Mental Health Status Examination PDF

OS 202: HUMAN BODY AND MIND 1: INTEGRATION AND CONTROL SYSTEMS MENTAL HEALTH STATUS EXAMINATION UPCM 2029 | Dr. Constantine L. Yu Chua | LU3 A.Y. 2024-2025 OUTLINE Guidelines in Conducting U...

OS 202: HUMAN BODY AND MIND 1: INTEGRATION AND CONTROL SYSTEMS MENTAL HEALTH STATUS EXAMINATION UPCM 2029 | Dr. Constantine L. Yu Chua | LU3 A.Y. 2024-2025 OUTLINE Guidelines in Conducting Use [2027 Trans] ​ Inform the patient that you will ask questions about his/her I.​ Mental Health Status V.​ Thought Content mental state Examination A.​ Common Findings ​ Obtain the patient’s consent A.​ Key Points in VI.​ Perception ​ Ensure that visual or hearing aids are in place (if needed) Conducting and A.​ Hallucinations ○​ Assure that the patient can clearly see and hear you Documenting the B.​ Illusions ​ Ensure that the seating arrangement is comfortable MSE C.​ Hallucinatory ​ Ensure that the environment is quiet and conducive B.​ Format of Gestures ○​ E.g. bipolar patients who are manic are very distractible which Documenting and VII.​ Sensorium and may make it difficult to perform the other components of the Reporting the MSE Cognition MSE II.​ General Survey A.​ Sensorium ​ Ensure that all testing materials are ready A.​ Appearance B.​ Cognition B.​ FORMAT OF DOCUMENTING AND REPORTING THE MSE B.​ Eye Contact VIII.​ Reporting the MSE C.​ Speech A.​ Case 1 1.​General Survey D.​ Attitude toward the B.​ Case 2 ○​ Appearance and Behavior Interviewer IX.​ Other notes ○​ Speech III.​ Mood and Affect X.​ References ○​ Eye Contact A.​ Mood ○​ Attitude B.​ Affect 2.​ Mood and Affect IV.​ Thought Process 3.​ Thought Process A.​ Common Findings 4.​ Thought Content 5.​ Perception I.​ MENTAL HEALTH STATUS EXAMINATION (MSE) 6.​ Sensorium and Cognition ​ A Mental Status Examination (MSE) is a detailed investigation and ○​ Orientation account of the different dimensions of the patient’s behaviors and ○​ Concentration responses that in totality may reflect his/her current mental state ○​ Memory based on observation of and interaction with the examiner in the ○​ Abstract thinking present. ○​ Judgment ​ In the context of the neurological examination, it focuses on testing ○​ Insight higher cortical functioning. ​ Remember that the documentation and reporting should follow ​ It is objective data. the prescribed format. ○​ It ONLY refers to what is observed and elicited during the Important interaction with the patient, i.e., what is on the here and now ​ Doc said in the pptx that “it is important to memorize all these“. ○​ Do NOT mix MSE findings with history (subjective) or from other informants (reported) II.​ GENERAL SURVEY ​ The mini mental state exam (MMSE) is primarily a test for cognition to screen for dementia. A.​ APPEARANCE AND BEHAVIOR ○​ Doesn’t include elements of the MSE like perception or mood ○​ It is not a replacement or a compressed version of the mental APPARENT PHYSICAL FEATURES status examination used for psychiatric evaluation. ​ Wounds/scars ○​ MMSE is NOT a summarized MSE. ​ Medical contraptions A.​ KEY POINTS IN CONDUCTING AND DOCUMENTING THE MSE ​ Dysmorphologies ​ The clinician may elicit findings from the patient in any sequence. MANNER OF DRESSING ○​ Most of the items in the MSE can be noted already simply talking with the patient Manner of dressing [2028 Trans] ○​ Try to maintain a conversational and smooth flow in eliciting MSE ​ Slow/normal/fast findings ​ Monotonous ​ The documentation and reporting should follow the prescribed ​ Dramatic/theatrical format. ​ Irritable ​ Pertinent negatives or normal findings should always be ​ Anxious stated. ​ Dysphoric ○​ Do NOT simply omit. ​ Loud/quiet ○​ Stating normal findings is clinically relevant and means the ​ Timid, angry, etc clinician checked. ○​ Example: “the patient denied having hallucinations” instead of PERSONAL HYGIENE omitting hallucinations from the report ​ Kempt ​ If an item cannot be assessed, the clinician should note this ​ Unkempt and explain. ○​ Do NOT confuse this with a negative finding. PSYCHOMOTOR SYMPTOMS ○​ Example: a patient who does not respond regarding suicidal ​ Restlessness ideations should not be documented as having “no suicidal ​ Psychomotor retardation/agitation ideations”. One may put “he did not respond when asked about ​ Tics suicidal ideations”. ​ Compulsions ​ For uncooperative patients, a detailed MSE is still possible. ​ Extrapyramidal symptoms (rigidity and tremors) ○​ Observing and listening to, then describing, their behaviors and ○​ Extrapyramidal symptoms are common side effects of some responses. psychiatric medications. [From Trans 2028] ○​ It is not acceptable to report that “no MSE was performed” for ​ Involuntary movement any patient. ​ Catatonic posturing , etc. ​ It is encouraged to give an additional qualitative description or explanation of the findings so long as they are relevant and helpful, NOTABLE BEHAVIORS and written in a manner appropriate for medical charting. ​ Clinging to a parent or caregiver ​ Documenting assumptions made by the clinician without ​ Looking for assurance explicitly eliciting through inquiry/conversation or objectively ​ Shying away from the interviewer observing is NOT acceptable ​ Fidgeting ○​ Example: “doesn’t appear to be suicidal based on the way he ​ Mannerisms, etc. spoke”, “likely not to be experiencing hallucinations” are not Additional information [2027 Transes] allowed. ​ Data and assessment of MSE starts at the arrival of the patient at ○​ NEVER ASSUME. the room and the start of the interview ○​ Report only what was explicitly elicited, not what was assumed. ​ How the patient looks and acts during the interview ​ Does the patient appear younger or older than his age? ​ Take note of the patient’s style of dress, physical features, style of interaction, and their appropriateness to the context (e.g., weather, occasion). ​ Distinguish features, e.g., disfigurations, scars & tattoos ​ Is the patient cooperative, agitated, disinhibited, or disinterested? Is this appropriate to the context? Trans 8 TG4: Batac, Bathan, Bermudez, Binangbang, Bisquera, Buhion, Busog TH: Oribello 1 of 10  B.​ EYE CONTACT ○​ A mismatch may suggest underlying psychological conditions. ​ Good/ fair/ poor ​ Range of Affect: Assess the range of emotional expression, ​ Shifting especially when discussing sensitive or distressing topics. ​ Fixed, etc. ○​ Normal: A broad range of emotional expression is evident, appropriate for the context. C.​ SPEECH ○​ Restricted: There is a noticeable decrease in the intensity of Table 1. SPEECH TESTING emotional expression. ○​ Flat: No emotional expression, even in situations where PARAMETER DESCRIPTION emotion would typically be expected (e.g., during moments of ​ Unresponsive happiness). ​ Uses gestures only ○​ Labile: The affect is markedly unstable, with rapid and frequent ​ Hypoproductive/non-spontaneous shifts in emotional expression Production ​ indicative of emotional dysregulation or mood disorders. ​ Normoproductive ​ Pressured speech (cannot be interrupted) ​ Incoherent IV.​ THOUGHT PROCESS ​ Flow of thoughts in the patient’s mind, which is best reflected ​ Slow/normal/fast through his speech and manner of answering questions ​ Monotonous ​ How thoughts are formulated, organized, and expressed ​ Dramatic/theatrical ​ Normal thought process: linear, organized, and goal-directed ​ Irritable Tone and Rate ​ Anxious A.​ COMMON FINDINGS ​ Dysphoric ​ Loud/quiet CIRCUMSTANTIALITY ​ Timid, angry, etc. ​ Patient answers are only partially connected with the question, usually involving many irrelevant details. Volume ​ Soft/normal/loud TANGENTIALITY ​ Child-like ​ Highfaluting ​ Patient’s answers are totally disconnected from the question. Other details ​ Overly formal FLIGHT OF IDEAS ​ Etc. ​ Patient has a lot of ideas which are connected to each other but are coming in and out of his/her mind too fast for completion or Additional description [2027 Trans] cohesiveness. ​ Fluency: command of one’s language, stuttering, word finding, ​ “paiba-iba” difficulties, paraphasic errors (e.g. patient identifies watch as a clock) LOOSENESS OF ASSOCIATIONS ​ Amount: normal, increased, decreased ​ Patient’s ideas are no longer connected to each other and do not follow conventional logic. D.​ ATTITUDE TOWARD THE INTERVIEWER ​ Reflect disorganization of thoughts ​ Cooperative THOUGHT BLOCKING ​ Hostile ​ Evasive ​ When an otherwise cooperative patient does not answer particular ​ Dismissive questions (as if not hearing anything), usually involving questions ​ Overly familiar of more personal or distressing content. ​ Condescending ​ Stopping midsentence (stopping midthought) is common. ​ Etc. ​ Common with severely traumatized patients III.​ MOOD AND AFFECT Additional information [2028, 2027 Trans, Lecture Handouts 2025] A.​ MOOD ​ Neologisms ​ Refers to the internal emotional state typically sustained over a ○​ A newly coined word or expression period of time. ○​ Origins and meanings are usually nonsensical and ○​ describes how the patient feels subjectively unrecognizable. ○​ represents the emotional climate the patient is experiencing at ○​ Typically associated with aphasia or schizophrenia the moment. ​ Word Salad ​ Mood is inherently subjective and is best assessed by using the ○​ Severely disorganized and virtually incomprehensible patient's own words. speech or writing, marked by severe loosening of associations ​ Examples of Mood States: strongly suggestive of schizophrenia ○​ Euthymic (neutral mood), elevated, elated, euphoric, depressed, ○​ The person’s associations appear to have little or no logical anxious, irritable, dysphoric, labile (fluctuating), or empty. connection ​ Assessment ○​ Also called jargon aphasia ○​ It is helpful to ask the patient to rate their mood to facilitate the ​ Tangentiality and looseness of association denote a discussion disorganization of thought commonly attributed to psychosis. ​ “On a scale of 0 to 10, how would you rate your mood or your ​ Circumstantiality and flight of ideas are common in mania or anxiety level?" hyperactive states. ○​ For pediatric populations, b (e.g., face charts) may be used to help the child express their feelings. V.​ THOUGHT CONTENT B.​ AFFECT ​ Things that the patient thinks about or believes ​ Refers to the outward emotional expression as observed by the A.​ COMMON FINDINGS clinician. ○​ Provides an objective measure of the patient’s emotional DELUSIONS presentation. ​ Fixed, false beliefs not amenable to logical explanation ​ Unlike mood, which is subjective, affect is considered an objective ​ Can either be bizarre or non-bizarre observation of how the patient appears emotionally. ​ It is important to assess whether the patient’s affect is congruent Bizarre delusions with their self-reported mood. ​ Things which cannot happen even in the extremes of reality, ​ The intensity of the emotional expression can vary and should be connotes a high degree of disordered thought common in primary noted psychosis ​ Degree of Emotional Expression: ​ Examples: ○​ Full: The patient expresses a wide range of emotions clearly and ○​ Schneiderian first rank symptoms: thought control (thoughts are appropriately. being controlled or taken away/inserted into one’s mind), ○​ Constricted: There is a slight decrease in emotional expression, withdrawal, insertion, and broadcasting but this may be within normal limits, ○​ Having microchip in brain ​ Typical to individuals who are more reserved or cautious about ○​ Abducted by aliens showing their feelings. ○​ Impostors replacing family ○​ Blunted: There is a significant reduction in emotional expression, ○​ Other similar “out of this world” delusions which is considered abnormal and may suggest certain Non-bizarre delusions psychopathologies. ○​ Flat: There is minimal to no emotional expression, even in ​ Things which can happen in the extremes of reality but are situations that would typically evoke emotion. simply not true [in the patient’s life] ​ May be: Appropriateness and Range of Affect [2027 Trans] ○​ Persecutory: believes that someone is plotting against them or ​ Appropriateness: Evaluate how the patient’s affect aligns with harming them the context, situation, and the topic being discussed. ○​ Erotomanic (romantic): convinced that someone really loves OS 202 Mental Health Status Examination 2 of 10  them to an extreme level (usually involves celebrities or really VII.​ SENSORIUM AND COGNITION popular/powerful figures) ○​ Grandiose: believes that they have superpowers or incredible A.​ SENSORIUM wealth, or beliefs that may have a religious undertone ​ Sensorium is the wakefulness of the patient ○​ Referential: believes that everything is about them like ​ Descriptions used: characters on the television or radio or even strangers are talking ○​ Awake about them ○​ Drowsy ○​ Somatic: belief that things, like infestations, etc., are happening ○​ Obtunded to one’s body ○​ Stuporous ○​ Delusional jealousy ○​ Comatose ​ Scale used: Glasgow Coma Scale Additional information [Lecture Handouts, 2025] ​ A common mistake is for the interviewer to report that the patient B.​ COGNITION “denies” delusions. Instead, the interviewer should report if ​ Cognition refers to the mental processes. delusions were elicited because this is not a yes-or-no category ​ Note that these are just screening but elicited through conversion. ○​ Those with subtle impairments can fall through the cracks ○​ Can possibly be sensitive but NOT specific PREOCCUPATIONS ​ Predominant themes of thought ORIENTATION ​ Everything that the patient could think about ​ Knowing the time (when), place (where), and person (who) ​ Religious or sexual themes are the most common. ​ Other themes can be included such as: Additional information [2028 Trans] ○​ Family problems ​ Some patients who have delirium (more neurologic than ○​ Going home from the hospital psychiatric cases) would have impairments in orientation ○​ Safety ○​ E.g., Cannot recognize people around them, people are seen as ○​ Physical symptoms or health dead relative, unaware that 3 days have already elapsed ○​ Being judged, etc. 2026 Trans OBSESSIONS ​ Time & Date ​ Repetitive, specific, and intrusive thoughts most often with ○​ Ask the patient for the date, day, month, year, season unreasonable distressing, or “taboo” content ○​ Take note that season in the Philippines is not a clear ​ May or may not be coupled with compulsions (irresistible urges or delineation to all people repetitive behaviors) ​ Season is delineated by months, and not that particular day’s ​ Examples: current climate ○​ Obsession of having germs which will cause illness ​ Person ○​ Death of a loved one ○​ Ask the name of patient, relatives, or watchers ○​ Repetitive images of unwanted sexual activity/violence, etc. ○​ “Who is with you? How are you related to this person? What is ○​ May also be about order or symmetry this person’s name?” ​ Place/Location IDEATIONS ○​ “Where are you now?” ​ Themes of patient’s plans that may have detrimental effects ○​ Do NOT give clues unless they really cannot answer ​ Includes suicidal, homicidal, escape, assault, or revenge ideations ○​ Hierarchy if a patient is unable to answer (give clues to the patients or prod them) Additional information [Lecture Handouts, 2025] ​ Spontaneous ​ For patients who have suicidal ideations, the content of the ​ Ask for specifics suicide inquiry should be reflected here. ​ Give choices ​ This may include: ​E.g., hospital, clinic, home ○​ Presence of a plan ○​ Motivation for wanting to die MEMORY ○​ Intensity and persistence of these thoughts ​ Can be immediate, recent, and remote ○​ One’s perceived control over the urges ○​ Reactions or feelings about a recent attempt, etc. Types of Memory [2028 Trans] Table 3. TYPES OF MEMORY VI.​ PERCEPTION ​ Perceptual disturbances IMMEDIATE RECENT REMOTE A.​ HALLUCINATIONS Within few minutes ​ Ask the patient to ​ False perceptual experiences that arise from no stimuli. Within the day, or A long time remember something, then maybe a day ago ago Table 2. MODALITIES OF HALLUCINATIONS let the patient repeat it after a few minutes AUDITORY VISUAL TACTILE ​ Depending on the impairment, different memory functions or Felt hallucinations; parts of the brain are affected Seen hallucinations; Can sometimes be Heard hallucinations; Most common noted in substance Most common in CONCENTRATION in organic brain use; “Formication” or primary psychiatric ​ The ability of the patient to keep on track of what he/she is disorders and sensation of ants disorders mentally performing delirium crawling under the skin ​ Usually screened using Serial 7’s ○​ Deducting 7 continually from 100 ​ Content, reaction, and other details should be elicited ​ Example: 100, 93, 86, 79, 72… ○​ What the voice is saying, who is saying it, the patient’s response ○​ Rules: (obedience/feelings towards it) should also be examined ​ The patient should do the whole process continuously WITHOUT intermittent verbal cues from the interviewer. Additional information [2027 Trans] ​To prevent testing for mathematical skills ​ Content: command, commentary, derogatory, etc. Specify ​ Patient should remember what they have said as this shows verbatim if possible. the ability to concentrate ​ Patient’s reaction: ignores, follows, converses, becomes ​ Alternative screenings for those with lower educational attainment: anxious, etc. ○​ Serial 3’s (deducting 7 continually from 100) ​ Other details: number of voices, identity of voice, volume, ○​ Spelling WORLD/MUNDO backwards exacerbating or relieving factors, etc. ○​ Saying the months of the year backwards B.​ ILLUSIONS OTHER HIGHER COGNITIVE SKILLS ​ Contrasting to hallucinations ​ Judgment ​ Distorted perceptions of existing stimuli ○​ Basic screening involves giving a situation such as smelling ○​ I.e., seeing the standing electric fan as a person smoke in a cinema. ​ More common in psychiatric disturbances associated with other ​ To see if there is a gross impairment, specifically frontal lobe medical conditions function ​ Abstract thinking C.​ HALLUCINATORY GESTURES ○​ Basic screening involves asking the patient to interpret a proverb ​ Describe actions of a patient that may point out to hallucinations or stating the similarities between two objects. indirectly ​ Note: These are just cognitive screening questions. ​ Talking by oneself, laughing without reason, gesturing ○​ Gross difficulties or wrong answers are red flags of cognitive spontaneously as if responding to a voice, etc. difficulties ○​ Getting it correctly DOES NOT mean optimal cognitive function. OS 202 Mental Health Status Examination 3 of 10  ○​ General survey: appearance and behavior, speech, eye contact, Additional information [2027 Trans] attitude ​ Judgment ○​ Mood and affect ○​ Person’s capacity to make good decisions and act on them ○​ Thought process ○​ Basic screening: ○​ Thought content: delusions, preoccupations, obsessions, ​ Give the patient a situation and observe how they respond to ideations or solve it [2026 Trans] ○​ Perception ​“What would you do if you found a stamped envelope on ○​ Sensorium and cognition: orientation, concentration, memory, the sidewalk?” abstract thinking, judgment, insight ​“If the patient suddenly wakes up and there is a fire in the room, what would they do?” A.​ CASE 1 ​ Giving a situation such as smelling smoke in a dark place like a cinema Note from trans group ○​ Social Judgment ​ The details for each case were categorized only by the trans ​ Is the patient doing things that are dangerous or going to get group based on and following the recommended format for the him/her into trouble? MSE report from Dr. Yu Chua’s lecture slides. ​ Is the patient able to effectively participate in his/her own care? MSE OF A PATIENT WITH BIPOLAR DISORDER CURRENTLY IN A ○​ Ensure that the reaction is a reasonable and pragmatic one MANIC EPISODE, WITH PSYCHOTIC FEATURES judging by the current condition/state of the patient [2026 ​ General survey Trans] ○​ Appearance: dress in revealing clothes not usual for her age ​ E.g., a patient without a leg who answers that they would run (middle-aged), with heavy make-up, excessive jewelry, and to put out the fire would exhibit poor judgment disheveled hair ○​ Abstract Thinking ○​ Behavior: pacing restlessly ​ Ability to shift back and forth between general concepts and ○​ Speech: pressured speech with loud volume and occasionally specific examples sing-song tone ​ Test their ability to deal with abstract concepts [2026 Trans] ○​ Eye contact: good eye contact with occasional intense stares ​ Basic screening: ○​ Attitude: overly familiar with the interviewer, occasionally ​Asking the patient to interpret a proverb making flattering comments and flirtatious remarks ​Identifying similarities between like objects or concepts ​ Mood and affect ○​ Apple and Pear ○​ Labile mood (i.e., generally elated with note of intermittent ○​ Bus and Airplane irritability) ○​ Poem and Painting ○​ Full, congruent affect ​ Cultural, educational factors, and other limitations should be ○​ Exhibited spontaneous bouts of laughter in the middle of kept in mind conversation ​ Thought process INSIGHT ○​ Apparent circumstantiality and flight of ideas throughout the ​ Refers to the patient’s awareness of having a mental disorder and conversation requiring help ​ Thought content ​ This can be elicited by questions such as: ○​ Delusions: exhibits mild paranoia and grandiose delusions (i.e., ○​ What is the reason you came here? claims of people plotting to steal her wealth) ○​ How can a psychiatrist help you? ​Denied feeling unsafe at this time ○​ What do you know about your condition? ○​ Preoccupations: sexually preoccupied as seen with her ○​ What do you think about your confinement? comments and jokes ​ E.g. Psychotic patients who do not think anything is wrong (poor ○​ Obsessions: no explicit obsessions were mentioned in the case insight), depressed patient who knows and expresses his/her report feelings and needs (insight might be good) ○​ Ideations: denied suicidal or violent ideations ​ Perception Levels of Insight ○​ Denied presence of hallucinations ​ Level 1: Total denial of the illness ​ No gestures indicating hallucinations observed ​ Level 2: Slight awareness of being sick but denies it at the same ​ Sensorium and cognition time ○​ Orientation: fully awake, oriented to time, place, and person ​ Level 3: Attribution of the illness to an external source, other ○​ Concentration: poor people, or unspecified medical causes ○​ Memory: intact immediate, recent, and remote memory ​ Level 4: Intellectual insight ○​ Abstract thinking and judgment: difficulties to assess ○​ Awareness of the disorder as existing but without application abstraction and judgment encountered ​ Level 5: True emotional insight ​ Patient insisted on different topics inquiry regarding these ○​ Awareness and understanding with application such as changes topics deferred at this time in coping mechanisms or expectations ○​ Insight: poor insight about her illness ​ claimed that she was in the ER because she was “framed” by Additional Cognitive Screening Tests (See Appendix) envious people ​ Glasgow Coma Scale (GCS) ​ Note: During the lecture of Dr. Yu Chua, no deductions were ○​ Assesses the wakefulness or consciousness of a patient based discussed for this case on eye opening, best verbal response, and best motor response B.​ CASE 2 quantitatively. ​ Mini-Mental State Examination (MMSE) MSE OF A PATIENT WITH MAJOR DEPRESSION ○​ Assesses patient’s cognition ○​ DOES NOT summarize the mental state examination (MSE) ​ General survey ​ No mood, thought process, or thought content ○​ Appearance: well-kempt and neatly groomed in white medical ​ Montreal Cognitive Assessment (MOCA) student’s uniform ​ Frontal Assessment Battery (FAB) ○​ Behavior: no notable behavior mentioned in the case report ○​ Focuses more on the frontal lobe functions such as sequencing besides observed hesitance and gaze aversion at the start of the and inhibition examination ○​ Questions involving similarities, lexical fluency, motor series, ○​ Speech: normoproductive speech with soft volume and frequent conflicting instructions, go-no go, etc. pauses. ​ The Mini-Mental State Examination (MMSE), Montreal Cognitive ​ Responses initially short but became more relaxed and Assessment (MOCA) and other cognitive screening tests can be spontaneous additionally performed for patients who are suspected to have ○​ Eye contact: fair eye contact with gaze aversion when talking neurocognitive disorders. about personal topics ○​ Attitude: initially hesitant and reserved but can be deduced to be generally cooperative throughout the rest of the examination Additional information [2028 Trans] ​ Mood and affect ​ Which patients require a more comprehensive exam? ○​ Reports depressed mood with a note of constricted but ○​ Geriatric patients congruent affect ​ You want to check if they have Alzheimer’s or just the normal ○​ Exhibited tearfulness talking about his family cognitive slowing or senescence in the elderly. Some might ○​ Reports feelings of hopelessness with current situation have psychiatric symptoms secondary to dementia. ​ makes death a possible escape in his mind ○​ Those who have neurologic problems ​ Thought process ​ E.g., Stroke, seizures, brain mass ○​ Linear thought process ​ The lesion might have affected specific aspects of their ○​ Discusses continuously and coherently cognition. ​ Thought content ○​ Delusions: no delusions elicited VIII.​ REPORTING THE MSE ○​ Preoccupations: preoccupied medical school related problems ​ This includes proper documentation of the mental status of the ​ Frequently states this as a source of his troubles patient by including all the following information: ○​ Ideations: OS 202 Mental Health Status Examination 4 of 10  ​ Occasional suicidal ideations NEUROLOGY PSYCHIATRY ​“On-and-off” thoughts ​Denies plans of carrying it out due to a sense of it being Emphasis on detecting wrong. Emphasis on detecting psychiatric symptoms ​ No ideations of aggression toward others neurocognitive disorders Detects major psychosocial risks ​ Perception and concerns ○​ Presence or absence of abnormal perceptions (i. e., hallucinations, illusions, and/or hallucinatory gestures) was NOT Examples are: sensorial mentioned in the given case report changes, memory problems, ​ Sensorium and cognition apraxias (motor planning Examples are: psychosis, mood ○​ Orientation: fully awake, oriented to time, place, and person. problems), aphasias (language and thought disturbances, etc. ○​ Concentration: good disorders due to brain tensions), ○​ Memory: intact immediate, recent, and remote memories visuospatial deficits, etc. ○​ Abstract thinking and judgment: exhibited good abstraction and judgment Nice to know/watch ○​ Insight: good insights ​ Here is a YouTube link to the mental status examination of a ​ Recognizes and acknowledges possibility of having patient with schizophrenia depression ○​ Description: This is a video that shows how one should ​ Consulted to direct efforts in getting better conduct an MSE specifically on a schizophrenic patient ​ Asks relevant questions about condition and its exhibiting signs of psychosis. management X.​ REFERENCES DEDUCTIONS FROM MR. B’s MSE REPORT Eftychios, A., Nektarios, S., & Nikoleta, G. (2021). Alzheimer disease and ​ Mr. B is cognitively intact, in-touch with reality, and generally able music-therapy: An interesting therapeutic challenge and proposal. Advances in to control himself. Alzheimer's Disease, 10(1), 1-18. ​ Some signs of depression are visible in the MSE. https://www.researchgate.net/publication/351948858_Alzheimer_Disease_and _Music-Therapy_An_Interesting_Therapeutic_Challenge_and_Proposal ​ There are no major red flags of impending danger. Mahendran, R., Chua, J., Feng, L., Kua, E. H., & Preedy, V. R. (2015). The mini-mental ​ Family and medical school may be aspects that have a lot of state examination and other neuropsychological assessment tools for detecting salience in his mind. cognitive decline. In Diet and Nutrition in Dementia and Cognitive Decline (pp. ​ Note that these deductions must always be connected with the 1159-1174). Academic Press. https://www.sciencedirect.com/science/article/abs/pii/B9780124078246001099 history and pertinent workup of the patient. Olsen, A. (2014). Cognitive Control Function and Moderate-to-Severe Traumatic Brain IX.​ OTHER NOTES Injury: Functional and Structural Brain Correlates. https://www.researchgate.net/publication/272176279_Cognitive_Control_Functi ​ The mental status examination may have different focuses in on_and_Moderate-to-Severe_Traumatic_Brain_Injury_Functional_and_Struct neurology and psychiatry ural_Brain_Correlates ○​ However, they both overlap and involve higher cortical functions UPCM 2027 Trans (2022, November 18). The Mental Status Examination. UPCM 2028 Trans (2023). The Mental Status Examination. ​ Aspects of both need to be present whether the patient is Yu Chua, C. L. (2025). Mental Status Examination OS202 [PPT]. primarily neurologic or psychiatric Yu Chua, C. L. (2025). LU3 OS202 and HD202 Mental Status Examination [Lecture Handouts]. Table 4. DIFFERENCES BETWEEN NEUROLOGY VS. PSYCHIATRY OS 202 Mental Health Status Examination 5 of 10  APPENDIX Table 5. SAMPLE CASES FOR MSE SAMPLE CASE 1: MSE of a Patient with Bipolar Disorder Currently in a Manic Episode, with Psychotic Features Miss A, a Filipino middle-aged woman, was seen pacing restlessly around the emergency room. She was noted to dress in revealing clothes not usual for her age, with heavy make-up, excessive jewelry, and disheveled hair. She had good eye contact with a note of occasional intense stares. She exhibited pressured speech with loud volume and occasionally a sing-song tone. She was overly familiar with the interviewer, occasionally making flattering comments and flirtatious remarks. She had a labile mood—she reports feeling generally elated but with a note of intermittent irritability. There is a full, congruent affect. She was noticed to have spontaneous bouts of laughter in the middle of the conversation. She has apparent circumstantiality and flight of ideas throughout the conversation. She was sexually preoccupied, as reflected by her comments and jokes. There was a note of mild paranoid and grandiose delusions, wherein she claims that people are plotting against her to steal her wealth. However, she denies feeling unsafe at this time. She denied suicidal or violent ideations. She denied the presence of hallucinations, and there were no gestures thereof. She was fully awake and oriented to time, place, and person. Concentration was poor. Immediate, recent, and remote memory were intact. Abstraction and judgment were difficult to assess due to the patient insisting on different topics–-inquiry was deferred at this time. She had poor insight about her illness, claiming that she was in the ER only because she was “framed” by people who were envious of her. Note: The patient’s mood is very elevated in relation to her manic state. SAMPLE CASE 2: MSE of a Patient with Major Depression Mr. B was seated in the OPD, well-kempt, and neatly groomed in a white medical student’s uniform. He had fair eye contact but noted to avert his gaze when talking about personal topics. He had normoproductive speech with soft volume and frequent pauses. He was initially hesitant to talk with the interviewer, responding only in short phrases, but became visibly relaxed and spontaneous through the progression of the interview, given assurances. He reports a depressed mood with a note of constricted but congruent affect. There was a note of tearfulness when talking about his family. He had a linear thought process and was able to discuss continuously and coherently. He confided occasional suicidal ideations. He described these as “on-and-off” but denies plans of carrying them out due to a sense that it is wrong to do so. He reported a feeling of hopelessness with his current situation that makes death a possible escape in his mind. There were no ideations of aggression towards others. He was preoccupied about his problems with medical school, frequently going back to it as a source of his troubles. There were no delusions elicited. He was fully awake and oriented to time, place, and person. Concentration was good. Immediate, recent, and remote memory were intact. He exhibited good abstraction and judgment. Insight was good in such that he recognizes and acknowledges the possibility of having depression and has consulted to direct his efforts in getting better. He was noted to ask relevant questions about his condition and its management. Figure 1. Glasgow Coma Scale Retrieved from Olsen, A. (2014). Cognitive Control Function and Moderate-to-Severe Traumatic Brain Injury: Functional and Structural Brain Correlates. https://www.researchgate.net/publication/272176279_Cognitive_Control_Function_and_Moderate-to-Severe_Traumatic_Brain_Injury_Functional_and_Structural_Brain_C orrelates OS 202 Mental Health Status Examination 6 of 10  Figure 2. The Mini-Mental State Exam Retrieved from Eftychios, A., Nektarios, S., & Nikoleta, G. (2021). Alzheimer disease and music-therapy: An interesting therapeutic challenge and proposal. Advances in Alzheimer's Disease, 10(1), 1-18. https://www.researchgate.net/publication/351948858_Alzheimer_Disease_and_Music-Therapy_An_Interesting_Therapeutic_Challenge_and_Proposal OS 202 Mental Health Status Examination 7 of 10  Figure 3. Montreal Cognitive Assessment (MOCA) Retrieved from Mahendran, R., Chua, J., Feng, L., Kua, E. H., & Preedy, V. R. (2015). The mini-mental state examination and other neuropsychological assessment tools for detecting cognitive decline. In Diet and Nutrition in Dementia and Cognitive Decline (pp. 1159-1174). Academic Press. https://www.sciencedirect.com/science/article/abs/pii/B9780124078246001099 OS 202 Mental Health Status Examination 8 of 10  Figure 4. Frontal Assessment Battery (FAB) - Page 1 OS 202 Mental Health Status Examination 9 of 10  Figure 5. Frontal Assessment Battery (FAB) - Page 2 OS 202 Mental Health Status Examination 10 of 10