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Examination Of A Psychiatric patient: Objective Evaluation Of Mental Status
Observing A Mental patient
From our previous hub, we discussed the importance of taking a detailed history of the patient. Sometimes such a procedure may take long hours or even days, depending on the status and readiness of the patient. But after taking the history, his mental state needs to be evaluated for a very good diagnosis. In the mental examination, the various psychological functions are specifically assessed.
Appearance And Behaviour Of A Psychiatric Patient
Appearance and behaviour: This feature of the patient is noted first. The looks of the patient, his dressing, hair style, level of cooperation, level of communication, etc, are to be noted.
Psychomotor activity: Note whether the activity is normal, decreased or increased and then look for specific disorders or motor activity such as stereotypy, stupor, mannerism, negativism etc.
Affect: Abnormalities include clation, depression, incongruity etc.
Thinking: This is brought out by noting the talk of the patient. Disorders of thinking manifest as disturbance of the stream, form or content of the thought. Suicidal tendencies and obsessions have to be brought out by interrogation.
Perception: Disorders of perception are hallucinations and illusions.
Consciousness: The level of consciousness has to be carefully recorded.
Orientation: Orientation in time is determined by asking the patient to state the time, the day, the date, month and year. Orientation to place is assessed by asking him to identify the place where he is during the time of interview. Orientation to person can be tested by asking the patient to identify his relatives or friends, or persons found in specific uniforms such as policeman or doctors.
Attention and concentration: Attention can be assessed during interrogation. Normally, attention is prompt and sustained as long as the stimulus continues. Attention and concentration can be tested as follows: The patient is asked to count:
- 1 to 20 forwards and then backwards or
- To deduct serially 3 from 40 or 9 from 100.
The rate of performance and the errors committed will give an idea of the state of attention and concentration. These factors also depend to a great deal on the level of his educational attainment.
Memory Evaluation Of A Psychiatric Patient
The immediate memory (power of retention), recent and remote memory have to be separately assessed. To test immediate memory, the patient is shown five objects which are then hidden. The patient is taught to recollect the objects and the places where they are hidden. The attention of the patient is deviated for five minutes and then he is made to recollect the name of the object and the places where they are hidden. Alternatively, the patient is given a full address. He is taught to recollect it. His attention is then drawn away. After five minutes, he is asked to recollect the address. Errors in these tests indicate the impairment in immediate memory.
Recent memory: Events which have taken place within 48 hours to 72 hours are relevant in recent memory tests. The patient is asked to name the persons who have visited, the food he has taken and the places to which he has gone in the recent past. The answers will have to be corroborated by the relatives. Wrong answers indicate the impairment of recent memory.
Remote Memory: This refers to events that have taken place long ago. This can be tested by questions regarding the name of the principal or director where he has studied, his date of birth, the date of his marriage, the date of his getting a job, and such important events. Though, this test helps to assess the remote memory of the patient, it should be realized that the educational attainment of the subject also plays a role in the outcome.
Evaluation Of Intelligence In Psychiatric Patients
This is measured by intelligence quotient (IQ) tests. Several different schemes are currently in practice, eg, Weschsler’s intelligence scale, Raven’s progressive matrices test, Bhatia’s Battery of intelligence scale, etc.
Judgment: This can be assessed by making the patient take decisions when confronted with specific situations. For example, the patient is asked “what will you do when you see a house on fire?” Or “What will you do when you get wound on your finger?” Answers to these types of questions help to reveal the impairment in judgement.
Insight: This is the appreciation of one’s own physical and mental state. To assess the level of insight, the patient is just asked whether he is sick or he needs any treatment. Patients who have no insight often answer that they are not ill and that they do not require any treatment.
In conclusion, no mental examination is complete without a thorough physical examination. At the end of the psychiatric and physical examination, a provisional diagnosis can be arrived at in most of the patients.
© 2014 Funom Theophilus Makama