Table 3: Mental Status Examination
| Element | Technique(s) | Evidence | Pre-Clerkship | Clerkship |
|---|---|---|---|---|
| Mental Status Examination | ||||
| 1. Appearance | Assess general health, self-care, dress, posture etc. | Able to assess | Assess; Interpret | |
| 2. Behaviour | Assess facial expression, eye contact, abnormal movements etc. | As above | As above | |
| 3. Level of consciousness | Assess whether alert, drowsy, ability to focus or pay attention | As above | As above | |
| 4. Speech and language | Assess quality i.e. fluency, slurring or quantity i.e. rapid, pressured and content e.g. Logic relevance | As above | As above | |
| 5. Mood and Affect | Assess prevailing emotional tone (mood) and moment-to-moment expression of emotion (affect). | As above | As above | |
| 6. Orientation | Assess memory and perceptual abilities to recall name, place and time. | As above | As above | |
| 7. Memory | Assess long-term, recent memory, immediate recall and new –learning ability | As above | As above | |
| Thought Content A) Delusions B) Hallucinations C) Illusions/Delirium D) Paranoid thinking E) Suicidality F) Homicidality | C) Confusion assessment method E) Elicitation of suicidal ideation | C) Inouye, 1990. E) Shea, 1998. | May describe May describe | May describe Assess; Interpret |
| Insight | Ask if patient appreciates her situation | Able to assess | Assess, Interpret | |
| Judgement | Does the patient appreciate the consequences of their actions. | |||
| Higher cognitive function A) Knowledge B) Calculation C) Abstraction D) Perception and Constructional Ability | -test fund of information e.g. Serial “7’s” eg. Test similarities – e.g. draw a clock or copy figure Mini-mental status examination (MMSE) | Positive clock-drawing tests suggests dementia + LR 9.6 Manos, 1994. | Able to administer tests | Interpret |
References
- Inouye SK, et al. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann.Intern.Med. 1990 Dec 15;113(12):941-948.
- Manos PJ, Wu R. The ten point clock test: a quick screen and grading method for cognitive impairment in medical and surgical patients. Int.J.Psychiatry Med. 1994;24(3):229-244.
- Shea SC. The chronological assessment of suicide events: a practical interviewing strategy for the elicitation of suicidal ideation. J.Clin.Psychiatry 1998;59 Suppl 20:58-72.