It is important to note a patient’s gait.
On the other hand, psychomotor agitation may indicate that a patient is acutely under the influence of a stimulant or exhibiting manic behavior. A patient with depression or a neurocognitive disorder may have psychomotor retardation. This can be described as normal, psychomotor retardation/bradykinesia, or psychomotor agitation/hyperkinesia. One aspect of monitoring is the speed of movements. Furthermore, as the dopamine system targeted by medications plays a vital role in the movement, it is especially essential in monitoring for medication side effects. Motor activity can indicate an underlying mental illness or neurological disorder. This describes how a patient is moving and what kinds of movements they have. However, if in that same scenario, the patient was laughing and smiling throughout the interview, it would be considered inappropriate. For example, it can be considered appropriate for a patient who was brought in via police for involuntary evaluation to be irritable and not cooperative. Lastly, it is important to note if the behavior the patient is displaying is appropriate for the situation. Patients that are unable to be redirected often are acutely responding to internal stimuli or exhibit manic behavior. For example, is the patient cooperative, or are they agitated, avoidant, refusing to talk, or unable to be redirected? A patient that is not cooperative with the interview may be reluctant if the psychiatric evaluation was involuntary or are actively experiencing symptoms of mental illness. Next, a description of their interaction with the interviewer should be noted. If a patient is in distress it may be due to underlying medical problems causing discomfort, a patient having been brought against their will to the hospital for psychiatric evaluation, or due to the severity of their hallucinations or paranoia terrifying the patient. First, it is essential to note whether or not the patient is in distress. This is a description obtained by observing how a patient acts during the interview. If a certain level of trust has been established through the interview, the interviewer can ask about the significance of the tattoos or scars and what story they tell about the patient. They can also depict gang marks, vulgar imagery, or extravagant artwork. Tattoos often are the name of a family member, significant other, or lost loved one. Self-inflicted injuries frequently include superficial cutting, needle tracks from IV drug use, or past suicide attempts. Scars tell stories about old, significant injuries from accidental trauma, harm caused by another individual, or self-inflicted harm. Tattoos and scars can paint a picture of a patient’s history, personality, and behaviors. Those with poor grooming or hygiene may be severely depressed, have a neurocognitive disorder, or be experiencing a negative symptom of a psychotic disorder such as schizophrenia. Those with poor hygiene and grooming generally denote that in the context of their mental illness that they currently have poor functioning. Grooming and hygiene can give an idea of a patient’s level of functioning. Patients that look older than their stated age may have underlying severe medical conditions, years of substance abuse, or often years of poorly controlled mental illness.
If a patient looks more youthful than their stated age, they may have a developmental delay or dress in an age-inappropriate manner.
Details to be included are if they look older or younger than their stated age, what they are wearing, their grooming and hygiene, and if they have any tattoos or scars. It can be determined within the first seconds of clinical introduction as well as noted throughout the interview. This is a description of how a patient looks during observation. Each section below will detail the definition, the proper method of assessment, and how that information has a use in the diagnosis and monitoring of mental illness. Cognition can subdivide into different cognitive domains depending on what areas the practitioner determines necessary to assess. For the purposes of this activity, the mental status examination can be divided into the broad categories of appearance, behavior, motor activity, speech, mood, affect, thought process, thought content, perceptual disturbances, cognition, insight, and judgment. The mental status examination is organized differently by each practitioner but contains the same main areas of focus.
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