euphoric • Apathetic • Dysphoric • Apprehensive

  15. Emotion • Affect • Definition

  16. Affect • Appropriateness • Intensity • Mobility • Range • Reactivity

  17. Thought

  18. Thought • Process • Content

  19. Thought • Process • Manner of organ./form. thought. • Stream of Thought • Goal directedness/Continuity • Other Abnormalities of Thought Process

  20. Thought • Process • Connectedness/Organization • Circumstantiality • Tangentiality • Loose Association • Word Salad

  21. “And now I’m here” “I was home” Start Finish “And he called an ambulance” “I felt some chest pain” “So I told my son”

  22. “And now I’m here” “I was home” “He’s a doctor too” Start Finish “My son, maybe you know him” “I felt some chest pain” “So I told my son” “He always worries so much” “What was my point? Oh, yeah”

  23. “I had five boys…” “Do you have children” “I was home” “And now I’m here” “If only he’d settle down and have some children” Start Finish “My son, He’s really great” “I felt some chest pain” “So I told my son”

  24. Thought Process • Other • Clanging • Echolalia • Neologisms • Perseveration • Thought blocking

  25. Thought • Content • Perceptual disturbances • Delusions • Other

  26. The cognitive exam • Consciousness • Orientation • Concentration and attention • Calculations • Memory • Intelligence

  27. Insight and Judgment

  28. Insight

  29. Insight • Patient’s capacity to • Acknowledge/Appreciate illness • Associated implications • Consequences

  30. Insight • Drugs/alcohol • Dementia/cognitive problems • Psychosis • Severe mood problems • Somatoform disorders

  31. Judgment

  32. Judgement • The process of • Consideration • Formulation • Leading to a • Decision • Action

  33. Judgement • Requires • Insight • Cognitive functioning • Other abstract abilities • Conceptualization • Forward thinking • Appreciation of what “rational people” would do.

  34. Reliability

  35. Reliability • Intellect • honesty and motivations • psychosis/organic defects • magnification/understatement

  36. Examples

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