Mental Health Review of Systems (ROS)

Constitutional = General + VITALS: BP: Pt. perception of health SIGECAPS: Sleep Increase during day Decrease during nite Interests Loss of interest Guilt (worthless) I. Appearance, Behavior & Attitude: Appearance: Physical characteristics Apparent age Peculiarity of dress Cleanliness Use of cosmetics Motor Status: posture Stooped erect Slouched Gait Shuffling staggering Stiff Awkward gestures tics grimacing extremities limp rigid tremors catalepsy picking at body mannerisms (stereotyped gestures) Activities: overactive underactive goal purposeful disorganized stereotyped graceful echopraxia (mimics) / , HR b/m, Resp: ,Temp: F, Ht: Energy (lack of) Easily fatigued Cognition reduced &/ or Concentration difficulties Appetite / wt loss or gain Decreased Increased (rare) Wt: lbs/ k, BMI:

Psychomotor Anxiety Lethargy Suicidal ideations / preocp with death

Facial expression: alert tense worried sad happy dreamy frightened in pain angry sneering ecstatic laughing smiling suspicious

Facial expression: indifferent frank friendly embarrassed seeking help evasive afraid resentful sullen angry irritable assaultive erotic negativistic denudative exhibitionistic dramatic impulsive

JDE: Rev. 05-11-2013

Page 1

Mental Health Review of Systems (ROS)

II. Characteristics of Talk Speech: soft loud stuttering hesitant accent enunciation Methodist episcopal Liquid linoleum Third royal riding artillery brigade Speech & Quantity Rate Varies with topic Varies with affect Relationship with motor activity talkativeness under talkative over talkative Delay in answering Intellectual deficiency fear suspicion language difficulty Talk Coherent incoherent logicalness Yes toward definite goal-ideas Illogical vague and loosely organized scattered stream of speech extreme = verbigeration: word salad neologisms (words or phrases) Blocking: sudden stop w/o external reason pt unable to account for block affectively charge topic delusional thoughts hallucinatory phenom Circumstantiality: Unnecessary detail given spontaneously Voluble (talkative) Not direct (lacks incisiveness) BUT GOAL REACHED Preservation: Repetition of speech or movement Despite pt. efforts to produce a new answer Flight of ideas: fragmented connections by association of fragments influenced by stimuli external internal GOAL (answer Q) NOT REACHED Punning Rhyming Clang association (alliteration) distractibility Mutism: indicates contact awareness of environment

Substitution: related words instead of definitive term III. Emotional State: Affective reaction: Objective Facial expression Motor behavior Tears Respiratory irregularities States of excitement Fear depression Relationship with examiner hostility suspiciousness flirtatiousness desire for bodily contact outspoken criticism Subjective How are you feeling? For general answers ask How does that affect you? Emotional trend established Depth / intensity Persistence Record verbatim response re: mood Relationship between mood & content of thought divergence How? Page 2

JDE: Rev. 05-11-2013

Mental Health Review of Systems (ROS)

Intense emotional response to subject? Flattening of affect? Dissociation or disharmony Silly instead of serious Simulation or play-acting Match other medical prof notes? Specify the ease with which pt. emotions fluctuate in response to pleasant or unpleasant stimuli Composed Complacent Frank Friendly Playful Teasing Silly Cheerful Boastful Elated Grandiose Ecstatic Tense Worried Anxious Pessimistic Sad Perplexed Bewildered Gloomy Depressed Frightened Aloof Superior Disdainful Distant Defensive Suspicious Irritable Resentful Hostile Sarcastic Angry Furious Indifferent Resigned Apathetic Dull affectless Emotional deterioration Easily suggestible state Progressive failure to show normal emotional response Specify instances indicating:

IV. Content of Thought: Special preoccupations and experiences Page 3 Main topics of complaint Ask: Why did you come to the hospital? Or Have you been ill or troubled in any way? Or Do you have any difficulties that you complain of? Physical complaints

Emotional complaints

Evasive topics?

Delusion (belief not correctable by reason) of Reference or persecution Ask: How have others been treating you? Do people like you? Have you ever been watched or spied upon? Have you ever been singled out for special attention? Do others have it in for you? What do they say or do?

JDE: Rev. 05-11-2013

Mental Health Review of Systems (ROS)

Delusions of alien control (passivity) Do you ever feel your thoughts or actions are under any outside influences or control? How do you become aware of it? Have you ever been hypnotized? Is your mind controlled by thought-waves, electricity or radio-waves? Have you ever felt thoughts in your mind which were not your own? Are you able to influence others, to read their minds or to put thoughts in their minds? Delusions of strange experiences Have you had any unusual experiences? Have you received strange messages? Have you been in communication with a god or the virgin Mary? Have you received any messages from heaven? Delusions of nihilism (nothing exists) Nothing exists Missing body parts Cannot die Eternal life Delusions of self-depreciation often with severe depression unworthiness sinfulness ugliness emitting obnoxious odors punishment or torture due Have you tended to feel responsible or to blame yourself for you illness, difficulties or situations? Why? Delusions of grandeur Great wealth Strength Power Sexual potency Identification with a famous person Identification with the Lord Delusions of somatic issues Cancer Lues (???) as in venereal disease? Obstructed bowels JDE: Rev. 05-11-2013 Leprosy Some horrible disease Hallucinations From outside From inside Clarity and distinctiveness of perception Intensity? Other senses: Auditory Visual Olfactory Gustatory Tactile Are you sensitive to noise? Do the noises in your head or ears disturb you? Do you have a vivid imagination? Tell me what happened? Do you hear your own thoughts as if a voice were speaking? With visual: Do you dream vividly? Do you ever have such visions when you are awake? Have you seen anything unusual? Feeling of unreality Do things seem natural or real to you? Do people, trees, etc. look as always to you? Depersonalization Do you feel natural? Are you aware of any change in yourself? Does your body feel changed or unreal or strange? Obsessions Do you have thoughts you cant get rid of? Do you find yourself thinking of things and cant stop or are you ever aware of thoughts, words, phrases or tunes going round and round in your mind and you find yourself unable to control them?

Compulsions Do you feel compelled to do certain acts or perform certain rituals? Do they seem reasonable to you? Do you feel uncomfortable until they are done, even though you may know them to be foolish or unimportant? Repetitive hand washing Dressing in a certain order Locking and relocking doors repeatedly Tapping on all wooden objects a certain number of times Fluctuations in kinds of compulsions Page 4

Mental Health Review of Systems (ROS)

Meaning to these acts? Phobias (objects or situations) that lead to avoidance trains Subways Elevators Close spaces Crowds Open spaces Fantasies and daydreams Do you ever imagine yourself going situations before you meet them? Do you ever have any thoughts as to what you would do if you were very powerful or rich? Just how would you change yourself or the world or both if you could? Try to evaluate whether the emotional reaction is primary and mental trend is secondary to the affective stateor vice versa V. Orientation Patients ability to grasp the significance of his immediate situation Clearness of conscious processes Toxic or organic factors??? A&O x 4 Person: recognize doctor, nurse Place: city of domicile Time: hour/ weekday / date Self: who are you? Have you kept track of the time? If so, what is todays date? VI. Memory Immediate retention/recall Recent past Remote past Defect Variable constant is amnesia a time period more extensive confabulation (fabricate memories) Has your memory been good? Have you had any difficulty in concentrating or in remembering what you read? Difficulty with phone numbers, appts times, etc. JDE: Rev. 05-11-2013 RECALL of remote past experiences (life hx) Time and place of birth Schools attended Occupational hx Date of marriage Number of children Childrens ages Chronological data related to past illnesses Recall of RECENT past experiences (present illness) Events leading to hospitalization When they came to hospital When they quit work Which docs and nurses he has met What examinations What treatments Recall of IMMEDIATE impressions (retention) Ability to retain a persons name after intro Give three unrelated facts / repeat now & 5 min Name Color Street address Repetition of digits 5-9-4-1 6-5-2-8 7-3-0-8 4-2-7-5 9-6-8-1 1-3-9-4 5-4-6-2 8-5-4-9 4-7-1-6 General grasp and recall Read story aloud and repeat the gist with as many details as possible Give pt. the cowboy story at end of form Details: Cowboy Arizona San Francisco dog, left at a friends purchased a new suit of clothes. Dressed in the new suit, he went back to the dog; whistled to him, called him by name and patted him. nothing to do with him in his new hat and coat, mournful howl. Page 5

Mental Health Review of Systems (ROS)

Coaxing had no effect, cowboy went away and donned his old garments. dog immediately showed his wild joy on seeing his master What is the difference between a dwarf and a child? What would you do with $10,000 if it were given to you? (Dont allow your own bias to enter into the evaluation of reasoning ability) VII. Insight Try to determine whether the pt. understands and realizes the significance of sx and the situation in which they find themselves Do they consider themself ill or not What do you make of this whole situation? Is there an explanation for your symptoms? Offered by doc, friends or relatives Do you accept these explanations? Do you have any suggestions for your treatment? Knows they are ill Not ill Something wrong (but not ill) Doesnt understand IX. Summary important positive psychopathological facts contributory negative feelings Tentative diagnosis Include facts from medical Hx and Physical exam in arriving at dx

VII. General Intellectual Evaluation Distinguish between factual knowledge and The ability to use facts comprehensively Standardized intelligence tests Adults: Bellevue-Wechsler Children: Terman modification of the Stanford-Binet General information Ask to give the five largest citiesin the United States Capitals of various states Dates of the principal wars in the United States & the issues involved Names of the last four presidents The governor of the state Define differences in abstract words Idleness and laziness Poverty and miser Character and reputation Calculation Subtract 7 from 100 and continue until you can go no further 100 93 86 79 72 65 58 51 44 37 30 23 16 9 2 Do no correct, encourage to go on (15 of them) Time taken: If two apples cost five cents, how many apples can you buy for thirty-five cents? 14 Reasoning and judgment Correctly estimate and form opinions concerning external objective matters JDE: Rev. 05-11-2013

Page 6

Mental Health Review of Systems (ROS)

The Cowboy Story A cowboy from Arizona went to San Francisco with his dog, which he left at a friends while he purchased a new suit of clothes. Dressed in the new suit, he went back to the dog; whistled to him, called him by name and patted him. The dog would have nothing to do with him in his new hat and coat, but gave a mournful howl. Coaxing had no effect, so the cowboy went away and donned his old garments. Then the dog immediately showed his wild joy on seeing his master as he thought he ought to be.

JDE: Rev. 05-11-2013

Page 7