I.

MENTAL STATUS
EXAMINATION
IDENTIFICATION DATA OF PATIENT
 Name: Mrs Sukhjinder Kaur
 Age: 45 years
 Sex: Female
 Religion: Hindu
 Marital Status: Married
 Educational Status: Uneducated
 Occupation: Tailor
 Income Per Month: Nil
 Languages Known: Hindi
 Ward: OPD
 Diagnosis: Sleep Disorder
 Address: Mauli Jagran
 Date of Admission: 20th August, 2021
 Informant: Mr. Kamaljit Virk
 Relationship with Patient: Husband
 Reliability of information: Yes

A. General Appearance:-
 Facial expressions were inappropriate to the subject under discussion. Patient
looked anxious. Patient did not show any elation or uncontrolled laughter,
depressed or vacant gaze.
 Posture:- Patient’s posture was stiff
 Mannerisms were present in client. She repeatedly blinked her eyes. repeated
small movements of a habitual kind under stress
 Dress:- patient was dressed with normal neatness. And the clothes were
appropriate to the season and the occasion.

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  Hygiene:- the patient was clean, her hair were combed, and finger nails were
cut.
 Physical Features:- Patient looked one’s age
B. Motor Disturbances:-
a. Overactivity or hyperactivity:-
Increased Motor activity -
There are two main types of excessive activity or hyperactivity.The activity is not well
organized and it is purposeless.
 Excitement/stupor
 Abnormal involuntary movements like tics, tremors,akathisia, restlessness/ill at ease
 Compulsive acts, rituals or habits
 Catatonic signs
 Mild restlessness present in client.
b. Underactivity or motor retardation:- -It is decreased psychomotor activity means
the patient takes too long to start the activity.
Inference-Absent in client
c. Stupor:- She is fully conscious, does not remain in one position for hours at a time.
d. Stereotype: - No stereotype present.
e. Compulsive movements or compulsion:- Blinking of eyes present
f. Echopraxia:- Absent in client
g. Negativism: - Patient is cooperative
h. Automatic obedience: - Not present in client

DISORDERS OF SPEECH (DISORDERS OF THOUGHT)

There are three aspects of disorders: -

 Disorders of form of thought

 Disorders of content of thought
 Disorders in rate of speech

I. DISORDERS OF FORM OF THOUGHT:-

(a)Circumstantiality:-
: The client provides unnecessary detail but gets to the point eventually

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 Patient- Mai yaha apne ilaj krvane ayi hu.. mujhe aisa lgta hai koi mujhe maarna
chahta hai.. Inference- Circumstantiality is absent

(b.)Tangential Thinking:- It is same as circumstantiality except that the goal is never

reached. The client moves from one related thought to the next but never reaches the point.

Nurse- Aapne aaj nashte me kya lia?

Patient- Mai aaj hospital aayi hu
Inference- Tangential thinking is present
(C)Incoherence:-
Nurse- Wo do log kya kar rhe hain?
Patient- Mujhe kya malum. Baat kr rhe honge
Inference- Incoherence is absent
Irrelevant :- When the patient does not answer appropriately to the action.
Nurse- Humara rashtriya sangeet konsa hai?
Patient- Jana Gana Mana
Inference- Irrelevant speech is absent

Neologism :-
Nurse- Aapke Parivar me kon kon hai?
Patient- Mere Parivar me mai, mere pati or do bache hain
Inference- Neologism is absent
Word salad: words put together in a completely incoherent manner, e.g “The purple
Christmas fish road living pie.” I’ve seen this term co-opted by the online narcissistic abuse
community, but the meaning that’s been assigned to it in that context is not the same as the
psychiatric meaning.
Inference-Word salad making is absent in client
a. Perseveration:- No repetition of a specific word or idea which persists inspite of
patients efforts to move on to new idea.
i. Ambivalence or Ambivalent Ideas:- No two contradictory ideas, emotions, attitudes
or wishes exist in the mind of patient and they are allowed to exist without the rejection of
either.

Re-evaluation of Speech should include:

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 i. Intensity:- patient’s voice was normally audible
ii. Pitch:- the voice was monotonous
iii. Speed :- the usual rate of speed was normal
iv. Spontaneity :- she respond only when questions were put to him or was he mute.
v. Manner:- the manner of speaking was relaxed
vi. Reaction time:- was appropriate

DISORDERS IN THE CONTENT OF THOUGHT

a) Delusions :- Delusional disorder, previously called paranoid disorder, is a type of serious

mental illness — called a “psychosis”— in which a person cannot tell what is real from what
is imagined. The main feature of this disorder is the presence of delusions, which are
unshakable beliefs in something untrue.

The various types of Delusions

 Persecutory Delusions:- This refers to the belief that you or someone close to you is
being unfairly mistreated, harmed, or watched. The conviction is so strong that the
person may seek help from the authorities.
Nurse- Kya aapko lagta hai ki aapko kisi chiz se khatra hai?
Patient- han mujhe lgta hai mujhe koi maarna chahta hai
Inference- Persecutory delusions present in client

 Delusions of Reference:- : This refers to the belief that something like a poster, song,
or advertisement has a direct reference to or a hidden meaning for you. A person with
this delusion may see a sign that has nothing to do with them, but change their whole
life plan as a result.

Nurse- Kya aapko lagta hai ki apke bare me log baat karte hain?
Patient- nahi mujhe aisa nahi lgta
Inference- Delusion of reference absent in client.
 Delusions of Influence or Passivity:-
Nurse- Kya aapko lagta hai ki apse kisi ki dushmani hai or aapko koi kaabu
me rkh rha hai ?
Patient- han mujhe lgta hai mujhe koi maarna chahta hai

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 Inference- Delusion of Influence present in client

 Delusions of Sin & Guilt:- This refers to unwarranted and extreme feelings of
remorse or a severe sinking feeling that you’ve done something horribly wrong.

i.
Nurse- Kya aapko lagta hai ki aapne koi aisa kaam kia hai jiski aapko mafi
nahi mil skti ?
Patient- nahi mujhe aisa nahi lagta
Inference- Delusion of sin and guilt absent in client.
 Hypochondrial Delusions (Delusions of Bodily Disease):-
Nurse- Kya aapko lagta hai ki aapne koi aapko koi bimari hai?
Patient- nahi mujhe aisa nahi lagta
Inference- Delusion of bodily disease absent in client.

 Delusions of Grandeur:- Delusional beliefs of great power, wealth and influence. A

person with this type of delusional disorder has an over-inflated sense of worth,
power, knowledge, or identity. The person might believe he or she has a great talent
or has made an important discovery.

Nurse- Kya aapko lagta hai ki aapke pas bahut paisa hai or taakat hai ?
Patient- aisa nahi hai
Inference- Delusion of grandeur absent in client.

 Nihilistic Delusions:- This is the belief that you or parts of you do not exist, or that
some object in external reality is not actually real.

Nurse- Kya aapko lagta hai ki dunia me ab kuch bhi nahi bacha hai or apke
shirr me ab kuch nahi reh gya hai ?
Patient- nahi mujhe aisa nahi lagta
Inference- Nihilistic Delusions absent in client
b. Obsessions :- Blinking of eyes present in client
c. Phobia:-
Nurse- Kya aapko kisi chiz se darr lgta hai?
Patient- mujhe koi maar na de bus yahi darr hai

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 Inference- Phobia present in client
d. Preoccupation:- Day dreaming, fantasy absent in client

DISORDERS OF RATE OF SPEECH

a. Pressure of Speech:- Under activity seen in client
b. Flight of Ideas:- There is no tendency of the patient to start talking on one
subject and then switch to another and then to another with little
connection between them.
2. Retardation :- Slowing of speech absent .
2. Mutism:- Not present
2. Aphonia:- Not present
2. Thought Block:- The patients thought and speech are proceeding at an
essentially average rate but are very suddenly and completely interrupted in the
middle of a sentence,
3. Clang Association:- Not present

DISORDERS OF PERCEPTION

 Auditory Hallucinations:- These are when someone hears something that is not
there, such as a voice or radio.

Nurse- Kya aapko aawaze sunayi deti hain ?

Patient- nahi
Inference- auditory hallucinations absent in client

 Visual Hallucinations:- These cause someone to see something that is not real, such
as a person or animal.

Nurse- Kya aapko kuch dikhayi deta hai ?

Patient- nahi
Inference- visual hallucinations absent in client

 Olfactory Hallucinations:- These can occur when a person smells something that is
not there.

Nurse- Kya aapko ajib smell ati hain ?

Patient- nahi

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 Inference- olfactory hallucinations absent in client
 Gustatory Hallucinations-: These cause someone to taste something they did
not eat.
Nurse- Kya aapko kizi ajib chiz ka taste aata hai?
Patient- nahi
Inference- gustatory hallucinations absent in client
 Tactile Hallucinations:- Involving the sense of touch e.g. crawling of ants on
the body.
Nurse- Kya aapko aisa lgta hai ki aapke shrir pr chintiya chal rhi hain ?
Patient- nahi
Inference- tactile hallucinations absent in client
 Hypnogogic Hallucinations:- False sensory perception occurring including
between falling asleep and being awake.
Nurse- Kya aapko sote wqt aur uthne se pehle aisa lgta hai kuch apke as pas hai?
Patient- nahi
Inference- hypnogogic hallucinations absent in client
 Lilliputian Hallucination:-
Nurse- Kya aapko aisa lgta hai ki jo apke aas pas pdi hui chizen hai wo choti ho rhi
hai?
Patient- nahi
Inference- lilliputian hallucinations absent in client
DISORDERS OF MEMORY

 Immediate:-
Nurse- mai aapko kuch chizo k naam btati hu.. aap mujhe firse batein- seb, santra,
table chair, kitab
Patient- seb, santra, chair, table, kitab
Inference- Immediate memory intact

 Recent:- Ability to recall events that happened in the last 24 hours. E.g. what he had
to eat at dinner.
Nurse- aapne kal rat nashte me kya khaya ?
Patient- bhindi aur roti
Inference- Recent memory intact

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  Dija Vu:-
Nurse- Kya aapko aisa lgta hai ki aapne kisi aisi chiz ya insan ko pehle b kahi dekha
ho aur ye yaad na ho ki aap kisi jagah gaye ho aur apko yad na ho
Patient- han kabhi hota hai
Inference- Dija vu present in client
 James Vu:-
Nurse- apko kbhi aisa mehsoos hua ki aapke sath kuch ghanta hui nahi hai pr apko
lgta hai ki hui hai
Patient- nahi
Inference- James vu absent in client
False feeling of unfamiliarity with  a real situation one has experienced.
o Orientation:-

Nurse- aaj kya Tarikh hai?

Patient- aaj 18 september hai
Inference- patient is oriented to date
Nurse- ye konsi jagah hai?
Patient- ye 16 ka hospital hai
Nurse- ye jo apke sath aye hai wo kon hai?
Patient- ye meri beti hai
Inference- patient is oriented to time, place and person
 Insight:-
Nurse- kya aapko pta hai apko kya bimari hai?
Patient- Mujhe pta hai mujhe kuch nahi hua hai .. or mere ghrwle mujhe yaha leke
aaye hain
Inference- Patient’s insight is not intact
 Abstract Thinking:- 
Nurse- table or chair me kya antar hai ?
Patient- malum nahi
Inference- abstract thinking not intact.

 Sleep:- Patient has temporary insomnia

General observation:- Patient does household work, sleeps on time, takes nap in the
afternoon.

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Episodic Disturbances:- No episodic disturbances  

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