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Physical Examinations IV

Mental Status Examination

Published: April 30th, 2023

1Yale School of Medicine

The mental status exam is a clinical evaluation of emotional, perceptual, and cognitive functioning that spans both the fields of psychiatry and neurology. Developing skill in the psychiatric portions of the examination are important to describe salient aspects of the patient's mental state that may be observed during routine history and/or physical exam. Proficiency in the cognitive portions of this evaluation is vital while caring for patients with suspected cognitive impairment from illnesses like dementia, delirium, and substance intoxication. This video will teach students how to assess both cognitive and psychiatric portions of this examination, including behavior, speech, mood, affect, thought process and content, perception, attention, orientation, registration, and executive function.

The mental status exam is unique in that a variety of non-clinical factors may differentially impact how a patient performs while undergoing this exam in English. Furthermore, the mental status examination differs from other forms of physical examination as it requires a combination of directed questions and passive observation. Due to its reliance upon clinicians' perception and passive observation of diverse patient populations, proper execution and cultural validity of the exam are facilitated by an awareness of how several sociocultural factors may differentially impact patient presentation and clinician interpretation. Additionally, examiners often rely upon tests of verbal fluency and math skills to evaluate cognitive function. However, it is important for examiners to be sensitive to the needs of the patients with a wide diversity of languages and education levels. Therefore, this video will also address how to equitably administer the examination for patients from various socioeconomic, educational, and cultural backgrounds.

1. Appearance and Behaviour

  1. Attire, grooming, hygiene— Make observations about the patient's attire. For example, are the patient's clothes well-suited for the weather? Are clothes disheveled? Is there evidence of soiling (e.g., layers of old dirt on skin or body odor suggesting inadequate bathing)? Responses may range from well-groomed to disheveled, good to fair to poor hygiene, and appropriate or inappropriate attire.
  2. Nourishment— Note whether the patient appears well-nourishe.......

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