LESSON 6

Hygiene and grooming, appropriate dress, posture, eye contact, unusual movements or mannerisms, speech.

refers to the standard procedure used to evaluate the client’s mental and emotional functioning at the time the client is seen by the mental health professional. It involves a precise series of observations as well as some specific questions.

Categories of Mental Status Examination

Repeated purposeless behaviors indicative of anxiety such tapping the foot, twisting locks of hair

maintenance of posture or position over time even when it is awkward or uncomfortable

ability to interact with the interviewer

note agitation, retardation, tense, lethargy

refers to the internal emotional tone of the patient. It is a subjective way a client explains feelings. It may be sustained for days or weeks, or it may fluctuate during a day.

normal mood

elated/ exaggerated happiness

changeable mood/ common in bipolar

depressed, restless

the outward expression of the client’s emotional state. It fluctuates with thought content and can be observed in facial expressions, vocal fluctuations, and gestures.

disharmony between the stimuli and the emotional reaction

displaying one type of expression usually serious or sober

severe reduction in emotional reaction

absence or near absence of emotional reaction

dulled emotional tone

presence of two opposing feelings
ex: bittersweet, love-hate

feeling of strangeness towards oneself

feeling of strangeness towards the environment

the way the client functions intellectually (how client is thinking). The process or way of thinking or analysis of the world. The way of connecting or associating thoughts, the over-all organization of thoughts. The quality and quantity of speech, tone, associations and fluency of speech should be noted.

pathological coining of new words

over inclusion of details

incoherent mixture of words and phrases

meaningless repetition of words and phrases

persistence of response to a previous question

pathological repetition of words of others

shifting of one topic from one subject to another in a somewhat related way

shifting of a topic from one subject to another in a completely unrelated way

the sound of the word gives direction to the flow of thought— rhyming but doesn’t make sense

conversation never reached due to lack of direction

stops speaking suddenly and without explanation

the type of ideas expressed by the patient (what the client is thinking). These are hallucinations, delusions, and other perceptual disturbances.

misperception of an actual external stimuli

false sensory perception in the absence of external stimuli
Note: Illusions and hallucinations can be visual, tactile, auditory, gustatory or olfactory

false belief which is inconsistent with one’s knowledge and culture ; Fix false belief

delusional belief that others can hear or know what the client is thinking.

a delusional belief that others are putting ideas or thoughts into the client’s head – that is, the ideas are not those of the client.

a delusional belief that others are taking the client’s thoughts away and the client is
powerless to stop it.

the central theme of this is the unfaithfulness of a spouse or lover.

the central theme involves bodily functions or sensations. A false belief that there is a physical ailment.

belief that the patient is loved intensely by the “loved object,” who is usually married, of a higher socio-economic status, or otherwise unattainable. (ex: fans, stalkers)

The central theme is the patient’s belief that he or she is being conspired against, cheated, spied on, followed, poisoned, drugged, maliciously maligned, harassed, or obstructed is pursuit of long-term goals.

the central theme is that a significant other (usually a family member) has been replaced by and identical impostor

the central theme is that others are aging while the client appears to remain the same age.

the central theme is that client is associated with famous people or celebrities or that the client is capable of great feats.

the central theme often center to the second coming of Christ or another significant religious figure or a prophet. These religious delusions are not part of the client’s faith but occur suddenly as a part of the client’s psychosis.

no one delusional theme predominates, and the patient presents with two or more types of delusions. Patients are usually women who experience feelings of depersonalization and derealization.

believe that gestures and words of others are specifically directed at them. They become convinced that they are the focus of song lyrics, books or comments made by someone on television.

the delusion that things (or everything, including the self) don't exist; a sense that everything is unreal. Clients may claim that they are invisible or inaudible.

no one delusional theme predominates, and the patient presents with two or more types of delusions. Clients are usually women who experience feelings of depersonalization and derealization.

the client believes that his /her sexual behavior is known to others, that he/she is a rapist, pedophile or pregnant, that his/her excessive masturbation led to insanity.

the ability to think and know.

alert, drowsy, suspicious

person, place and date

repeat 5 digits forward and backward or spell a five letter word forward and backward.

ability to recall 3 objects seen after 5 minutes

evidenced by client’s detailed recall of past events in the history.

ability to recall about a holiday or world event within the past few months.

filling in of memory gaps; using environment to fill the gaps; common in alcoholic

inability to recall past events

loss of memory of the immediate past, days and months

loss of memory of the distant past, years

feeling of having been to place which one has not yet visited

feeling of not having been to a place which one has visited

addition and subtraction of simple math problems.

proverb interpretation and similarities.

client gives literal translations.

is a person’s awareness of his or her own thoughts and feelings and ability to compare them with the thoughts and feelings of others. It is the ability to understand the true nature of one’s situation and accept personal responsibility for that situation.

is the ability to reach a logical decision about a situation and to choose a course of action after examining and analyzing various possibilities.