Describe the elements of a mental status exam

What will be an ideal response?


The mental status exam typically consists of the following items (Gallo et al., 2000; Lukas, 1993):
Appearance

• How does the client look and act?

• Stated age, dress, and clothing

• Psychomotor movements, tics, facial expressions

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Reality Testing

• Judgment

• Dangerous, impulsive behaviors

• Insight

? To what extent the client understands his or her problem

? How the client describes the problem

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Speech

• Volume: low, inaudible

• Rate of speech: rapid, slow

• Amount: poverty of speech

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Emotions

• Mood: how the client feels most of the time

? Anxious, depressed, overwhelmed, scared, tense, restless, euthymic, euphoric

• Affect: how the client appears to be feeling at this time

? Variability (labile)

? Intensity (blunted, flat)

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Thought

• Content: What the client thinks about

? Delusions: unreal belief, distortion

o Delusions of grandeur: unusual or exaggerated power

o Delusions of persecution: unreal belief that someone is after the client

o Delusions of control: someone else is controlling the client's thoughts or actions

o Somatic delusions: unreal physical concerns

? Other thought issues

o Obsessions: unrelenting, unwanted thoughts

o Compulsions: repeated behaviors, often linked to an obsession

o Phobias: obsessive thoughts that arouse intense fears

o Thought broadcasting: belief that others can read the client's mind

o Ideas of reference: insignificant or unrelated events that have a secret meaning to the client

? Homicidal ideation: desire or intent to hurt others

? Suicidal ideation: range from thought, desire, intent, or plan to die

? Process: how the client thinks

o Circumstantiality: lack of goal direction

o Perseveration: repeated phrase, repeated topic

o Loose associations: move between topics without connections

o Tangentiality: barely talking about the topic

o Flight of ideas: rapid speech that is unconnected

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Sensory Perceptions

• Illusions

? Misperception of normal sensory events

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Hallucinations

? Experience of one of the senses: olfactory (smell), auditory (hearing), visual (sight), gustatory (taste), tactile (touch)

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Mental Capacities

• Orientation times four: oriented to time, person, place, and situation

• General intellect: average or low intelligence

• Memory: remote (past presidents), recent (what the client ate yesterday for breakfast), and immediate (remember three items)

• Concentration: Distraction during interview, count backward by 3s Attitude Toward Interviewer

• How the client behaves toward the interviewer: suspicious, arrogant, cooperative, afraid, reserved, entertaining, able to trust and open up, forthcoming

Social Work & Human Services

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