PNI

Mental Status Examination

Just as neurologic evaluation is critical to finding subtle deficits, mental status evaluation is the key to a successful psychiatric evaluation and can reflect pathology that may be symptomatic of the CHIT.

This is performed sequentially on several occasions along the time based examination.

There are many different ways of performing the mental status examination in neuropsychiatry. No one technique is necessarily better than another.

We approach mental status by making sure the major aspects are prioritized. The special structure involves mnemonics as a helpful means to recall items otherwise forgotten.

In mental status evaluations, the special skill is to be as flexible as possible. Some mental status headings are ambiguous as you can, for example, describe certain signs under a person's appearance and very often, the same features could equally well relate to the patient's affect - the appearance of the patient may be sad and that same sadness should be picked up with regard to his emotions.

The mental status examination in psychiatry is the equivalent of the physical examination in general medicine. Both logically follow the taking of a medical history. This elicits as much information as possible and prioritizes what needs to be evaluated; then you examine the patient. There is a fundamental difference, however: much of the psychiatric examination is performed by taking a history - this is a special skill itself as the two functions of history and examination are therefore performed simultaneously and sequentially.

Often the mental status examination is confused with history taking. For example, when the patient gives historical information, he may not admit to any hallucinations: this may or may not be true; this is not part of the mental status examination. It is part of the mental status evaluation. It is clearly important to inquire about hallucinatory experiences, but asking about hallucinatory experience may get the response, "No, I never hear voices," when the patient is floridly hallucinating. The patient may or may not tell you about the voices he is hearing. Alternatively, he may describe voices he does not hear to ensure conscious or unconscious gains like admission to hospital (and a warm bed and caring environment) as well as fulfilling dependency needs. In the CHIT patient, where medicolegal facets are often relevant, particular attention should be paid to possible dissimulation or malingering.

We should distinguish between the historical mental status evaluation, which consists of the symptom cluster descriptions relevant to mental status, and the mental status examination, that component of evaluation often

We should distinguish between the historical mental status evaluation, which consists of the symptom cluster descriptions relevant to mental status, and the mental status examination, that component of evaluation often relating to the historical data but eliciting physical signs about mental status.

History taking involves probing. This is often facilitated by basic techniques

History taking involves probing. This is often facilitated by basic techniques or maneuvers that occur during the interview. Very often, history-taking involves eliciting both symptoms and signs: to do so, the skilled examiner, as required by the demands of the situation, shifts his interaction with the patient. This involves performing frequent probes, and keenly observing the response that results. These have both content and process components:

The single major mnemonic for mental status is ACCLAIMED. In the CHIT we evaluate the nine major subheadings of ACCLAIMED. In these nine major subheadings, which imply the essence of every facet of the mental status examination. The order of this mnemonic was empirically derived from the most logical direction to do the mental status examination; it is not contrived with headings made to fit the mnemonic. ACCLAIMED constitutes a priority system for the larger of the headings of mental status examination.

ACCLAIMED

A APPEARANCE
IMPACT?
C CONSCIOUSNESS
PSYCHIATRY/MEDICAL WARD?
C COGNITION
DIAGNOSIS OF PSYCHOPATHOLOGY?
L LESION LOCALIZATION
NEUROPSYCHIATRIC?
A AFFECT
SEVERITY INDEX?
I INSIGHT AND JUDGMENT
PSYCHOSIS?
M MOTOR-MOTIVATION
SUCCESS? LABELING ?
E EGO-ENVIRONMENT
PSYCHOTHERAPY?
D DANGER-DISABILITY
HOSPITAL?
BACK

Copyright 1997- 2002 Pacific Neuropsychiatric Institute