Consciousness, Behavior and Attitude

General Appearance and Context

The mental examination starts from the first eye contact. It is vital to record the general characteristics and the environment where the evaluation is performed (hospital, private practice, emergency), as this influences the patient's behavior.

It should be noted how the patient arrives: whether he/she attends of his/her own free will, referred, accompanied or under restraint/deception, as this determines his/her initial disposition.

In terms of appearance, the constitutional aspect (biotypes such as pnicnic, athletic, leptosomatic or endomorphic, mesomorphic, ectomorphic) and the pondo-statural development according to age are evaluated.

Dress is also a key indicator; it should be analyzed if it is in accordance with gender, age and context (for example, arriving in a bathing suit to an office is inappropriate), as well as its neatness and cleanliness.

Attitude and State of Consciousness

The patient's attitude toward the examiner can vary widely and should be accurately described: cooperative, suspicious, hostile, aggressive, inhibited, seductive, or defensive.

The patient's motor behavior is also observed when sitting, if he/she maintains eye contact, if he/she shows restlessness (moving legs, looking at the watch) or tics.

As for consciousness, it is determined whether the patient is Vigil (preserved alertness), Hypervigil (excessive alertness), Hypovigil (low alertness), obtunded or in a dreamlike state.

Finally, orientation is evaluated on three levels: autopsychic (orientation in person) and allopsychic (orientation in time and space).

Summary

The mental examination begins by observing the context and general appearance of the patient, including biotype and clothing. It is vital to record whether he/she attends voluntarily or under restraint, as this conditions his/her initial disposition.

The attitude towards the examiner, which may vary from cooperative to hostile or seductive, should be accurately described. Motor behavior is also observed, such as restlessness, tics or maintenance of eye contact.

Finally, the state of consciousness is determined, assessing whether the patient is vigilant, hypervigilant or cloudy. Orientation is explored in three fundamental planes: autopsychic (person) and allopsychic (time and space).