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MENTAL STATUS EXAMINATION

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Mental status examination• Consciousness• Rapport• General appearance and motor behavior• Attention and concentration• Language functions• Orientation• Memory• Abstract ability• Judgment• General information• Calculation• Intelligence

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Mental status examination• Thought

o Streamo Formo Possessiono Content

• Mood and Affect • Perception• Other psychotic phenomena• Insight

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Thought Stream- (Progress)

o Spontaneityo Volume o Tonal fluctuations o Retardation o Pressured speech

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• Poverty of speech: Restriction in amount, brief, concrete, unelaborate

• Poverty of content: Long reply, adequate speech, less content

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• Flight of Ideas:• Thoughts follow each other rapidly• No general direction of thinking• Connections between successive thoughts

appear to be due to chance and can usually be understood (alliteration, clang)

• E.g.: I live in Birmingham, Kingstanding, see the king, sing sing, bird on the wing….

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• Prolixity: Ordered flight of ideas• Speed not as fast• Despite irrelevances, able to return to the task

• Circumstantiality:• Unnecessary and trivial details, but finally the

point is reached• Goal is never completely lost

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• Inhibition or retardation:• Train of thought is slowed down• Number of ideas, images decrease• Usually experienced as difficulty in making

decisions, lack of concentration or loss of clarity of thinking

• Depression

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Mood and affect• Mood- Prolonged subjective prevailing state or disposition; • Sad, happy, worried, angry, fearful; • Depth; predominant mood over the last 1 week

• Affect- Objective state; range, reactivity, mobility and

communicability;

• Depressed, elated, euphoric, anxious, perplexed, blunted

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Other psychotic phenomena• Somatic passivity- bodily sensations especially

sensory symptoms experienced as imposed by external force

• Made action, affect and impulse

• Negative symptoms

• Depersonalization and derealization

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Insight

• Awareness,

• Attribution and

• Acceptance of intervention

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6 grades

o Grade 1: Denial

o Grade 2: Slight awareness but denying it at the same time

o Grade 3: Awareness present but attribute it to external factors

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o Grade 4: Awareness present but attribute it to something unknown, acceptance

o Grade 5: Intellectual insight- Awareness present, attributes it to psychological causes but does not apply it to future experiences

o Grade 6: True emotional insight

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Case summary• Basic data and socio-economic profile• Presenting complaints (including HOPI)• Relevant past, family, developmental,

occupational history etc.• Pre-morbid personality• Relevant M.S.E. findings• Relevant Physical examination findings• Diagnosis• Management