Mental Basic Examination at the first meeting (mbe)
The interview here
outlined, which some European schools of psychiatry call assessment of
present basal psychic functioning, is intended to provide a snap shot
of the patients, a picture of them as they exist at one point in time. In fact,
frequently several interactions are required, along with information about the
patient's usual level of function, bias in reactions and communications, before
you can come to any meaningful conclusions about their current condition. It is
not conceived as a substitute of a psychiatric evaluation or the part devoted
to the mind in the interview performed by neurologists, it is rather a guidance
for young practitioners as well as non-specialists, and may be employed as a
During the course of a
common interview, in actual practice, most of the information relevant to
assess a patientís mental status is obtained indirectly. MBE, as a mind-bending
of the aspects to test, provides a list of relevant issues to consciously
think. It is a tool for self-training and a help for memory, because it
prepares your mind to organize explicit memories into discrete
†In the daily practice of clinical psychology
or medicine and even throughout all of our interactions, we continually come
across persons who have altered capacity for memory, slightly or significantly
impaired cognitive abilities, disordered thought processes and otherwise
abnormal mental status.
The goal of the present protocol is to help to note
when these abnormalities exist, avoiding that they might be missed and then to
categorize them as specifically as possible. Sometimes physical conditions, as
well as personality impairments or depressed level of consciousness, will
preclude a complete, ordered evaluation of mental status, so flexibility is
important. MBE is not tailored for the formulation of actual diagnoses (e. g.
in DSM categories), which is the final step in a process starting by this
protocol. Nevertheless, sometimes MBE can provide a provisional definition of a
condition, as for Delirium Syndrome and Dementia.†
Mental basic examination
- Appearance: How does the patient look?
Neatly dressed with clear attention to detail? Well groomed?
- Orientation or awareness of
Do they know where they are and what they are doing here? Do they know who
you are? Can they tell you the day, date and year?
- Level of alertness and self
the patient conscious? If not, can they be aroused? Is the patient aware
of self-appearance, congruous or inadequate? Is the patient insight
defective? Can they remain focused on your questions and conversation?
What is their attention span?
- Mood: How do they feel? You may ask
this directly (e.g. "Are you happy, sad, depressed, angry?"). Is
it appropriate for their current situation?
- Affect: How do they appear to you?
This interpretation is based on your observation of their interactions
during the interview. Do they make eye contact? Are they excitable? Does
the tone of their voice change? Common assessments include: flat
(unchanging throughout), excitable, appropriate.
- Behaviour: Pleasant? Cooperative?
Agitated? Appropriate for the particular situation?
- Speech: Is it normal in tone, volume
- Memory: Short-term memory is
assessed by listing three objects, asking the patient to repeat them to
you to insure that they were heard correctly, and then checking recall at
5 minutes. Long-term memory can be evaluated by asking about the
patientsí job history, where they were born and raised, family history,
- Ability to perform
Can they perform simple addition, multiplication? Are the responses
appropriate for their level of education? Have they noticed any problems
balancing their check books or calculating correct change when making
- Thought Process: This is a description of the
way in which they think. Are their comments logical and presented in an
organized fashion? If not, how off base are they? Do they tend to stray
quickly to related topics? Are their thoughts appropriately linked or
simply all over the map?
- Thought Content: A description of what the
patient is thinking about. Are they paranoid? Delusional (i.e. hold
beliefs that are untrue)? If so, about what? Phobic? Hallucinating (you
need to ask if they see or hear things that others do not)? Fixated on a
single idea? If so, about what. Is the thought content consistent with
their affect? If there is any concern regarding possible interest in
committing suicide or homicide, the patient should be asked this directly,
including a search for details (e.g. specific plan, time etc.). Note:
These questions have never been shown to plant the seeds for an otherwise
unplanned event and may provide critical information, so they should be asked!
- Judgment: Provide a common scenario and
ask what they would do (e.g. "If you found a letter on the ground in
front of a mailbox, what would you do with it?").
- Higher cortical functioning and
Involves interpretation of complex ideas. For example, you may ask them
the meaning of the phrase, "People in glass houses should not throw
stones." A few common interpretations include: concrete (e.g.
"Don't throw stones because it will break the glass"); abstract
(e.g. "Don't judge others"); or bizarre.
referred to as Altered Mental Status, Delta MS, Acute Confusional State, or
Toxic Metabolic State. This is a very common condition (particularly among
hospitalized patients) notable for an acute, global change in mental status
that can be the result of physiologic derangement anywhere within the body.
Causes include: infection, hypoxia, toxic ingestion, impaired ability of the
body to handle endogenously produced toxins (e.g. liver or kidney failure),
a wide spectrum of presentations, ranging from unarousable to extremely
agitated. Patients may appear quite ill, with markedly abnormal vital signs
that in themselves can suggest the cause of the delirium (e.g. hypotension,
infection). They are frequently confused, disoriented, agitated and
uncooperative. Formal evaluation of mood, affect, memory, judgment or insight
can be hopeless. Thought process is disordered and content notable for
delusions, paranoia and hallucinations. In general, the diagnosis is suggested
by the time course of the illness (i.e. the change is acute).
is dictated by the underlying insult, which can generally be determined after a
detailed history (usually with the help of others who are familiar with the
patient), review of medications, thorough examination, and appropriate use of
lab and radiological testing. The elderly as well as those with multiple
medical problems (conditions which frequently coexist) are at the highest risk
for developing this condition. Delirium in this patient sub-set can be provoked
by seemingly minor precipitants. Initial presentation of psychotic disorders as
well as dementia can be mistaken for delirium (and vice versa). This can only
be sorted out with time and appropriate testing, though these distinctions are
A final common pathway for multiple disorders
characterized by its slow, progressive nature, taking months to years to
develop. While quite uncommon under 50, the incidence increases markedly with
appearance and behaviour vary with the extent of involvement. This ranges from
well groomed, alert and cooperative to agitated, unable to care for themselves
and incapable of answering even simple questions. Mood and affect can range
widely, and may or may not be appropriate for the given situation. Thought
process and content have similar variability. Memory, judgment and higher
cortical function deteriorate with time. As this is a progressive disease,
presentation will depend on the level of advancement. Contributions from other
acute, reversible medical problems must be ruled out on the basis of history,
examination and laboratory testing.