Mental Status Exam Archetypes: Depression, Anxiety, Mania, Psychosis

0:00 this talk will review examples of mental status exams seen in depression anxiety Mania and psychosis while every patient is unique there are certain patterns in the mental status exam that are commonly seen in particular psychiatric illnesses gaining Proficiency in psychiatric diagnosis requires recognition of these common patterns this talk will walk through these patterns for a few of the most common psychiatric syndromes depression anxiety Mania and psychosis first here is a reminder of what a normal mental status exam looks like now let's walk through the typical mental status exam for each of these syndromes starting with depression for depression appearance is often disheveled as depressed patients May neglect their hygiene they may be guarded in response

0:47 to questions and their speech may be slowed soft and brief obviously the patient will often describe their mood as sad down or simply depressed their affect may appear dysphoric and constricted below you can see an example of a dysphoric affect you can see the downturned corners of the eyes and the lips and the Deep furrowing of the brow the thought process may be linear and logical though at times the patient may appear internally preoccupied and may lose track of the conversation due to being distracted by their own negative thoughts cognition is usually intact but insight and judgment may be impaired depending on the severity of their negative view of themsel and the world next let's discuss anxiety for anxiety if the patient anxieties extend to the management of their dress then they may

1:33 be meticulously groomed they may appear Restless fidgeting with their hands or tapping their feet and they may speak rapidly and include a lot of Superfluous detail the patient may describe their mood as nervous worried or simply anxious and their affect will appear worried below you can see an example of a worried affect note the wide open eyes and the furrowed brow the thought process may be circumstantial and over inclusive and the patient may need to be repeatedly redirected to the topic at hand unsurprisingly the thought content will include themes of worry cognition is usually intact but similar to depression insight and judgment may be impaired by the patient's High degree of anxiety next let's review Mania for Mania the patient grooming will often stand out in some way patients in a

2:19 manic state are likely to dress in brightly colored revealing or otherwise inappropriate clothing such as wearing sunglasses indoors or styling their hair in a wild manner their behavior is often disruptive or aggressive and they are easily distractable they have a characteristic kind of speech called pressured speech which is an endless stream of words that is almost impossible to interrupt they may use dramatic words to describe their mood such as fabulous ecstatic or on top of the world their affect is characteristically expansive which refers to a high level of euphoria and their affect may be highly labile switching rapidly between extreme states of emotion such as Elation anger and tearfulness below is an example of an angry affect a manic patient's thought process is extremely difficult to follow

3:06 and often described as flight of ideas their thought content often includes grandiose delusions such as beliefs about having superpowers or extreme superhuman accomplishments their cognition will be impaired often disoriented and inattentive and given their grandiose and delusional thoughts their insight and judgment are often very poor finally let's discuss psychosis psychosis is a highly debilitating condition and may lead to extreme states of dishevelment due to disorganized thought patterns these patients may also dress bizarrely such as wearing clothes on the wrong parts of the body or wearing non-clothing items patients with psychosis have impaired relatedness which refers to abnormalities in Social reciprocity such as limited use of non-verbal communication similarly their speech may

3:53 be brief and monotone lacking in the normal changes in tone that healthy individuals use to convey meaning and emphasis they may describe their mood with simple vague words but for those suffering from paranoid delusions they may instead convey fear or worry their affect is often flat showing no emotion and no reaction to stimuli an example of a flat affect is shown below their thought process may be grossly disorganized or may be impoverished meaning overall lacking in content but they may also endorse delusions most commonly paranoid delusions and referential delusions and may appear to respond to internal stimuli throughout the interview for example suddenly glancing at empty spaces in the room as though someone is there or speaking to themselves their cognition will be impaired and due to their delusional

4:39 thoughts their insight and judgment are often very poor that's the end of this talk getting good at the mental status exam requires a lot of practice so I've included some example interviews of actors displaying these psychiatric syndromes in the references thank you