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Mental Status Exam
General appearance: Well-dressed, well­
groomed, in colorful clothing, seductive, exces­
sively ingratiating, well-related, and without signs
of psychomotor retardation or agitation.
Speech: Variable volume, dramatic, alternates
between slow and rapid rates.
Mood:  Very bad,  depressed.
Affect: Labile, expansive, irritable, and inappropri­
ate at times.
Thought process: Linear. Goal-directed, but
vague.
Thought content: Patients may be preoccupied
with somatic complaints and perceived medical
problems, such as pain and dehydration.
Perceptual: Patients may endorse auditory,
visual, or command auditory hallucinations, the
details of which are difficult to elicit. Patients may
also report the feeling of being outside their body
(depersonalization).
Suicidality: Passive (no plan), active (with a
specific plan), or vague suicidal ideation that is
difficult to characterize.
Homicidality: Vague homicidal thoughts may
occur in borderline personality disorder, but
thoughts may be much more explicit in antisocial
personality disorder.
Sensorium/cognition: Alert and oriented, intact
memory, good concentration, thinking is concrete,
but with appropriate fund of knowledge. The mini­
mental state exam is usually normal.
Impulse control: Limited. Patients may attempt to
hurt themselves during the course of the interview,
particularly if they perceive that their symptoms
are not being taken seriously.
Judgment: Limited. The patient does not under­
stand how behavior affects other people.
Insight: Limited. The patient does not recognize
the nature of the illness and may relate symptoms
to environmental stressors alone.
Reliability: Poor. History is vague, and symptom
reporting is inconsistent.
Laboratory data: Complete blood count, chemis­
try, thyroid function tests, RPR, urine toxicology
screen, blood alcohol level, and pregnancy test.
Diagnostic testing: Projective psychological
testing, such as the Rorschach and the Thematic
Apperception Test, Hamilton Rating Scale for
Depression, and the CAGE questionnaire are
often positive.
Diagnosis: Axis II: Borderline, histrionic, narcis­
sistic, and antisocial personality disorders.
Differential diagnosis: Bipolar I and II disorders,
major depressive disorder, generalized anxiety
disorder, somatoform disorders, substance-in­
duced mood disorder, adjustment disorder, and
posttraumatic stress disorder.
Dramatic or Emotional Per-
sonality Disorders - Discus-
sion
I. Epidemiology. The most frequently encoun­
tered personality disorders on inpatient psychi­
atric units fall into the dramatic and emotional
cluster, also called cluster B. The cluster B
personality disorders are borderline, histrionic,
antisocial, and narcissistic personality disorder.
Cluster B personality disorders are more com­
mon in women with the exception of antisocial
personality disorder.
II. Etiology. Personality disorders are likely
caused by an interaction between biological
predisposition and environmental influence.
Antisocial and borderline personality disorders
may demonstrate familial inheritance. Histrionic
and borderline personality disorders are asso­
ciated with a history of physical or sexual
abuse.
III. Clinical evaluation
A. Personality disorders are diagnosed on Axis
II. They are difficult to assess in the context
of acute Axis I pathology, and clinicians tend
to defer their diagnosis until acute issues
have resolved.
B. Personality disorders are defined by a per­
vasive pattern of behavior that is persistent
over time, deviates from cultural standards,
and causes significant distress or functional
impairment to the patient.
C. Borderline personality disorder patients
exhibit a clinical tetrad of labile affect, unsta­
ble self-image, poor impulse control, and
volatile interpersonal relationships.
Dissociative phenomena of depersonaliza­
tion and derealization may occur and con­
tribute to feelings of identity confusion.
Patients may report that the pain of self­
mutilation serves to bring them back to
reality during a state of identity diffusion or
dissociation.
D. Histrionic personality disorder patients
have shallow emotional responses, but
express themselves in a dramatic fashion.
They constantly require attention and may
misinterpret superficial relationships as
being more intimate than they are in reality.
E. Antisocial personality disorder patients
are often manipulative, deceitful, and have
a lack of remorse about their behavior.
These patients had conduct disorder as a
child, and frequently have a history of vio­
lence and other criminal activity.
F. Narcissistic personality disorder patients
appear extremely self-entitled with a grandi­
ose sense of importance, but actually suffer
from low self-esteem and are extremely
sensitive to criticism. Narcissistic patients [ Pobierz całość w formacie PDF ]

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