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Part 1
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Mental Status Exam
~ Evaluation of a clients current mental functioning
~ Combined with other information to arrive at formal diagnosis
~ Behavioral Aspects
~ Physical characteristics (ethnicity, cleanliness, weight, dress–age and setting appropriateness)
~ Communication barriers
~ Alertness
~ Movement and activity (tension, perseverative movements, non-goal-directed behaviors, itching/picking)
~ Facial expressions and continuity with words
~ Eye contact
~ Speech patterns (articulation, stuttering, mumbling, baby-talk, use of cultural dialects)
~ Attitude toward therapist

Mental Status Exam
~ Mood and Affect
~ Mood: How they feel most days
~ Affect is more variable— How do they feel right now or at a specific time
~ Type, quality, appropriateness
~ Bland—nothing affects him may indicate dementia
~ Affective flattening is a negative symptom of schizophrenia

Mental Status Exam
~ Flow of Thought
~ Spontaneous or only in response to questions
~ Incoherent rambling: Intoxication
~ Common in mania or schizophrenia
~ Flight of ideas
~ Tangential speech (answers unrelated to questions)
~ Loose associations (I got up and it was sunny today. I had oatmeal for breakfast. My dog died last Thursday)

Mental Status Exam
~ Flow of speech
~ Rate of speech: pressured (hypomania) or too slow (depression or intoxication)
~ Suicidal/Homicidal Ideation and risk for violence

Mental Status Exam
~ Cognitive Aspects
~ Thought content (logical, deluded)
~ Perception (Accurate, hallucinations)
~ Consciousness and cognition
~ Awareness of, ability to process and communicate information and attention span
~ Orientation to person, place, time and situation, also may include familiar object identification and other people identification

Mental Status Exam
~ Cognitive Aspects
~ Language comprehension and fluency
~ Memory
~ Types
~ Immediate (5-10 seconds)
~ Short Term (5-10 minutes)
~ Long Term – ability to provide autobiographical hx
~ Deficit Indicators
~ Dementia
~ Amnesia
~ Mental disorder due to a medical condition (stroke, chronic fatigue)
~ Substance Induced Mental Disorder (Korsakoff’s Syndrome)
~ Depression
~ Anxiety

Mental Status Exam
~ Cognitive Aspects
~ General Intelligence
~ Poor intelligence despite a good educational background can indicate a neurological problem
~ Must consider age, education level, culture and degree of depression and anxiety when assessing performance (29% of Americans can’t name the vice president)
~ Abstract Thinking: Interpret a proverb
~ Don’t count your chickens before they hatch

Mental Status Exam
~ Insight and Judgement
~ Insight about problem severity and what needs to happen
~ Poor insight is associated with cognitive disorders, depression, psychosis and mania.
~ Poor judgement is often associated with mania, hypomania or FASD

~ A mental status exam should be done at admission to aid in assessment and treatment plan development
~ A mini mental status exam should be done at each contact.
~ Orientation to person, place, purpose and time
~ Sign in
~ Thought content and perception
~ What were 2 things you got out of group/session
~ Fund of information / memory
~ How did you apply the tools/homework from last week
~ Future plans
~ What do you plan to do over the next week to improve your recovery
~ Mood
~ What is your mood? Happy Anxious Angry/Irritable Depressed
~ Judgement
~ If you start having a bad day, what will you do?

Test Taking Tip
~ For ethics related questions your best guess is the answer that is best for the client.
~ When eliminating response options, eliminate answers which:
~ Don’t answer the whole question
~ Are true, but not relevant to the presenting problems and situation
~ Use extreme words like always or must
~ Represent a common misconception or a lay-persons view
~ Check each answer against every part of the clinical simulation especially the diagnoses
~ If two options are similar, Choose the one that is more case-specific. The best answer is relevant to both the case and the question being asked.