The Neuropsychiatric Mental Status Examination

ABSTRACT

Neuropsychiatric disorders can cause a wide range of effects. Many aspects of behavior, cognition, and personality can be impacted. This article illustrates sensitive interview techniques for obtaining structured pertinent information to capture the effects of neuropsychiatric disorders. It then goes on to explain the components of the cognitive evaluation, with an emphasis on the hierarchical nature of cognition. It includes practical comments about evaluating cognitive dysfunctions, along with recommendations regarding the use of practical batteries. The mental status examination is then presented in detail, including nuances in assessing activity, mood, and perceptual disturbances. The manuscript content provides a template for the overall evaluation of neuropsychiatric patients.

KEYWORDS

Mental status - cognition - behavior

REFERENCES

• 1 Lishman W A. Organic Psychiatry: The Psychological Consequences of Cerebral Disorder. 3rd ed. London, UK; Blackwell 1998
• 2 Zeman A. Consciousness.  Brain. 2001;  124(Pt 7) 1263-1289
• 3 Cummings J L. The one-minute mental status examination.  Neurology. 2004;  62(4) 534-535
• 4 Ross E D, Mesulam M M. Dominant language functions of the right hemisphere? Prosody and emotional gesturing.  Arch Neurol. 1979;  36(3) 144-148
• 5 Budson A E, Price B H. Memory dysfunction.  N Engl J Med. 2005;  352(7) 692-699
• 6 Dubois B, Feldman H H, Jacova C et al.. Research criteria for the diagnosis of Alzheimer's disease: revising the NINCDS-ADRDA criteria.  Lancet Neurol. 2007;  6(8) 734-746
• 7 Solomon P R, Hirschoff A, Kelly B et al.. A 7 minute neurocognitive screening battery highly sensitive to Alzheimer's disease.  Arch Neurol. 1998;  55(3) 349-355
• 8 Shin M S, Park S Y, Park S R, Seol S H, Kwon J S. Clinical and empirical applications of the Rey-Osterrieth Complex Figure Test.  Nat Protoc. 2006;  1 892-899
• 9 Nasreddine Z S, Phillips N A, Bédirian V et al.. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment.  J Am Geriatr Soc. 2005;  53(4) 695-699
• 10 Dubois B, Slachevsky A, Litvan I, Pillon B. The FAB: a Frontal Assessment Battery at bedside.  Neurology. 2000;  55(11) 1621-1626
• 11 Royall D R, Mahurin R K, Gray K F. Bedside assessment of executive cognitive impairment: the executive interview.  J Am Geriatr Soc. 1992;  40(12) 1221-1226
• 12 Borson S, Scanlan J M, Chen P, Ganguli M. The Mini-Cog as a screen for dementia: validation in a population-based sample.  J Am Geriatr Soc. 2003;  51(10) 1451-1454
• 13 Folstein M F, Folstein S E, McHugh P R. “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician.  J Psychiatr Res. 1975;  12(3) 189-198
• 14 Rogers D. Bradyphrenia in Parkinson's disease. In: Huber SJ, Cummings JL Parkinson's Disease: Neurobehavioral Aspects. New York, NY; Oxford University Press 1992
• 15 Fink M, Taylor M A. Catatonia: A Clinician's Guide to Diagnosis and Treatment. Cambridge, UK; Cambridge University Press 2003
• 16 Klein D F. Endogenomorphic depression. A conceptual and terminological revision.  Arch Gen Psychiatry. 1974;  31(4) 447-454
• 17 Moore D P. Textbook of Clinical Neuropsychiatry. 2nd ed. London, UK; Hodder Arnold 2008
• 18 Levy R, Dubois B. Apathy and the functional anatomy of the prefrontal cortex-basal ganglia circuits.  Cereb Cortex. 2006;  16(7) 916-928
• 19 Norris K. Acedia and Me: A Marriage, Monks, and a Writer's Life. New York, NY; Penguin 2008
• 20 Schiffer R, Pope L E. Review of pseudobulbar affect including a novel and potential therapy.  J Neuropsychiatry Clin Neurosci. 2005;  17(4) 447-454
• 21 Faber R, Reichstein M B. Language dysfunction in schizophrenia.  Br J Psychiatry. 1981;  139 519-522
• 22 Faber R, Abrams R, Taylor M A, Kasprison A, Morris C, Weisz R. Comparison of schizophrenic patients with formal thought disorder and neurologically impaired patients with aphasia.  Am J Psychiatry. 1983;  140(10) 1348-1351
• 23 Hamilton M Fish's Clinical Psychopathology. 2nd ed. Bristol, UK; Wright 1985
• 24 Devinsky O. Delusional misidentifications and duplications: right brain lesions, left brain delusions.  Neurology. 2009;  72(1) 80-87
• 25 Hamilton M Fish's Schizophrenia. 3rd ed. Bristol, UK; Wright 1984
• 26 Cloninger C R. Feeling Good. Oxford, UK; Oxford University Press 2004
• 27 Benson D F. The Geschwind syndrome.  Adv Neurol. 1991;  55 411-421
• 28 Rush A J, Trivedi M H, Ibrahim H M et al.. The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression.  Biol Psychiatry. 2003;  54(5) 573-583
• 29 Hamilton M. Development of a rating scale for primary depressive illness.  Br J Soc Clin Psychol. 1967;  6(4) 278-296
• 30 Montgomery S A, Asberg M. A new depression scale designed to be sensitive to change.  Br J Psychiatry. 1979;  134 382-389
• 31 Cummings J L, Mega M, Gray K, Rosenberg-Thompson S, Carusi D A, Gornbein J. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia.  Neurology. 1994;  44(12) 2308-2314
• 32 Reisberg B, Borenstein J, Salob S P et al.. Behavioral symptoms in Alzheimer's disease: phenomenology and treatment.  J Clin Psychiatry. 1987;  48(suppl) 9-15