eMJA: Hall & Hassett, Assessing and managing old age psychiatric disorders, Box 4

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Hall & Hassett,
Box 4

Indicative findings on mental status examination

Examination item	Dementia	Depression	Delirium
General appearance	Normal-to-neglected according to amount of care provided and degree of impairment
Behaviour	Variable	Recent self-neglect, psychomotor retardation or agitation	Restlessness, picking at clothes or bedclothes
Affect	Flat, apathetic, occasionally irritable	Depressed, tearful, apathetic, irritable	Fluctuates, labile. May be tearful, giggly, anxious
Thought stream	May be normal, depends on degree of impairment	Normal to slow	Not fluent. Fluctuating
Thought form	May be normal, depends on degree of impairment	Normal. Perhaps some "blocking"	Thought disorder
Thought content	Poverty of thought content, may be perseverative	Themes of hopelessness, helplessness, guilt, poverty, emptiness, unworthiness or paranoia. There may be suicidal ideas or intent. Possible mood-congruent delusions or somatic complaints such as constipation or contamination. Occasionally negativistic and nihilistic thoughts are of delusional intensity	There may be a variety of florid delusional beliefs of paranoid, grandiose or depressive nature.
Perception	Occasional hallucinatory experiences (usually auditory). May have periods of misidentification	Occasional hallucinatory experiences that are congruent with the depressive thought processes. Usually auditory hallucinations	Frequent florid and bizarre hallucinations. May be visual and in all other senses
Cognition
Attention and concentration	Usually intact	May be poor but can be engaged	Very poor
Orientation	Poor	Usually unaffected but may be uninterested	Absent
Short term memory	Poor	Usually intact but may not want to be bothered	Absent or fluctuates

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