CASE # 5: Mental Status Exam A middle-aged man enters your room. He is breathing
ID: 138282 • Letter: C
Question
CASE # 5: Mental Status Exam
A middle-aged man enters your room. He is breathing a little erratically and somewhat quickly. You notice he is wearing a women’s light raincoat although it is a beautiful day outside. His hair is disheveled, and he has a 5:00 shadow (stubble is evident). He seems to be in average physical condition; you notice his stomach when he takes off his coat. He nervously accepts your offer to sit. As he sits down, you notice his socks do not match and his shoes have mud on them. He does not seem comfortable in the chair and he continues to shift himself around while sitting.
He makes eye contact with you but never for very long. His eyes are moving around appearing to be scanning your office. You ask him how you can be of help. His conversation moves like his eyes. He begins to speak very quickly, “thanks so much for seeing me. I really appreciate it”. He thanks you several times again. “I don’t know where to begin” he says. You have difficulty following his train of thought and several times you need to ask questions to make sense of what he is saying. “Well you see, it’s my wife, and my job, well, it’s not god, but it’s not dead yet, but my wife…” his voice raises as he speaks, then he becomes quiet and mumbles to himself.
“I feel agitated all the time. I can’t ever relax, I feel like I am just wound up so tightly right now,” he shares with you. As the interview progresses, he seems to settle down a bit, but he shares he is usually uptight. “I can’t get the business out of my mind,” he says. “It is so close to doing great. Do you know anything about the communications field?” he asks you. “This is so big! It’s going to revolutionize the communication industry.” You are silent, but he continues on. “I am starting at the ground floor of an emerging market that will transform how we all think about communication! My wife just doesn’t see it that way.” He shares his story of how the business started and how he met his wife. “I remember when I first met her just after college.” “I couldn’t understand what she saw in me, but I guess I tricked her into marrying me.” “I was never very attractive or athletic and the girls were never lining up to see me, but she really liked me.”
You learn he is a small business owner of two years, about to declare bankruptcy. His wife left him two weeks ago and he has been staying at the YMCA since then. He lost his jacket and borrowed his secretary’s upon leaving work because he heard it was going to rain. He asks if you are able to prescribe medications. He states he has an important meeting to make at 4 pm., so he needs to be going. “You’re a really good listener”, he says on his way out. “I’ll see you next time.”
Based on the above vignette for Case #5, complete the Mental Status Exam form that can be found on the student answer sheet.
Appearance & Behavior
Age
Grooming
Posture
Psychomotor Activity
Attitude
Cooperation
Speech
Emotions
Mood
Affect
Thought
Content
Process
Suicidal ideation
Homicidal ideation
Cognitive Functions
Orientation
Memory
Attention/Concentration
Insight & Judgment
Appearance & Behavior
Age
Grooming
Posture
Psychomotor Activity
Attitude
Cooperation
Speech
Emotions
Mood
Affect
Thought
Content
Process
Suicidal ideation
Homicidal ideation
Cognitive Functions
Orientation
Memory
Attention/Concentration
Insight & Judgment
Explanation / Answer
Appearance and behavior
Age- Middle aged
Grooming- Disheveled and unkempt on presentation
Posture- normal but with protruded abdomen
Psychomotor activity- Agitated and restless, frequently changing seats, lack of eye contact.
Attitude- Impatient and thankful
Cooperation- cooperative
Speech- loud pressured followed by mumbling
Emotions
Mood and Affect- Labile but appropriate to content of his speech, appeared anxious and irritable.
Thought
Content- He exhibited loosening of association and flight of ideas. He intermittently and unpredictably shifted topic of conversation from bussiness to wife.
Suicidal and homicidal ideation- No suicidal or homicidal ideation present.
Cognitive function
Orientation- Oriented to time and place, but claimed
Memory- Not impaired
Attention and concentration- Deficient, preoccupied with ideas of bussiness and wife.
Insight and judgement
He is unreliable and exhibited poor judgement, Insight present as he asks for medications.
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