Mental status examinations

Accurate diagnosis of patients with inhalant use disorders may require a variety of methods, including psychiatric history and mental status examination, physical examination and laboratory testing, neuropsychological testing, and neurophysiological testing. 

FIGURE 32-2. Treatment algorithm for Alzheimer s disease. A. Cognitive treatment. B. Treatment of psychiatric or behavioral symptoms. AD, Alzheimer s disease MMSE, Mini Mental Status Examination NINCDS-ADRDA National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer s Disease and Related Disorders Association. (From Faulkner JD, Bartlett J, Hicks P. Alzheimer s disease. In DiPiro JT, Talbert RL, Yee GC, et al, (eds.) Pharmacotherapy A Pathophysiologic Approach. 6th ed. New York McGraw-Hill 2005 1164, with permission.)... 

Diagnostic work-up depends on clinical Mental status examination... 

Evaluation of the anxious patient requires a complete physical and mental status examination appropriate laboratory tests and a medical, psychiatric, and drug history. 

Depressed patients should have a medication review, physical examination, mental status examination, a complete blood count with differential, thyroid function tests, and electrolyte determinations. 

Common causes of insomnia are shown in Table 72-2. In patients with chronic disturbances, a diagnostic evaluation includes physical and mental status examinations, routine laboratory tests, and medication and substance abuse histories. 

The mental status examination remains an essential part of the evaluation. Often patients with schizophrenia will appear nnkempt or otherwise oddly dressed. Sometimes they will be friendly and affable, but when they are paranoid, they can be angry and hostile. Patients may have odd stereotypical movements that can become extreme in catatonic states. The patient with schizophrenia is usually quite alert and well oriented to his/her surroundings. This observation helps to distinguish the psychosis of schizophrenia from that of a delirium due to a medical illness or substance use. 

To answer these questions, a complete assessment should include a thorough history from both the patient AND one or more family members, a mental status examination, a physical examination, and diagnostic tests. 

In addition, you should perform some objective measure of the patient s intellectual functioning. The most commonly used measure is the Folstein Mini-Mental Status Examination (MMSE). The 30 point MMSE assesses many of the intellectual functions that might be impacted by dementia orientation to surroundings, registration of new information into memory, recall of that same information, concentration, word-finding, following directions, and visuospatial tasks. A score of 25 or lower should raise concern but early dementia is not ruled out even with higher scores. 

The evaluation should include a careful history and a thorough mental status examination. At the time of the initial visit, the patient will likely be in crisis. It will be this crisis that has brought him/her into treatment, and its resolution will be the first... 

Essential elements of the mental status examination for children are described below, with a nonexhaustive list of examples. 

In a research setting, structured interviews need to be done in conjunction with a comprehensive psychiatric evaluation and mental status examination, given the following ... 

Observational methods of assessing anxiety in real life or analogue situations are a useful adjunct to the mental status examination in a clinical setting. These methods generally involve the child or others (e.g., trained raters, parents, teachers, clinicians) monitoring anxi-... 

A neurological exam, including a mental status examination and a baseline EEG... 

Chronically hospitalized elderly inpatients with schizophrenia (n = 121 mean age 74 years) were rated for tardive dyskinesia and cognition (288). Subjects with tardive dyskinesia (60%) were older than those without. In subjects who were taking typical neuroleptic drugs (n = 119) there was no difference in dosage between those with and without tardive dyskinesia. Cognitive scores (Mini-Mental Status Examination) were significantly lower in the subjects with tardive dyskinesia... 

The physician will take a medical history and perform a physical examination. The details of the mental status examination will be greater from a psychiatrist than a primary care physician, and the primary care physician will probably conduct a more thorough physical examination than most psychiatrists. In common, their consultations will usually include the elements in Table 9.6. 

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