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A. Psychiatric Axesnavigator

  1. Major Psychiatric Illness
  2. Behavioral / Personality
  3. Major Medical Illness
  4. Stresses
  5. Global Functioning
  6. These axes are used to fully characterize a patient's condition

B. Elements of the Mental Statusnavigator

  1. General Behavior and Appearence
  2. Speech
  3. Mood and Affect
  4. Thought Form
  5. Thought Content
    1. Delusions
    2. Hallucinations
  6. Cognition
  7. Optional Components of MSE
    1. Obsessions / Compulsions
    2. Phobias

C. Speechnavigator

  1. Fluency
    1. Rate: slow or rapid
    2. Rhythm: constant or grouped speech
    3. Volume
    4. Speech pressured or not
  2. Aphasia
    1. Improper speech
    2. Expressive aphasia (Broca)
    3. Receptive (Fluent) Aphasia (Wernicke)

D. Moodnavigator

  1. General Mood over past several weeks
  2. Should be reported in patient's own words

E. Affectnavigator

  1. How patient appears to interviewer
  2. Restricted range
  3. Amplitude of responses - blunted or animated
  4. Others: euthymic, irritable, dysphoric, elevated, appropriate, inappropriate

F. Thought Formnavigator

  1. Clarity - Dysarthria vs Aphasia
  2. Logical or Loose: directed (to the point) or not
  3. Circumstantial: some extraneous material, but gets to the point
  4. Tangential - looseness of association
  5. Flight of Ideas

G. Thought Contentnavigator

  1. Delusions
    1. Fixed, false, idiosyncratic beliefs (incorrigible)
    2. Not explainable by cultural or religious background
    3. Delusions are common in Schizophrenia (usually paranoid type)
  2. Examples of delusions:
    1. Do others control patient's mind and/or body?
    2. Does the patient think they are famous?
  3. Hallucinations
    1. Visual hallucinations are usually with organic brain disease
    2. Other hallucinations include Tactile (proprioception), olfactory, auditory
  4. Paranoia
  5. Suicidal or Homicidal

H. Cognitionnavigator

  1. Various scales have been developed to assess level of cognition (understanding)
  2. The Mini-Mental Examination is the most commonly used in internal medicine [1]
  3. MMSSE and MIS Screening for Dementia [2]
    1. MMSE: Likelihood ratio (LR) for positive result: 6.3; negative result 0.19
    2. MIS: LR for positive result 33; negative result 0.08

I. Other Considerationsnavigator

  1. These are not typically part of the MSE
  2. Obsessions / Compulsions
    1. Obsessions are worrisome or troublesome thoughts that cannot get out of one's mind
    2. Compulsions are the motor equivalent of obsessions
    3. May be alien or immoral thoughts or acts
  3. Phobias
    1. Troublesome fears
    2. May be completely idiopathic
    3. Usually cause patient to avoid situation
    4. Tolerance to a phobia may be learned by the patient

J. Perspectives on Psychiatric Illnessnavigator

  1. Disease - major psychiatric illness
  2. Dimensions - personality traits
  3. Behaviors - goal directed activities
  4. Life Story - explanation for actions

References navigator

  1. Folstein MF, Folstein SE, McHugh PR. 1975. J Psychiatr Res. 12:189 abstract
  2. Holsinger T, Deveau J, Boustani M, Williams JW Jr. 2007. JAMA. 297(21):2391 abstract