Psychiatric Exams

Mental Status Exams

The Mini-Mental Status Exam (MMSE) is a frequently-used test to assess gross cognitive functioning. The areas of cognitive function it evaluates include:

• Orientation (person, place, time)

• Memory (immediate registry, recent recall)

• Concentration and attention (serial 7’s or spell “world” backwards)

• Language (naming, repetition, comprehension)

• Reading/writing

• Visuospatial ability (copy a design)

The MMSE is graded out of 30 points, with >25 indicating intact cognition.

Diagnositic Testing

Personality

Personality testing can be objective or projective:

• Objective: Minnesota Multiphasic Personality Inventory (MMPI-2)

• Projective: Thematic Apperception Test (TAT) and Rorschach Test

The Thematic Apperception Test involves asking the patient to create stories based on pictures of people in various situations.

The Rorschach Test involves interpretation of inkblots to identify themes in perception that give insight to personality.

Intelligence

Intelligence testing results in an IQ score, which has a mean of 100 and a standard deviation of 15.

The Wechsler Adult Intelligence Scale (WAIS) is the most commonly used IQ test for adults.

The Stanford-Binet Test is used in children and adolescents.

Mental retardation is typically diagnosed at IQ < 70. As of DSM-V, mental retardation is no longer stratified in severity according to IQ scores.

Depression

Beck's Inventory is used to measure the severity of a patient's depression. For patients 13 and above.

Brain lesions

The Halstead-Reitan battery is used to identify and localize brain lesions.

Others

Mood refers to how the patient is feeling.

• Example: A patient reports feeling sad (a depressed mood).

Affect refers to how the patient expresses his/her feelings.

• Example: A patient recalls tragic events without emotion (a flat affect).

Tangentiality refers to a thought process that escapes onto a tangent, and never returns to the intended end point.

• Example: "I was feeling suicidal because last time I went to my friend's house, which is back by this really cool place I used to hang out by as a kid, where I used to."

Circumstantiality refers to a thought process that includes numerous unnecessary side-comments and information, but eventually returns to the intended point (high-yield!).

• Example: "The voices are worse when I either use cocaine, which I get from my dealer, who is really good at chess and random things like, or when I use heroin."

Ideas of reference: Belief that some general event is uniquely related to the patient.

• Example: The patient believes the radio is talking to him/her.

​Thought broadcasting: Belief that one's thoughts can be heard by others.

• Example: The patient is paranoid that someone will not like them because of negative thoughts they had about that person.

Illusions are inaccurate perceptions of real stimuli.

• Example: Mistaking a man for one's dead husband.

Hallucinations are perceptions that occur in absence of any real stimulus.

• Example: Hearing a man's voice in an empty room.

Hypnagogic (immediately before falling sleep) and hypnopompic (before waking up) hallucinations can occur with narcolepsy, though they may also occur in patients without the disorder.

Visual hallucinations are common in delirium, alcohol withdrawal, and drug intoxication. Many other miscellaneous causes may be responsible as well, including Lewy body dementia.

Auditory hallucinations are common in schizophrenia. Command hallucinations are auditory hallucinations that specifically tell the individual to perform certain actions.

Olfactory hallucinations (those of smells) often occur as an aura of psychomotor epilepsy or as the result of a brain tumor.

Tactile hallucinations (those of touch) can occur in patients with delirium tremens from alcohol withdrawal and cocaine use. An example of a common tactile hallucination is formication, the sensation of ants crawling on one's skin.