Appendix C. Mental Status Assessment

GENERAL PHYSICAL APPEARANCE

• Appears stated age
• Dress
• Grooming/hygiene
• Posture, gait, coordination, and station
• Physical handicaps
• Eye contact during interaction
• Facial expressions
• Orientation (time, place, identity situation)
• General state of health (well nourished, clear skin, dark circles under eyes)
• Reaction to the interview
• Manner of relating during interview
• Consistency of behavior and what is verbalized

BEHAVIOR ACTIVITY

• Overactive (restless, agitated, constant movement, outbursts, destructive behaviors)
• Underactive (lethargic, slow motion, stupor)
• Lethargic
• Mannerisms (pacing, tics)
• Unusual motor behaviors
  • akathisia (extreme restlessness, where the client can't remain still)
  • choreiform movements (irregular, involuntary muscle movements of the face and extremities)
  • compulsive behavior (repetition of specific actions)
  • catalepsy (a trancelike state with a lack of voluntary movement)
  • cataplexy (transient loss of muscle tone due to intense emotional feelings)
  • catatonic excitement (extreme hyperactivity)
  • catatonic stupor (extreme hypoactivity)
  • dyskinesia (involuntary motor activity, such as tics and spasms
  • echopraxia (repetitive impersonation of another's movements)
  • hyperkinesia (excessive movement)
  • impulsiveness (sudden and unpredictable outbursts of activity)
  • Parkinson-like symptoms (demonstrating a shuffling gait, tremors, rigidity, masklike facial appearance, and drooling
  • psychomotor retardation (a major decrease in overall activity)
  • tremors (involuntary, purposeless, rhythmic movements)
  • waxy flexibility (maintaing the extremities in certain positions for long periods)

SPEECH

• Words are clear and intelligible
• Rate of speech
• Volume and intonation (flow, quantity, coherence, and logic)
• General communication ability
• Barriers to communication such as confusion, delusions, and language
• Vocabulary appropriate to social economic background
• Unusual speech
  • pressured (excessive talkativeness with rapid expression of ideas)
  • aphasia (partial or total loss of ability to express selt or understand the communication of another person)
  • clanging (a speech pattern characterized by rhyming)
  • echolalia (repeating the speech of another person)
  • mutism (lack ofcommunication over a period of time)
  • neologisms (words made up by the client that aren't easily understood by others)
  • perseveration (repeating a single word or phrase over and over)
  • verbigeration (repetitive, meaningless expression of words, phrases, or sentences)

AFFECTIVE STATE

• Affect (range of intensity and appropriateness of emotions)
• Mood or expression of emotions
  • ambivalent (the presence of two opposing feelings at the same time)
  • anxious (diffuse apprehension that is manifested by feelings of insecurity and uncertainty)
  • blunted (loss of natural affective expression)
  • depressed (intense feelings of sadness, helplessness, and hopelessness)
  • elated (a powerful sense of self-confidence and optimism)
  • euphoric (overwhelming feelings of well-being inappropriate for the situation)-
  • flat or shallow (less than normal expression of feelings or lack of an appropriately strong response)
  • labile (sudden change in expression of mood)

THOUGHT PROCESS

• Thought form (normal, concrete, scattered, illogical)
• Thought progression
  • blocking (a sudden interruption in the natural course of thinking or speaking)
  • circumstantial (the relying on numerous details and explanations before getting to the point or answering the question)
  • confabulation (creating information to fill in a loss of memory
  • flight of ideas (a continuous flow of speech in which the person jumps from one topic to another)
  • ideas of reference (false impressions that external events have special meaning )
  • loose associations (thinking is confusing and illogical)
  • tangential (the speaker changes the topic frequently, and it's difficult to follow what's being expressed)
  • word salad (words that lack apparent connections and meaning)
• Thought content
  • delusions (false beliefs, with lack of supporting evidence)
  • grandiose (exaggerated belief about one's own importance)
  • obsessive (persistent, unwanted, recurring thoughts)
  • hypochondrias (excessive concern about one's health and feeling sick without any medical basis)
  • phobias (intense irrational fears of objects, situations, or places)
  • poverty of thought (speech that's brief and uncommunicative

PERCEPTION

• Use of and orientation to time
• Altered awareness to self or the environment
  • illusions (misinterpretation or external stimuli)
  • hallucinations (false sensory experiences with no external stimuli present)
  • fantasies or daydreams (ideas, beliefs, and use of imagination to preoccupy and distract a person from reality)
  • hypnagogic hallucinations (misperceptions that occur as the person is falling asleep)
  • hypnopompic hallucinations (misperceptions that occur as the person is waking up)

MEMORY

• Memory of remote past, recent past, and present
• General knowledge and information (accuracy and reality)
• Calculation
• Ability to think abstractly or make generalizations
• Insight (awareness of nuances of current situation, health or illness state, need for help, and acceptance of personal responsibility)
• Judgment or problem solving
• Alertness

COPING SKILLS

• Patterns of handling stressors and crises
• Unique personal concerns or problems (disabilities, environmental situations, obsessions)
• Self-concept
• Sources of strength and hope (supportive people, spiritual practices, meaning and purpose in life)
• Ability to socially conform as necessary