Mental Status Exam

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Thuy Huynh

November 16, 2012

Mental Status Exam

1) Appearance (unkempt, unclean, clothing disheveled, atypical clothing, well-groomed, drab, meticulous, obese, underweight, etc.)

-clothing were disheveled, unshaven-ed beard, unclean, unkempt attire

2) Attitude (resistive, cooperative, complacent, detached, resentful, suspicious, uncooperative, overly compliant, provocative, other symptom)

-detached from surrounding environment, seemed to be on guard at all times

3) Mood (sad, melancholy, euphoric, labile, irritable, hostile, apathetic, anxious, other symptom)

-anxious

4) Affect (flat, blunted, appropriate to mood, inappropriate to mood, euphoric, other symptom)

-animatedand/or inappropriate affect

5) Behavior (repetitive movements, posturing, waxy flexibility, agitated, impulsive, seductive, anxious, avoids eye contact, psychomotor retardation, hyperactive, violent, restless, other symptom)

-anxious, restlessness, pacing back and forth, talking to self, performing defensive moves in hallway, paranoid

6) Speech Content (grandiose, self-depreciative, flight of ideas, loose associations, ideas of reference, hallucinations, delusions, phobias, other symptom)

- loose associations

7) Speech Quality and Quantity (overly talkative, slowed, pressured, mute, stutter, dysarthria, guarded, calm, monotone, soft, loud, relevant, coherent, other)

- monotone at times, when speaking to self speech was soft, incoherent on occasion

8) Sensorium and Intellectual Functioning

A) Orientation- did not seem oriented to place or time

B) Memory (remote, retention, confabulation)- not able to track

C) Patient’s store of general information- knew basic information

D) Ability to Abstract-not able to assess

9) Insight (patient’s reaction to problem and assessment of causes)

-was not quite able to get an accurate assessment on whether or not he had insight to his disease

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