Based on the diagnostic hypotheses (generated, tested, and refined during history taking), the mental status examination, and the observation of family interaction, the inquiry plan proceeds to physical examination and, if required, to laboratory testing, special investigations, consultations, and psychological testing.
Figure 7–1 summarizes the flow of clinical reasoning from history taking, mental status examination, and the generation of diagnostic hypotheses, through physical examination and special investigations, the refinement of the clinical pattern, secondary diagnostic hypotheses, psychological testing, and the diagnostic conclusion, to the diagnostic formulation and treatment plan.
The process of clinical reasoning.
I. CHILD MENTAL STATUS EXAMINATION
PURPOSE OF THE CHILD MENTAL STATUS EXAMINATION
The child mental status examination is a set of systematic observations and assessments that provide a detailed description of the child's behavior during the diagnostic interview. Combined with the history and physical assessment, the mental status examination yields evidence that helps the clinician to refine, delete, or accept the diagnostic hypotheses generated during the diagnostic encounter and to decide whether special investigations are needed in order to test particular diagnostic hypotheses. Thus, the mental status examination is an integral part of the inquiry plan. In accordance with the diagnostic hypotheses and the inquiry plan, the mental status examination may be brief or comprehensive, but it always incorporates both standard and discretionary probes.
The mental status examination of the adolescent is similar to that of the adult (see Chapter 4). However, the examination of children is sufficiently different to warrant separate discussion. Many of the observations required to complete the mental status examination are made in the course of the semistructured interview with the child (see Chapter 7). Other observations, such as the clinical tests that screen cognitive functions, are part of a standardized set of questions.
AREAS ADDRESSED BY THE MENTAL STATUS EXAMINATION
Table 7–1 lists the areas covered by the mental status examination. For the most part, the first five areas are noted as the interview proceeds, whereas the last five require special questions.
Table 7–1Areas Covered by the Mental Status Examination |Favorite Table|Download (.pdf) Table 7–1 Areas Covered by the Mental Status Examination
Voice, speech, and language
Interaction with the examiner
Mood and affect
Note the following: height, weight, nutritional status; precocious or delayed physical maturation or secondary sexual characteristics; abnormalities of the skin, head, facies, neck, or general physique; personal hygiene and grooming; and style and appropriateness of dress.
Observe the following: general level of physical activity (e.g., hyperkinesis, hypokinesis, ...