# 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)&#x20;
* *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.
