Appearance, behavior, cognition, and thought processes
The four main areas that must be addressed when assessing mental status are appearance, behavior, cognition, and thought processes. Mood, affect, and consciousness are part of behavior and orientation is part of cognition, as are memory and attention. Perception, orientation, and attention are part of thought content; language is an aspect of speech, which is part of appearance. Abstract reasoning is used for assessing higher intellectual function but is no longer part of the general assessment.
His level of consciousness is best described as stuporous. A person in a stupor responds only to persistent and vigorous shake or pain; has appropriate motor responses (i.e., withdraws hand to avoid pain); can only groan, moan, or move restlessly; and has intact reflexes. Delirium/delirious is used to describe someone who has clouding of consciousness (dulled cognition, impaired alertness); is inattentive; has incoherent conversation; has impaired recent memory and is confabulatory for recent events; is often agitated and having visual hallucinations; and is disoriented, with confusion worse at night when environmental stimuli are decreased. Lethargic is used to describe someone who is not fully alert, drifts off to sleep when not stimulated, can be aroused to name when called in a normal voice but looks drowsy, responds appropriately to questions or commands but whose thinking seems slow and fuzzy, is inattentive, loses train of thought, and whose spontaneous movements are decreased.
Flight of ideas
This patient response is an example of flight of ideas, which is an abrupt, rapid skipping from topic to topic in a practically continuous flow of accelerated speech; topics usually have recognizable associations or are plays on words. Word salad refers to an incoherent, illogical, disconnected mixture of words, phrases, and sentences, including neologisms. Echolalia, obsession, circumlocution and delusion are abnormalities of thought process. Echolalia is imitation, the repetition of another's words or phrases, often with a mumbling, mocking, or mechanical tone. Loosening associations is shifting from one topic to another unrelated one with a seeming lack of awareness of the unrelatedness.