In the clinical setting, the set of subtests known as the mental status exam helps us understand the relationship of the brain to the body. Ultimately, this is accomplished by assessing behavior.
An image of neural pathways in the brain taken using diffusion tensor imaging
Image by Thomas Schultz
Mental Status Exam
Vincent van Gogh's 1889 Self Portrait suggests the artist's mood and affect in the time leading up to his suicide.
Image by Vincent van Gogh/Wikimedia
Vincent van Gogh's 1889 Self Portrait suggests the artist's mood and affect in the time leading up to his suicide.
Image by Vincent van Gogh/Wikimedia
Mental Status Exam
In the clinical setting, the set of subtests known as the mental status exam helps us understand the relationship of the brain to the body. Ultimately, this is accomplished by assessing behavior. Tremors related to intentional movements, incoordination, or the neglect of one side of the body can be indicative of failures of the connections of the cerebrum either within the hemispheres, or from the cerebrum to other portions of the nervous system. There is no strict test for what the cerebrum does alone, but rather in what it does through its control of the rest of the CNS, the peripheral nervous system (PNS), and the musculature.
Sometimes eliciting a behavior is as simple as asking a question. Asking a patient to state his or her name is not only to verify that the file folder in a health care provider’s hands is the correct one, but also to be sure that the patient is aware, oriented, and capable of interacting with another person. If the answer to “What is your name?” is “Santa Claus,” the person may have a problem understanding reality. If the person just stares at the examiner with a confused look on their face, the person may have a problem understanding or producing speech.
Source: CNX OpenStax
Additional Materials (6)
An image of neural pathways in the brain taken using diffusion tensor imaging
Visualization of a DTI measurement of a human brain. Depicted are reconstructed fiber tracts that run through the mid-sagittal plane. Especially prominent are the U-shaped fibers that connect the two hemispheres through the corpus callosum (the fibers come out of the image plane and consequently bend towards the top) and the fiber tracts that descend toward the spine (blue, within the image plane)
Image by Thomas Schultz
Mental Status Examination - Psychiatric Mental Health Nursing Principles - @LevelUpRN
Video by Level Up RN/YouTube
Brief Interview for Mental Status (BIMS)
Video by CMSHHSgov/YouTube
How to do the Mental Status Exam | Merck Manual Professional Version
Video by Merck Manuals/YouTube
Mental Status Exam Mnemonics (Memorable Psychiatry Lecture)
Video by Memorable Psychiatry and Neurology/YouTube
Mental State Examination (MSE) a 5 Minute Overview
Video by PsychStudent/YouTube
An image of neural pathways in the brain taken using diffusion tensor imaging
Thomas Schultz
4:33
Mental Status Examination - Psychiatric Mental Health Nursing Principles - @LevelUpRN
Level Up RN/YouTube
22:36
Brief Interview for Mental Status (BIMS)
CMSHHSgov/YouTube
5:44
How to do the Mental Status Exam | Merck Manual Professional Version
Merck Manuals/YouTube
7:37
Mental Status Exam Mnemonics (Memorable Psychiatry Lecture)
Memorable Psychiatry and Neurology/YouTube
5:12
Mental State Examination (MSE) a 5 Minute Overview
PsychStudent/YouTube
Neurological Exam
Neurological Exam
Also called: Neurological Assessment, Neurological Examination, Neuro Exam
A neurological exam is a series of tests that check for disorders of the brain and spinal cord. These disorders cause serious health problems. The exam can help lead to diagnosis and treatment.
Neurological Exam
Also called: Neurological Assessment, Neurological Examination, Neuro Exam
A neurological exam is a series of tests that check for disorders of the brain and spinal cord. These disorders cause serious health problems. The exam can help lead to diagnosis and treatment.
A neurological exam is a group of questions and tests to check for disorders of your nervous system. It's sometimes called a "neuro" exam.
Your nervous system includes your:
Brain and spinal cord, which are also called your central nervous system
Peripheral nerves that carry signals back and forth between your central nervous system and all parts of your body, including your skin, muscles, and organs
Your nervous system plays a role in almost every part of your health and well-being. Because it controls so many body processes, a neurological exam has many different types of tests. The tests you have will depend on why you're having the exam. There are nerve tests to check for problems with your:
Muscle movement, balance, and coordination. These activities are controlled by nerves called motor nerves.
Breathing, heartbeat, digestion, and other processes that happen without thinking. Autonomic nerves control these activities.
Sense of touch, smell, hearing, and vision. Sensory nerves carry this information from your senses to your brain.
Thinking and memory. Certain parts of your brain control these and other types of complex mental activity, including your emotions.
A neurological exam may be used to:
Check the health of your nervous system during a routine checkup.
Help find out whether a nervous system disorder is causing certain symptoms. There are hundreds of disorders that affect the brain and nerves. Some examples include:
Degenerative nerve diseases, such as certain types of dementia and Parkinson's disease
Diabetic nerve problems
Epilepsy
Headache disorders, such as migraines and cluster headaches
Meningitis
Multiple sclerosis
Help find out if an injury has damaged part of the nervous system and how serious the damage may be.
Monitor a known nerve condition and/or see if treatment is helping.
You may need a neurological exam if you have symptoms that may be from a nervous system disorder. Because your nerves affect every part of your body, nervous system disorders can cause many different types of symptoms, including:
Pain in your back, neck, head, or along a nerve, such as sciatica
Tremors
Weak or stiff muscles
Problems with balance and/or coordination
Numb or tingling skin
Changes in any of your senses (hearing, vision, taste, smell, and touch)
Slurred speech
Confusion or other changes in mental ability
Seizures
You may also need a neurological exam if you have had an injury that may have damaged your peripheral nerves, spinal cord, or caused a traumatic brain injury (TBI).
A neurological exam is often done by a neurologist. A neurologist is a doctor who specializes in diagnosing and treating disorders of the nervous system. Certain other providers may also do a neurological exam.
The exam is usually done in a provider's office. If you've had a serious injury, the exam may be done in the emergency room or in the hospital.
First, the provider will usually:
Ask questions about any symptoms you may have
Ask about your medical history
Do a physical exam, including checking your heart and lungs
Next, the provider will do specific tests to check how different parts of your nervous system are working. The tests you have will depend on your symptoms. The tests may check your:
Mental status. This includes your memory, problem-solving ability, alertness, and mood. During a mental status exam, you may answer questions about the date, time, and where you are. You may also be asked to remember a list of items, name objects, repeat words, and/or draw specific shapes.
Cranial nerves. These 12 nerves connect your brain with your eyes, ears, nose, face, tongue, throat, shoulders, and certain organs. The provider will test the nerves that may be involved with your symptoms. For example, to test your sense of smell, you may be asked to sniff certain smells and identify what they are. If you're having speech problems, you may be asked to try to talk while you stick out your tongue.
Coordination, balance, and walking. These tests check how well your nervous system controls your muscle movements. You may be asked to walk in a straight line, placing one foot directly in front of the other. Other tests include checking your handwriting and having you touch your finger to your nose with your eyes closed.
Reflexes. A reflex is your body's automatic movement in response to certain triggers. For example, if your knee is tapped with a rubber hammer, your lower leg will jerk on its own. There are many types of reflexes that are tested in different ways. Reflex tests show how well nerves between your spinal cord and muscles are working.
Sensory nerves. The provider may test how well you can feel touch, hot and cold temperatures, vibrations, and pain. These tests involve gently touching part of your skin with different objects, such as a dull needle or a cotton swab. You will be asked to describe what you can feel.
Autonomic nervous system. A neurological exam tests the part of your nervous system that controls your breathing, heart rate, digestion, and other processes that happen without thinking. Examples of these tests include checking your blood pressure and heartbeat. Another test checks how your eyes respond to light.
You don't need any special preparations for a neurological exam.
There is no risk to having a neurological exam.
If the results of any part of your neurological exam are not normal, your provider will probably order more tests to help make a diagnosis. The tests will depend on what type of condition your provider thinks you could have. They may include:
Blood and/or urine tests
Imaging tests, such as an MRI
Cerebrospinal fluid (CSF) testing, also called a lumbar puncture
Biopsy
Electroencephalography (EEG) or electromyography (EMG), which use small electric sensors to measure brain activity and nerve function
If you have questions about your results, talk with your neurologist or other provider.
Nervous system disorders and mental health problems can have similar symptoms. For example, problems paying attention could be a symptom of either type of disorder. So in certain cases, your provider may do a mental health screening before or after a neurological exam.
Mental Health Screening
Mental Health Screening
Also called: Mental health assessment, Mental illness test, Psychological evaluation, Psychology test, Psychiatric evaluation
A mental health screening helps find out if you have a mental disorder. Many mental disorders can be treated successfully with medicine and/or talk therapy.
Mental Health Screening
Also called: Mental health assessment, Mental illness test, Psychological evaluation, Psychology test, Psychiatric evaluation
A mental health screening helps find out if you have a mental disorder. Many mental disorders can be treated successfully with medicine and/or talk therapy.
A mental health screening is a standard set of questions that a person answers to help a health care provider check for signs of a mental disorder. The questions help the provider learn about a person's mood, thinking, behavior, and memory.
A mental health screening is a way to catch mental health conditions early. If the screening shows signs of a disorder, more testing is usually needed to diagnose a specific mental disorder. Mental disorders are also called mental illnesses, and a mental health screening may be called a "mental illness test" or a "psychology test."
More than half of all Americans will have a mental disorder at some point in their lives. Their symptoms may range from mild to severe. Common mental disorders include:
Mood disorders, which include depression, bipolar disorder, seasonal affective disorder (SAD), and self-harm.
Anxiety disorders, which include panic disorder, phobias, and obsessive-compulsive disorder (OCD). Anxiety is a common disorder in children.
Eating disorders, which include anorexia and bulimia.
Attention deficit hyperactivity disorder (ADHD). ADHD is one of the most common mental health disorders in children. It can also continue into adulthood.
Post-traumatic stress disorder (PTSD).
Personality disorders.
Substance use disorders, which include alcohol use disorder and drug use and addiction.
Psychotic disorders, which include schizophrenia.
These and other mental disorders affect people of all ages, including children. So, there are special mental health screening tests designed for children, teenagers, and older adults. Some screening tests look for general signs of the most common mental disorders. Other screening tests look for signs related to specific types of disorders.
Mental health screening can be an important part of your total health at every stage of life. Mental health symptoms can be a sign of certain physical conditions. And certain mental disorders can increase the risk of developing physical health problems. With proper mental health screening, diagnosis, and treatment, people with mental health disorders can get better and many recover completely.
A mental health screening is usually used as the first step to find out if a person has signs of a mental disorder. It may be part of a routine checkup. A screening test is used to see whether a person:
Has a risk for developing a mental disorder
Needs more testing to diagnose or rule out a mental health disorder
Needs mental health care right away, before diagnostic testing can be finished
Mental health screening may also be used to see if treatment for a mental disorder is working.
A primary care provider may use mental health screening to help decide if a person needs to see a mental health provider for testing and/or treatment. A mental health provider is a health care professional who specializes in diagnosing and treating mental health problems. A mental health provider may use the results of a screening test to choose which other tests are needed to diagnose or rule out a specific mental disorder.
You or your child may need a mental health screening if you have symptoms of a mental disorder. Different disorders have specific symptoms.
General symptoms of mental disorders may include:
Eating or sleeping too much or too little
Pulling away from people and usual activities
Fatigue and lack of energy
Feeling helpless, hopeless, or numb like nothing matters
Smoking, drinking, or using drugs more than usual
Feeling unusually confused, forgetful, nervous, angry, worried, or scared
Severe mood swings that cause problems in relationships
Thoughts and memories that you can't get out of your head
Hearing voices or believing things that aren't true
Thinking about death, suicide or harming yourself or others
Signs of mental disorders in children may also include:
Frequent tantrums and other behavior problems
Frequent stomachaches or headaches without a known medical cause
Difficulty in school
Repeating actions or constantly checking things out of fear that something bad will happen
Talking a lot about fears, worries, death, or suicide
If you or someone you know needs immediate help for a mental health disorder:
Call 911 or go to your local emergency room
Contact a crisis hotline. In the United States, you can reach the National Suicide and Crisis Lifeline at any time:
Call or text 988
Chat online with Lifeline Chat
TTY users: Use your preferred relay service or dial 711 then 988
Veterans can contact the Veterans Crisis Line:
Call 988 then press 1
Text 838255
Chat online
Call your mental health provider or other provider
Reach out to a loved one or close friend
If you are having a mental health screening, you'll answer a set of questions about your symptoms. The questions will be about your feelings, mood, sleep, appetite, and other parts of your life. A provider may ask you the questions or you may fill out a questionnaire and discuss your answers afterwards. It's important that your answers are honest and complete.
If your primary care provider is doing the screening, you may also have a physical exam and blood tests. There are no medical tests that can diagnose mental health disorders. But certain blood tests can show if a physical condition, such as thyroid disease or an electrolyte imbalance, is causing mental health symptoms.
During a blood test, a health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.
If your provider thinks your symptoms could be caused by physical problems with your brain or nerves, you may have a neurological exam or imaging tests of your brain.
If your child is having a mental health screening, the test will be geared to your child's age and abilities. You may be asked to fill out a questionnaire about your child's behavior.
The screening may be done by your child's primary care provider or a mental health provider who works with children and teenagers. Your child's provider may also order medical tests to look for physical causes of mental disorders. Some schools provide mental health screening services.
You usually don't need any special preparations for a mental health screening. If your child is having a screening, you may be asked to keep notes on your child's behavior for a few days before the test.
There is no risk to having a physical exam or taking a questionnaire.
There is very little risk to having a blood test. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.
Usually, the provider who did the screening will explain the results. If the results show signs of a mental health disorder, the next steps depend on the type of disorder and how serious it may be. If a primary care provider did the screening, the provider may:
Talk with you about treatments
Order tests to check for other health problems that may be causing symptoms
Refer you or your child to a mental health provider
A mental health provider may do more tests to confirm a diagnosis and help develop a treatment plan. Starting treatment as soon as possible may improve the chance of recovery.
There are many types of mental health providers who treat mental disorders. Your or your child's primary health care provider or school can help you find the right support.
These are some of the providers who have training to treat mental health disorders:
Psychiatrists are medical doctors who specialize in mental health. Psychiatrists can prescribe medicine.
Psychologists generally have doctoral degrees, but they do not have medical degrees. They can't prescribe medicine unless they have a special license. Some psychologists work with providers who can prescribe medicine. Psychologists may use one-on-one counseling and/or group therapy sessions.
Psychiatric-mental health nurses are nurses with special training in mental health problems. Nurses who may have a master's or doctoral degree in psychiatric-mental health nursing include, advanced practice registered nurses (APRNs), certified nurse practitioners (CNPs), and clinical nurse specialists (CNSs). In some states, certain nurses can prescribe medicines.
Licensed clinical social workers have at least a master's degree in social work with special training in mental health. They can't prescribe medicine, but may work with providers who can prescribe medicine. Providers who are licensed clinical social workers usually have LCSW or LICSW after their names.
Licensed professional counselors (LPC) may also be called clinicians or therapists. States have different names of these licenses, such as LMFT (licensed marriage and family therapist). These professionals usually have a master's degree in a field related to mental health. They can't prescribe medicine but may work with providers who can prescribe.
Mental Health Screening: MedlinePlus Medical Test [accessed on Dec 20, 2022]
Additional Materials (15)
Pay Attention to Your Mental Health
Document by Office on Women's Health, U.S. Department of Health and Human Services
Major brain structures implicated in autism.
Image by National Institutes of Mental Health, National Institutes of Health
MEG scanner with patient
Image by NIMH Image Library
Functional magnetic resonance imaging
High resolution fMRI of the Human brain.
Image by National Institute of Mental Health
Attention Deficit Hyperactivity Disorder - Signs and Symptoms
ADHD brain time-lapse :maturation of the brain, as reflected in the age at Which a cortex area attains peak thickness in ADHD (above) and normal development (below). Lighter areas are thinner, darker areas thicker. Light blue in the ADHD sequence corresponds to the same thickness as light purple in the normal development sequence. The darkest areas in the lower part of the brain, Which are not associated with ADHD, had already peaked in thickness Either by the start of the study, or, for statistical Reasons, were not amenable to on-defining age of peak cortex thickness.
Image by National Institute of Mental Health
5 Action Steps for Helping Someone in Emotional Pain
Suicide is complicated and tragic, but it can be preventable. Knowing the warning signs for suicide and how to get help can help save lives.
Document by National Institute of Mental Health (NIMH)
Beat the winter blues
"Seasonal affective disorder is a variant of major depressive disorder where depressive episodes show up seasonally." - Maj. Donald Christman, 86th Medical Operations Squadron mental health flight commander.
Image by U.S. Air Force graphic by Jeff Gates
Preventing suicide: Reaching out, saving lives
Service members are reminded to put the fear of hurting their careers aside and seek the mental help they may need. Additionally, they are encouraged to use the acronym ACE--ask, care and escort to care for their wingman. For assistance, call the Aviano Mental Health Clinic at 632-5321 or the Chapel office at 632-5211. (U.S. Air Force photo illustration by Senior Airman Areca T. Bell/Released)
Image by Photo by: Senior Airman Areca T. BellReleased | VIRIN: 150924-F-IT851-014.JPG; www.usafe.af.mil
Your Guide to Physical Activity and Your Heart
This booklet will help you to understand the impact of physical
activity on your heart, as well as the power of regular activity to
help keep you healthy overall. It will also offer plenty of ideas on
starting a physical activity program that will be both healthful and
enjoyable. Just as important, you’ll get tips for keeping up with the
activity or activities you choose, since staying active over time is
important to long-term health. So use this booklet often for information,
ideas, and to keep you motivated. When to start getting fit?
There’s no time like today.
Document by National Heart, Lung, and Blood Institute
How is schizophrenia treated?
Disorganized thinking A cloth embroidered by a person with schizophrenia, a written example of a "word salad"; a meaningless mixture of words and phrases. This is one example of the disorganized thinking caused by the disorder.
Image by United States: National Institutes of Health, National Institute of Mental Health
Baby With Mom
Image by PublicDomainPictures/Pixabay
7 Tips to Stay Healthy During the Holidays
Take some time out of the hustle and bustle of the holiday season to consider these 7 healthy habits
that help prevent chronic diseases like type 2 diabetes, cancer, and heart disease.
Document by Centers for Disease Control and Prevention (CDC)
Methamphetamine
Title: Brain Scan - Methamphetamine Description: Methamphetamine abuse decreases dopamine transporter activity and compromises mental function. Categories: Research in NIH Labs and Clinics Type: Color, Photo Source: National Institute on Drug Abuse (NIDA)
Image by National Institutes of Health (NIH)
Depression is a real illness
Mental stress, along with depression (which affects twice as many women as men), have a more debilitating effect on women's hearts than on men's.
Image by TheVisualMD
What are the treatments for Fragile X syndrome?
Silencing of the FMR1 Gene in Fragile X Mental Retardation Syndrome: Artistic representation of events occurring during gene silencing in Fragile X mental retardation syndrome (FXS). The FMR1 gene, which is on the X chromosome, colocalizes with a fragile site seen in FXS cells that gives this disorder its name. FXS alleles become associated with SIRT1. SIRT1, a class III histone deacetylase, deacetylates lysine 9 of histone H3 and lysine 16 of histone H4, ultimately leading to chromatin compaction and gene silencing
Image by Dr. Marian L. Miller (Journal-Cover-Art.com)
Pay Attention to Your Mental Health
Office on Women's Health, U.S. Department of Health and Human Services
Major brain structures implicated in autism.
National Institutes of Mental Health, National Institutes of Health
MEG scanner with patient
NIMH Image Library
Functional magnetic resonance imaging
National Institute of Mental Health
Attention Deficit Hyperactivity Disorder - Signs and Symptoms
National Institute of Mental Health
5 Action Steps for Helping Someone in Emotional Pain
United States: National Institutes of Health, National Institute of Mental Health
Baby With Mom
PublicDomainPictures/Pixabay
7 Tips to Stay Healthy During the Holidays
Centers for Disease Control and Prevention (CDC)
Methamphetamine
National Institutes of Health (NIH)
Depression is a real illness
TheVisualMD
What are the treatments for Fragile X syndrome?
Dr. Marian L. Miller (Journal-Cover-Art.com)
Depression Screening
Depression Screening
Also called: Depression Test, PHQ-9 Depression Assessment
A depression screening is a set of questions you answer to see if you have depression, a mental health condition that often gets better with treatment. Screening can help find depression early. And treating depression early may make recovery faster.
Depression Screening
Also called: Depression Test, PHQ-9 Depression Assessment
A depression screening is a set of questions you answer to see if you have depression, a mental health condition that often gets better with treatment. Screening can help find depression early. And treating depression early may make recovery faster.
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Use the slider below to see how your results affect your
health.
20
40
60
80
Your result is Normal.
This score indicates that your behaviors are normal.
Related conditions
A depression screening is also called a depression test. It's a standard set of questions that you answer to help your health care provider find out whether you have depression.
Depression is a common, serious mental health condition. Everyone feels sad at times, but depression is different than normal sadness or grief. Depression can affect how you think, feel, and behave. It makes it hard to function at home and work. You may lose interest in activities you once enjoyed. Some people with depression may feel worthless and might even think about harming themselves. Depression may also be part of other mental health conditions, such as bipolar disorder.
Because depression is a common mental health problem, depression screening is often done as part of a routine health checkup. Medical experts recommend that depression screening should be done for everyone starting at age 12. Screening can help find depression early. And treating depression early may make recovery faster. Most people with depression will get better.
A depression screening is used to:
Help diagnose depression
Understand how severe depression may be
Help figure out what type of depression you have
There are different types of depression. The most common types are:
Major depression, also called major depressive disorder. The symptoms typically make it difficult to work, sleep, study and eat. With major depression, you have symptoms most of the time for at least two weeks.
Persistent depressive disorder, also called dysthymia. The symptoms are less severe than major depression, but they last much longer, usually for at least two years.
Seasonal affective disorder (SAD). This form of depression usually happens in winter when there's less sunlight. Most people with SAD tend to feel better in the spring and summer.
Postpartum depression. This is major depression that happens after giving birth. It's more severe and lasts longer than mild unhappiness and other mood changes that are often called the "baby blues." Major depression may also begin during pregnancy. Depression that happens during or shortly after pregnancy is called "perinatal depression." Medical experts recommend routine depression screening during pregnancy and after birth.
Depression screening is often part of a routine checkup. You may also need depression screening if you show signs of depression, which may include:
Loss of interest or pleasure in activities you used to enjoy
Feeling sad or anxious
Feelings of guilt, worthlessness or helplessness
Trouble sleeping (insomnia) or sleeping too much
Fatigue and lack of energy
Trouble concentrating, remembering details, or making decisions
Changes in your weight
Thoughts of hurting yourself or suicide
If you are thinking about suicide or hurting yourself, get help right away:
Call 911 or go to your local emergency room
Contact a suicide hotline. In the United States, you can reach the National Suicide and Crisis Lifeline at any time:
Call or text 988
Chat online with Lifeline Chat
TTY users: Use your preferred relay service or dial 711 then 988
Veterans can contact the Veterans Crisis Line:
Call 988 then press 1
Text 838255
Chat online
Call your mental health provider or other provider
Reach out to a loved one or close friend
During a depression screening, you'll answer a standard set of questions. Your provider may ask the questions, or you may fill out a questionnaire form to discuss with your provider later.
In general, the questions ask you about:
Changes you've noticed in your:
Mood
Sleep habits
Appetite or weight
Energy levels
Ability to focus your attention
Stress levels
Medicines you take
Alcohol and drug use
Your personal and family history of depression and other mental health conditions
You may also have a physical exam. There's no lab test that can diagnose depression. But your provider may order blood tests to find out if another health condition, such as anemia or thyroid disease, may be causing depression.
During a blood test, a health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.
If you are being tested by a mental health provider, he or she may ask you more detailed questions about your feelings and behaviors. You may also be asked to fill out a questionnaire about these issues.
You usually don't need any special preparations for a depression test or a blood test.
There is no risk to answering questions or having a physical exam.
There is very little risk to having a blood test. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.
If you are diagnosed with depression, your provider will discuss your treatment options. Starting treatment as soon as possible may improve your chance of recovery. Treatment for depression may take time to work, but it can help reduce symptoms and shorten how long depression lasts.
Your provider may suggest that you see a mental health provider for your care. A mental health provider is a health care professional who specializes in diagnosing and treating mental health problems. If you are already seeing a mental health provider, a depression test may help guide your treatment.
There are many types of mental health providers who treat depression. Your primary health care provider can help you find the right support.
These are some of the professionals who have training to diagnose and treat depression:
Psychiatrists are medical doctors who specialize in mental health. Psychiatrists can prescribe medicine.
Psychologists generally have doctoral degrees, but they do not have medical degrees. They can't prescribe medicine unless they have a special license. Some psychologists work with providers who can prescribe medicine. Psychologists may use one-on-one counseling and/or group therapy sessions.
Psychiatric or mental health nurses are nurses with special training in mental health problems. Nurses who may have a master's or doctoral degree in psychiatric-mental health nursing include, advanced practice registered nurses (APRNs), certified nurse practitioners (CNPs), and clinical nurse specialists (CNSs). In some states, certain nurses can prescribe medicines.
Licensed clinical social workers have at least a master's degree in social work with special training in mental health. They can't prescribe medicine, but they may work with providers who can prescribe medicine. Providers who are licensed clinical social workers usually have LCSW or LICSW after their names.
Licensed professional counselors (LPC) may also be called clinicians or therapists. States have different names of these licenses, such as LMFT (licensed marriage and family therapist). These professionals usually have a master's degree in a field related to mental health. They can't prescribe medicine, but may work with providers who can prescribe.
Depression Screening: MedlinePlus Medical Test [accessed on Dec 20, 2022]
Depression Screening - My HealtheVet - My HealtheVet [accessed on Dec 20, 2022]
Depression Test - Free mental health tests from Mental Health America. MHA Screening. Dec 14, 2022 [accessed on Dec 20, 2022]
Depression Test - Self Quiz - AnxietyCentre.com. May 15, 2021 [accessed on Dec 20, 2022]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Additional Materials (50)
Older Adults and Depression
Older Adults and Depression
Document by National Institute of Mental Health
Depression Basics
Do you feel sad, empty, and hopeless most of the day, nearly every day? Have you lost interest or pleasure in your hobbies or being with friends and family? Are you having trouble sleeping, eating, and functioning? If you have felt this way for at least 2 weeks, you may have depression, a serious but treatable mood disorder.
Document by National Institute of Mental Health
Teen Depression
Teen Depression
Document by National Institute of Mental Health
Depression Risk Factors, Symptoms, & Diagnosis
Who is at risk for depression? Depression can occur at any age, although it's most common in individuals in their twenties and thirties. Race, education, marital situation, and socio-economic status also affect a person's risk for depression. Unsurprisingly, poverty is associated with an increase in risk, although depression occurs at all economic levels of society.
Image by TheVisualMD
Depression
Image by PublicDomainPictures/Pixabay
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What Is Depression?
Take a trip inside your head to see what happens in your brain when you have depression. Hear depression sufferers talk about living with this devastating disorder, and top experts explain how depression feeds upon itself. Travel deep into the brain to zero in on the organs implicated in emotional disorders. Voyage deeper still to witness electrical impulses racing across neurons. Depression acts like a neurotoxin: view the chemicals that can cause those neurons to wither. Learn the factors that put you at risk. Discover which organs of the brain may atrophy, while others become too active. Hear a message of hope from someone who knows: even people with severe depression can become symptom-free.
Video by TheVisualMD
Depression, Loneliness, Man, Mood
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Brain Development
Your brain develops rapidly in infancy and adolescence, but it continues to change throughout your life. The connections formed by your brain's neural pathways, which connect one part of your nervous system with another, continue to change as well. These pathways are very important for understanding depression. In this image, a woman is seen lying down, eyes averted gloomily. Depression is a neurological phenomenon that statistically affects more women than men.
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Types of Depression
Depression, There is Hope : If you or someone you know has depression, there are many reasons to be optimistic and to seek out help. Advances in pharmacologic, psychological, and other forms of therapy have made it possible for millions of people to recover from clinical depression and to achieve remission--that is, to have no more than minimal symptoms of depression.
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Causes of Depression
Who is most likely to develop depression? Depression can occur at any age, although it’s most common in individuals in their twenties and thirties. Race, education, marital situation, and socio-economic status also affect a person’s risk for depression. Unsurprisingly, poverty is associated with an increase in risk, although depression occurs at all economic levels of society.
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Comparing Talk Therapy and Other Depression Treatments With Antidepressant Medicines
This information comes from a research report that was funded by the Agency for Healthcare Research and Quality, a Federal Government agency.
Document by Agency for Healthcare Research and Quality (AHRQ)
Depression Changes Your Brain
Actual structural changes, changes in the physical form of the brain, can be observed in people who have depression. Regions of the brain that may be affected by depression include the ventricles, corpus callosum, hippocampus, and all parts of the limbic system- which is involved with emotion formation as well as processing, learning, and memory.
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Causes of Depression
Who is most likely to develop depression? Depression can occur at any age, although it’s most common in individuals in their twenties and thirties. Race, education, marital situation, and socio-economic status also affect a person’s risk for depression. Unsurprisingly, poverty is associated with an increase in risk, although depression occurs at all economic levels of society.
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Depression and Pain
Pain and depression walk hand in hand. People with depression tend to experience more severe and longer-lasting pain than people without depression. In fact, having untreated clinical depression increases by 50% the likelihood that you’ll develop a chronic pain condition. Pain disorders suffered by people with depression can include nerve pain, irritable bowel syndrome, low back pain, fibromyalgia, and headaches (particularly migraines).
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Depression and Neurotransmitters
Your brain contains dozens of neurotransmitters. Four of them-serotonin, norepinephrine, dopamine, and GABA-have been linked with depression. The color-coded lines in the image at left show their pathways through the brain.
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Postpartum Depression
Postpartum Depression
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Depression Changes the Brain
Actual structural alteration-changes in the physical form of the brain-can be observed in people who have depression. These changes are associated with changes in blood flow to the brain and with altered glucose metabolism. Some areas may experience physical disruption, others may change in size.
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Treatment for Depression, Antidepressants
Antidepressants act on the theory that depression is caused by a lack of the key neurotransmitters responsible for mood: serotonin, norepinephrine, and dopamine. The idea is to keep these neurotransmitters \"on\" by preventing them from early reuptake after they are released into the synapses, or from being broken down by monoamine oxidase.
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Vagus Nerve Stimulation
Vagus Nerve Stimulation, Surgically Implanted Electrode: Vagus nerve stimulation is an option for the treatment of chronic, or recurrent, depression. It is intended for people who have not responded to the usual forms of treatment or who are unable to take medication. In vagus nerve stimulation, a device similar to an electronic pacemaker is surgically implanted under the skin on the left side of the chest. A wire from the electrode is connected to the left vagus nerve, stimulating the brain's limbic system. The limbic system regulates mood, appetite, motivation, and sleep patterns, all of which can be affected by depression.
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Vagus Nerve Stimulation, Wire from Electrode
Vagus nerve stimulation is an option for the treatment of chronic, or recurrent, depression. It is intended for people who have not responded to the usual forms of treatment or who are unable to take medication. In vagus nerve stimulation, a device similar to an electronic pacemaker is surgically implanted under the skin on the left side of the chest. A wire from the electrode is connected to the left vagus nerve, stimulating the brain's limbic system. The limbic system regulates mood, appetite, motivation, and sleep patterns, all of which can be affected by depression.
Image by TheVisualMD
Vagus Nerve Stimulation
Vagus nerve stimulation is an option for the treatment of chronic, or recurrent, depression. It is intended for people who have not responded to the usual forms of treatment or who are unable to take medication. In vagus nerve stimulation, a device similar to an electronic pacemaker is surgically implanted under the skin on the left side of the chest. A wire from the electrode is connected to the left vagus nerve, stimulating the brain's limbic system. The limbic system regulates mood, appetite, motivation, and sleep patterns, all of which can be affected by depression.
Image by TheVisualMD
Depression and Pain
Pain and depression walk hand in hand. People with depression tend to experience more severe and longer-lasting pain than people without depression. In fact, having untreated clinical depression increases by 50% the likelihood that you’ll develop a chronic pain condition. Pain disorders suffered by people with depression can include nerve pain, irritable bowel syndrome, low back pain, fibromyalgia, and headaches (particularly migraines).
Image by TheVisualMD
Depression Changes the Brain
Actual structural alteration—changes in the physical form of the brain—can be observed in people who have depression. These changes are associated with changes in blood flow to the brain and with altered glucose metabolism.
Image by TheVisualMD
Norepinephrine Molecule
Norepinephrine, a neurotransmitter as well as a hormone (see page XX), is related to adrenaline (also referred to as epinephrine), known mostly for its' stimulating affects on the body. Norepinephrine is responsible for, among other things, arousal and alertness. For a long time, it was thought to be the primary neurotransmitter responsible for depression. Reduced levels of this chemical may partially explain the apathy seen in individuals with this and other mental disorders. Elevated levels of norepinephrine are strongly associated with anxiety disorders, which frequently coexist with depression.
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Norepinephrine Receptor
Norepinephrine, a neurotransmitter as well as a hormone (see page XX), is related to adrenaline (also referred to as epinephrine), known mostly for its' stimulating affects on the body. Norepinephrine is responsible for, among other things, arousal and alertness. For a long time, it was thought to be the primary neurotransmitter responsible for depression. Reduced levels of this chemical may partially explain the apathy seen in individuals with this and other mental disorders. Elevated levels of norepinephrine are strongly associated with anxiety disorders, which frequently coexist with depression.
Image by TheVisualMD
Forms of Depression
Major depressive disorder, also known as clinical depression, is a serious illness that affects millions of people each year. (The term "clinical" is used to indicate that the condition is serious enough to require clinical intervention.) But clinical depression is far more than the just feeling "depressed," "down," or "blue.") Depression can cause feelings of numbness or emptiness. It can cause a number of physical symptoms, like muscle aches and back pain. In fact, major depressive disorder is a whole-body illness that causes a surprising range of emotional and physical symptoms. Major depressive disorder alters how you think, how you feel, and how you behave.
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Symptoms and Diagnosis
Although depression may create physical changes in the brain, there is no physical test to determine whether or not someone has depression. Depressive disorder is diagnosed by the presence of certain core emotional and behavioral symptoms. These are known as the DSM-IV Diagnostic Criteria. For a diagnosis of major depression, at least five of the following symptoms must be present during the same 2-week period and represent a change from previous functioning. For a diagnosis of minor depression, from two to four of these symptoms must be present. For both major and minor depression, at least one of the symptoms must be either 1) depressed mood or 2) loss of interest or pleasure.
Image by TheVisualMD
Forms of Depression
Major depressive disorder, also known as clinical depression, is a serious illness that affects millions of people each year. (The term "clinical" is used to indicate that the condition is serious enough to require clinical intervention.) But clinical depression is far more than the just feeling "depressed," "down," or "blue.") Depression can cause feelings of numbness or emptiness. It can cause a number of physical symptoms, like muscle aches and back pain. In fact, major depressive disorder is a whole-body illness that causes a surprising range of emotional and physical symptoms. Major depressive disorder alters how you think, how you feel, and how you behave.
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Woman Having Postpartum Depression
Childbirth is a time for joy, but for many women this emotion quickly turns into feelings ranging from sadness and anxiety to restlessness and a sense of loss. Hormonal changes following birth are normal, and can wreak havoc in new mothers. You may feel overwhelmed one minute and exhausted the next. Usually, these \"baby blues\" go away after a week or so. This is the case for most women. For others, prolonged symptoms are a sign of postpartum depression. This can begin any time following childbirth up until a year later. In addition to the factors mentioned above, some women have an unrealistic need to be perfect. Others eat too much or too little or find themselves crying constantly. In many cases the new mother withdraws from her family and friends. All of this just adds to the stress of motherhood. This type of response falls within the scope of our discussion of depression.
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Forms of Depression
Major depressive disorder, also known as clinical depression, is a serious illness that affects millions of people each year. (The term "clinical" is used to indicate that the condition is serious enough to require clinical intervention.) But clinical depression is far more than the just feeling "depressed," "down," or "blue.") Depression can cause feelings of numbness or emptiness. It can cause a number of physical symptoms, like muscle aches and back pain. In fact, major depressive disorder is a whole-body illness that causes a surprising range of emotional and physical symptoms. Major depressive disorder alters how you think, how you feel, and how you behave.
Image by TheVisualMD
The Depression Cascade
Depression isn’t all in your head—it has major physiological effects on all of your body’s major systems and increases the likelihood of developing many major diseases. Having a depressive disorder unleashes a cascade of harmful effects on your body.
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Finding Balance
If you have depression, you may blame yourself and think that somehow you caused this condition or should be able to pull yourself out of it. But being depressed is not a failure on your part. You are not to blame for it, and you aren’t weak because you can’t “just snap out of it.” Depression is a disease—and like many other diseases, it responds to treatment. Many different forms of treatment are available. The key is to find balance: balance in your life, and the right balance of depression treatments.
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Forms of Depression
Forms of Depression : Major depressive disorder affects millions of people throughout the world and can cause both physical and psychological symptoms. Major depressive disorder, also known as clinical depression, is a serious illness that affects millions of people each year. (The term "clinical" is used to indicate that the condition is serious enough to require clinical intervention.) But clinical depression is far more than the just feeling "depressed," "down," or "blue.") Depression can cause feelings of numbness or emptiness. It can cause a number of physical symptoms, like muscle aches and back pain. In fact, major depressive disorder is a whole-body illness that causes a surprising range of emotional and physical symptoms. Major depressive disorder alters how you think, how you feel, and how you behave.
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Symptoms and Diagnosis of Depression
Symptoms and Diagnosis of Depression
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Neurotransmitters
Neurotransmitters Involved in Pain and Depression : It's known that in people with depression, there are changes or reductions in serotonin and norepinephrine and their receptors. Concentrations and output of the two neurotransmitters become erratic, leading to a dysregulated signaling system. The pathways of serotonin and norepinephrine in the brain begin in the brain stem and project to various brain regions, including the frontal cortex, hypothalamus, and limbic regions. Symptoms of depression are associated with the frontal cortex and limbic regions. The hypothalamus is associated with loss of appetite, weight loss or gain, and loss of pleasure.
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Antidepressants
Treating Depression with Antidepressants : Antidepressants act on the theory that depression is caused by a lack of the key neurotransmitters responsible for mood: serotonin, norepinephrine, and dopamine. The idea is to keep these neurotransmitters "on" by preventing them from early reuptake after they are released into the synapses, or from being broken down by monoamine oxidase.
Image by TheVisualMD
Normal Hippocampus
The hippocampus is part of the brain's limbic system and helps to regulate emotion and to store and retrieve memories. It is located deep in the forebrain. People with depression often have a hippocampus that is reduced in size, similar to the shrinkage seen in victims of abuse and individuals with post-traumatic stress disorder. This shrinkage may explain why depressed individuals often have more difficulty processing and retaining information.
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Blood Vessel
Blood-brain barrier whose most important function is to keep unwanted substances from entering the brain. It is a layer consisting of the hundreds of small capillaries that supply blood to the brain. These blood vessels are lined with cells that \"screen\" the blood before it enters the brain to make certain that nothing harmful gets in. Antidepressants have been designed to cross this barrier.
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Shrunken Hippocampus
The hippocampus is part of the brain's limbic system and helps to regulate emotion and to store and retrieve memories. It is located deep in the forebrain. People with depression often have a hippocampus that is reduced in size, similar to the shrinkage seen in victims of abuse and individuals with post-traumatic stress disorder. This shrinkage may explain why depressed individuals often have more difficulty processing and retaining information.
Image by TheVisualMD
Limbic System, lateral view
The limbic system is a set of brain structures that supports a variety of functions including emotion, behavior, and long-term memory. The limbic system includes the amygdala, hippocampus, cingulate gyrus, fornix, hypothalamus, and thalamus.
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Depression, Mental Health, Sadness
Image by HASTYWORDS/Pixabay
What Makes You Unique
Everything you think of as making up your essential "self," your intellect, emotions and feelings, desires, thoughts and perceptions, and dreams, all depend on a 3-pound mass of cells inside your skull: your brain. Your brain joins with your spine and billions of nerve cells, or neurons, to form your nervous system. The nervous system is both an internal network of consciousness and connections, and your sensory pathway to the outside world.
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Depression and Neurotransmitters
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Treating Depression
Discover why depression is a very treatable disease. Find out why it's essential to seek medical care if you have symptoms of depression-and why so many people with depression don't. See just how untreated depression affects the physical structure of your brain. Journey inside to view, on a cellular level, how talk therapy can restore the normal functioning of your brain cells. Zoom down to the molecular level to observe the way in which antidepressants change the balance of your brain's mood-affecting neurotransmitters. View the incredible network of blood vessels that feed your energy-hungry brain, making exercise and diet an essential part of treatment. Find out why the odds of successfully treating depression are very good.
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Depression (mood)
Take a trip inside your head to see what happens in your brain when you have depression. Hear depression sufferers talk about living with this devastating disorder, and top experts explain how depression feeds upon itself. Travel deep into the brain to zero in on the organs implicated in emotional disorders. Voyage deeper still to witness electrical impulses racing across neurons. Depression acts like a neurotoxin: view the chemicals that can cause those neurons to wither. Learn the factors that put you at risk. Discover which organs of the brain may atrophy, while others become tooactive. Hear a message of hope from someone who knows: even people with severe depression can become symptom-free.
Image by TheVisualMD
Forms of Depression
Major depressive disorder, also known as clinical depression, is a serious illness that affects millions of people each year. (The term "clinical" is used to indicate that the condition is serious enough to require clinical intervention.) But clinical depression is far more than the just feeling "depressed," "down," or "blue.") Depression can cause feelings of numbness or emptiness. It can cause a number of physical symptoms, like muscle aches and back pain. In fact, major depressive disorder is a whole-body illness that causes a surprising range of emotional and physical symptoms. Major depressive disorder alters how you think, how you feel, and how you behave.
Image by TheVisualMD
Treatment: Antidepressants
Although depression may create physical changes in the brain, there is no physical test to determine whether or not someone has depression. Depressive disorder is diagnosed by the presence of certain core emotional and behavioral symptoms. These are known as the DSM-IV Diagnostic Criteria. For a diagnosis of major depression, at least five of the following symptoms must be present during the same 2-week period and represent a change from previous functioning. For a diagnosis of minor depression, from two to four of these symptoms must be present. For both major and minor depression, at least one of the symptoms must be either 1) depressed mood or 2) loss of interest or pleasure.
Image by TheVisualMD
Action Potential of Neuron
Neurons consist of three elements: the cell body, axons, and dendrites. A signal is transmitted from neuron to neuron by an electrical force known as the action potential. The size of the signal is always the same; what varies is whether it's switched \"on\" or \"off.\" When a cell body receives enough stimulation--for example, when you touch a very hot teapot--voltage-gated ion channels open on its surface to let charged particles (ions) into, and then out of, the cell. The flow of these particles causes the cell to generate an electrical discharge that is transmitted down the length of the axon to its end, or terminal.
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Nerve Components
Nerve Components : A nerve is made up of bundles of neuron axons that are grouped together and encased in protective tissue. Each nerve is made up of afferent fibers, which carry information from the outside world to the brain, and efferent fibers, which carry information from the brain to the different parts of the body. Nerve Components : A nerve is made up of bundles of neuron axons that are grouped together and encased in protective tissue. Each nerve is made up of afferent fibers, which carry information from the outside world to the brain, and efferent fibers, which carry information from the brain to the different parts of the body.
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Neural Pathways
Your Brain, Neural Pathways, and Synapses : Information, in the form of electrical impulses, travels along neural pathways composed of interconnected neurons. Neuron cells are composed of three basic elements: the cell body, the axon, and the dendrite. Axons are long fibers, sometimes branched, which extend out of the cell body and transmit electrical impulses to the next neuron. Electrical impulses generated by a presynaptic neuron are transmitted by way of neurotransmitters (messenger chemicals) across a synaptic cleft and to the postsynaptic neuron, which then propagates the electrical signal onward to its eventual destination.
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Older Adults and Depression
National Institute of Mental Health
Depression Basics
National Institute of Mental Health
Teen Depression
National Institute of Mental Health
Depression Risk Factors, Symptoms, & Diagnosis
TheVisualMD
Depression
PublicDomainPictures/Pixabay
4:51
What Is Depression?
TheVisualMD
Depression, Loneliness, Man, Mood
PublicDomainPictures/Pixabay
Brain Development
TheVisualMD
Types of Depression
TheVisualMD
Causes of Depression
TheVisualMD
Comparing Talk Therapy and Other Depression Treatments With Antidepressant Medicines
Agency for Healthcare Research and Quality (AHRQ)
Depression Changes Your Brain
TheVisualMD
Causes of Depression
TheVisualMD
Depression and Pain
TheVisualMD
Depression and Neurotransmitters
TheVisualMD
Postpartum Depression
TheVisualMD
Depression Changes the Brain
TheVisualMD
Treatment for Depression, Antidepressants
TheVisualMD
Vagus Nerve Stimulation
TheVisualMD
Vagus Nerve Stimulation, Wire from Electrode
TheVisualMD
Vagus Nerve Stimulation
TheVisualMD
Depression and Pain
TheVisualMD
Depression Changes the Brain
TheVisualMD
Norepinephrine Molecule
TheVisualMD
Norepinephrine Receptor
TheVisualMD
Forms of Depression
TheVisualMD
Symptoms and Diagnosis
TheVisualMD
Forms of Depression
TheVisualMD
Woman Having Postpartum Depression
TheVisualMD
Forms of Depression
TheVisualMD
The Depression Cascade
TheVisualMD
Finding Balance
TheVisualMD
Forms of Depression
TheVisualMD
Symptoms and Diagnosis of Depression
TheVisualMD
Neurotransmitters
TheVisualMD
Antidepressants
TheVisualMD
Normal Hippocampus
TheVisualMD
Blood Vessel
TheVisualMD
Shrunken Hippocampus
TheVisualMD
Limbic System, lateral view
TheVisualMD
Depression, Mental Health, Sadness
HASTYWORDS/Pixabay
What Makes You Unique
TheVisualMD
Depression and Neurotransmitters
TheVisualMD
Treating Depression
TheVisualMD
Depression (mood)
TheVisualMD
Forms of Depression
TheVisualMD
Treatment: Antidepressants
TheVisualMD
Action Potential of Neuron
TheVisualMD
Nerve Components
TheVisualMD
Neural Pathways
TheVisualMD
Cerebral Cortex
Cerebral Cortex
Image by Lorenzo Bandieri
Cerebral Cortex
Cerebrum, side view. This drawing is meant to show the "classical" anatomical features of the cerebral cortex, with its main gyri and sulci, more in a didactical than naturalistic fashion.
Image by Lorenzo Bandieri
Functions of the Cerebral Cortex
Functions of the Cerebral Cortex
The cerebrum is the seat of many of the higher mental functions, such as memory and learning, language, and conscious perception, which are the subjects of subtests of the mental status exam. The cerebral cortex is the thin layer of gray matter on the outside of the cerebrum. It is approximately a millimeter thick in most regions and highly folded to fit within the limited space of the cranial vault. These higher functions are distributed across various regions of the cortex, and specific locations can be said to be responsible for particular functions. There is a limited set of regions, for example, that are involved in language function, and they can be subdivided on the basis of the particular part of language function that each governs.
The basis for parceling out areas of the cortex and attributing them to various functions has its root in pure anatomical underpinnings. The German neurologist and histologist Korbinian Brodmann, who made a careful study of the cytoarchitecture of the cerebrum around the turn of the nineteenth century, described approximately 50 regions of the cortex that differed enough from each other to be considered separate areas (image). Brodmann made preparations of many different regions of the cerebral cortex to view with a microscope. He compared the size, shape, and number of neurons to find anatomical differences in the various parts of the cerebral cortex. Continued investigation into these anatomical areas over the subsequent 100 or more years has demonstrated a strong correlation between the structures and the functions attributed to those structures. For example, the first three areas in Brodmann’s list—which are in the postcentral gyrus—compose the primary somatosensory cortex. Within this area, finer separation can be made on the basis of the concept of the sensory homunculus, as well as the different submodalities of somatosensation such as touch, vibration, pain, temperature, or proprioception. Today, we more frequently refer to these regions by their function (i.e., primary sensory cortex) than by the number Brodmann assigned to them, but in some situations the use of Brodmann numbers persists.
Brodmann's Areas of the Cerebral Cortex
On the basis of cytoarchitecture, the anatomist Korbinian Brodmann described the extensive array of cortical regions, as illustrated in his figure. Subsequent investigations found that these areas corresponded very well to functional differences in the cerebral cortex. (credit: modification of work by “Looie496”/Wikimedia Commons, based on original work by Korvinian Brodmann)
Area 17, as Brodmann described it, is also known as the primary visual cortex. Adjacent to that are areas 18 and 19, which constitute subsequent regions of visual processing. Area 22 is the primary auditory cortex, and it is followed by area 23, which further processes auditory information. Area 4 is the primary motor cortex in the precentral gyrus, whereas area 6 is the premotor cortex. These areas suggest some specialization within the cortex for functional processing, both in sensory and motor regions. The fact that Brodmann’s areas correlate so closely to functional localization in the cerebral cortex demonstrates the strong link between structure and function in these regions.
Areas 1, 2, 3, 4, 17, and 22 are each described as primary cortical areas. The adjoining regions are each referred to as association areas. Primary areas are where sensory information is initially received from the thalamus for conscious perception, or—in the case of the primary motor cortex—where descending commands are sent down to the brain stem or spinal cord to execute movements (image).
Types of Cortical Areas
The cerebral cortex can be described as containing three types of processing regions: primary, association, and integration areas. The primary cortical areas are where sensory information is initially processed, or where motor commands emerge to go to the brain stem or spinal cord. Association areas are adjacent to primary areas and further process the modality-specific input. Multimodal integration areas are found where the modality-specific regions meet; they can process multiple modalities together or different modalities on the basis of similar functions, such as spatial processing in vision or somatosensation.
A number of other regions, which extend beyond these primary or association areas of the cortex, are referred to as integrative areas. These areas are found in the spaces between the domains for particular sensory or motor functions, and they integrate multisensory information, or process sensory or motor information in more complex ways. Consider, for example, the posterior parietal cortex that lies between the somatosensory cortex and visual cortex regions. This has been ascribed to the coordination of visual and motor functions, such as reaching to pick up a glass. The somatosensory function that would be part of this is the proprioceptive feedback from moving the arm and hand. The weight of the glass, based on what it contains, will influence how those movements are executed.
Source: CNX OpenStax
Additional Materials (11)
Prefrontal cortex of left cerebral hemisphere
Prefrontal cortex of left cerebral hemisphere
Image by Database Center for Life Science(DBCLS)
Cerebral Cortex Region Related to Hearing
3D visualization of the cerebral cortex reconstructed from scanned human data. The cerebral cortex, the outermost region of the brain, can be divided into regions depending on function. The region dedicated to hearing and sound perception occupies a space on the temporal lobe. The Wernicke's area, auditory association area, and primary auditory cortex are the three areas of this region that perceive pitch, rhythm, sound, and make memories of past sounds.
Image by TheVisualMD
Prefrontal cortex
The ventromedial prefrontal cortex in your brain is active in every choice you make. It`s Decision Central. The dorsolateral prefrontal cortex is more active when you are keeping your impulses in check by employing self-control.
Image by TheVisualMD
Prefrontal cortex of left cerebral hemisphere
Prefrontal cortex of left cerebral hemisphere
Image by Database Center for Life Science(DBCLS)
Cerebral Cortex Region Related to Sight
3D visualization of the cerebral cortex reconstructed from scanned human data. The cerebral cortex, the outermost portion of the brain, can be divided into regions depending on function. Depicted here is the region dedicated to sight located on the posterior aspect of the brain covering most of the occipital lobe.
Image by TheVisualMD
Overview of the functions of the cerebral cortex
Video by khanacademymedicine/YouTube
The Nervous System: Cerebral Cortex
Video by ProEdify/YouTube
Frontal Lobe – Cerebral Cortex | Lecturio
Video by Lecturio Medical/YouTube
Emotions: cerebral hemispheres and prefrontal cortex | MCAT | Khan Academy
Video by khanacademymedicine/YouTube
Cerebral cortex | Organ Systems | MCAT | Khan Academy
Assessment of cerebral functions is directed at cognitive abilities. The abilities assessed through the mental status exam can be separated into four groups: orientation and memory, language and speech, sensorium, and judgment and abstract reasoning.
Orientation and Memory
Orientation is the patient’s awareness of his or her immediate circumstances. It is awareness of time, not in terms of the clock, but of the date and what is occurring around the patient. It is awareness of place, such that a patient should know where he or she is and why. It is also awareness of who the patient is—recognizing personal identity and being able to relate that to the examiner. The initial tests of orientation are based on the questions, “Do you know what the date is?” or “Do you know where you are?” or “What is your name?” Further understanding of a patient’s awareness of orientation can come from questions that address remote memory, such as “Who is the President of the United States?”, or asking what happened on a specific date.
There are also specific tasks to address memory. One is the three-word recall test. The patient is given three words to recall, such as book, clock, and shovel. After a short interval, during which other parts of the interview continue, the patient is asked to recall the three words. Other tasks that assess memory—aside from those related to orientation—have the patient recite the months of the year in reverse order to avoid the overlearned sequence and focus on the memory of the months in an order, or to spell common words backwards, or to recite a list of numbers back.
Memory is largely a function of the temporal lobe, along with structures beneath the cerebral cortex such as the hippocampus and the amygdala. The storage of memory requires these structures of the medial temporal lobe. A famous case of a man who had both medial temporal lobes removed to treat intractable epilepsy provided insight into the relationship between the structures of the brain and the function of memory.
Henry Molaison, who was referred to as patient HM when he was alive, had epilepsy localized to both of his medial temporal lobes. In 1953, a bilateral lobectomy was performed that alleviated the epilepsy but resulted in the inability for HM to form new memories—a condition called anterograde amnesia. HM was able to recall most events from before his surgery, although there was a partial loss of earlier memories, which is referred to as retrograde amnesia. HM became the subject of extensive studies into how memory works. What he was unable to do was form new memories of what happened to him, what are now called episodic memory. Episodic memory is autobiographical in nature, such as remembering riding a bicycle as a child around the neighborhood, as opposed to the procedural memory of how to ride a bike. HM also retained his short-term memory, such as what is tested by the three-word task described above. After a brief period, those memories would dissipate or decay and not be stored in the long-term because the medial temporal lobe structures were removed.
The difference in short-term, procedural, and episodic memory, as evidenced by patient HM, suggests that there are different parts of the brain responsible for those functions. The long-term storage of episodic memory requires the hippocampus and related medial temporal structures, and the location of those memories is in the multimodal integration areas of the cerebral cortex. However, short-term memory—also called working or active memory—is localized to the prefrontal lobe. Because patient HM had only lost his medial temporal lobe—and lost very little of his previous memories, and did not lose the ability to form new short-term memories—it was concluded that the function of the hippocampus, and adjacent structures in the medial temporal lobe, is to move (or consolidate) short-term memories (in the pre-frontal lobe) to long-term memory (in the temporal lobe).
The prefrontal cortex can also be tested for the ability to organize information. In one subtest of the mental status exam called set generation, the patient is asked to generate a list of words that all start with the same letter, but not to include proper nouns or names. The expectation is that a person can generate such a list of at least 10 words within 1 minute. Many people can likely do this much more quickly, but the standard separates the accepted normal from those with compromised prefrontal cortices.
Language and Speech
Language is, arguably, a very human aspect of neurological function. There are certainly strides being made in understanding communication in other species, but much of what makes the human experience seemingly unique is its basis in language. Any understanding of our species is necessarily reflective, as suggested by the question “What am I?” And the fundamental answer to this question is suggested by the famous quote by René Descartes: “Cogito Ergo Sum” (translated from Latin as “I think, therefore I am”). Formulating an understanding of yourself is largely describing who you are to yourself. It is a confusing topic to delve into, but language is certainly at the core of what it means to be self-aware.
The neurological exam has two specific subtests that address language. One measures the ability of the patient to understand language by asking them to follow a set of instructions to perform an action, such as “touch your right finger to your left elbow and then to your right knee.” Another subtest assesses the fluency and coherency of language by having the patient generate descriptions of objects or scenes depicted in drawings, and by reciting sentences or explaining a written passage. Language, however, is important in so many ways in the neurological exam. The patient needs to know what to do, whether it is as simple as explaining how the knee-jerk reflex is going to be performed, or asking a question such as “What is your name?” Often, language deficits can be determined without specific subtests; if a person cannot reply to a question properly, there may be a problem with the reception of language.
An important example of multimodal integrative areas is associated with language function (image). Adjacent to the auditory association cortex, at the end of the lateral sulcus just anterior to the visual cortex, is Wernicke’s area. In the lateral aspect of the frontal lobe, just anterior to the region of the motor cortex associated with the head and neck, is Broca’s area. Both regions were originally described on the basis of losses of speech and language, which is called aphasia. The aphasia associated with Broca’s area is known as an expressive aphasia, which means that speech production is compromised. This type of aphasia is often described as non-fluency because the ability to say some words leads to broken or halting speech. Grammar can also appear to be lost. The aphasia associated with Wernicke’s area is known as a receptive aphasia, which is not a loss of speech production, but a loss of understanding of content. Patients, after recovering from acute forms of this aphasia, report not being able to understand what is said to them or what they are saying themselves, but they often cannot keep from talking.
The two regions are connected by white matter tracts that run between the posterior temporal lobe and the lateral aspect of the frontal lobe. Conduction aphasia associated with damage to this connection refers to the problem of connecting the understanding of language to the production of speech. This is a very rare condition, but is likely to present as an inability to faithfully repeat spoken language.
Broca's and Wernicke's Areas
Two important integration areas of the cerebral cortex associated with language function are Broca’s and Wernicke’s areas. The two areas are connected through the deep white matter running from the posterior temporal lobe to the frontal lobe.
Sensorium
Those parts of the brain involved in the reception and interpretation of sensory stimuli are referred to collectively as the sensorium. The cerebral cortex has several regions that are necessary for sensory perception. From the primary cortical areas of the somatosensory, visual, auditory, and gustatory senses to the association areas that process information in these modalities, the cerebral cortex is the seat of conscious sensory perception. In contrast, sensory information can also be processed by deeper brain regions, which we may vaguely describe as subconscious—for instance, we are not constantly aware of the proprioceptive information that the cerebellum uses to maintain balance. Several of the subtests can reveal activity associated with these sensory modalities, such as being able to hear a question or see a picture. Two subtests assess specific functions of these cortical areas.
The first is praxis, a practical exercise in which the patient performs a task completely on the basis of verbal description without any demonstration from the examiner. For example, the patient can be told to take their left hand and place it palm down on their left thigh, then flip it over so the palm is facing up, and then repeat this four times. The examiner describes the activity without any movements on their part to suggest how the movements are to be performed. The patient needs to understand the instructions, transform them into movements, and use sensory feedback, both visual and proprioceptive, to perform the movements correctly.
The second subtest for sensory perception is gnosis, which involves two tasks. The first task, known as stereognosis, involves the naming of objects strictly on the basis of the somatosensory information that comes from manipulating them. The patient keeps their eyes closed and is given a common object, such as a coin, that they have to identify. The patient should be able to indicate the particular type of coin, such as a dime versus a penny, or a nickel versus a quarter, on the basis of the sensory cues involved. For example, the size, thickness, or weight of the coin may be an indication, or to differentiate the pairs of coins suggested here, the smooth or corrugated edge of the coin will correspond to the particular denomination. The second task, graphesthesia, is to recognize numbers or letters written on the palm of the hand with a dull pointer, such as a pen cap.
Praxis and gnosis are related to the conscious perception and cortical processing of sensory information. Being able to transform verbal commands into a sequence of motor responses, or to manipulate and recognize a common object and associate it with a name for that object. Both subtests have language components because language function is integral to these functions. The relationship between the words that describe actions, or the nouns that represent objects, and the cerebral location of these concepts is suggested to be localized to particular cortical areas. Certain aphasias can be characterized by a deficit of verbs or nouns, known as V impairment or N impairment, or may be classified as V–N dissociation. Patients have difficulty using one type of word over the other. To describe what is happening in a photograph as part of the expressive language subtest, a patient will use active- or image-based language. The lack of one or the other of these components of language can relate to the ability to use verbs or nouns. Damage to the region at which the frontal and temporal lobes meet, including the region known as the insula, is associated with V impairment; damage to the middle and inferior temporal lobe is associated with N impairment.
Judgment and Abstract Reasoning
Planning and producing responses requires an ability to make sense of the world around us. Making judgments and reasoning in the abstract are necessary to produce movements as part of larger responses. For example, when your alarm goes off, do you hit the snooze button or jump out of bed? Is 10 extra minutes in bed worth the extra rush to get ready for your day? Will hitting the snooze button multiple times lead to feeling more rested or result in a panic as you run late? How you mentally process these questions can affect your whole day.
The prefrontal cortex is responsible for the functions responsible for planning and making decisions. In the mental status exam, the subtest that assesses judgment and reasoning is directed at three aspects of frontal lobe function. First, the examiner asks questions about problem solving, such as “If you see a house on fire, what would you do?” The patient is also asked to interpret common proverbs, such as “Don’t look a gift horse in the mouth.” Additionally, pairs of words are compared for similarities, such as apple and orange, or lamp and cabinet.
The prefrontal cortex is composed of the regions of the frontal lobe that are not directly related to specific motor functions. The most posterior region of the frontal lobe, the precentral gyrus, is the primary motor cortex. Anterior to that are the premotor cortex, Broca’s area, and the frontal eye fields, which are all related to planning certain types of movements. Anterior to what could be described as motor association areas are the regions of the prefrontal cortex. They are the regions in which judgment, abstract reasoning, and working memory are localized. The antecedents to planning certain movements are judging whether those movements should be made, as in the example of deciding whether to hit the snooze button.
To an extent, the prefrontal cortex may be related to personality. The neurological exam does not necessarily assess personality, but it can be within the realm of neurology or psychiatry. A clinical situation that suggests this link between the prefrontal cortex and personality comes from the story of Phineas Gage, the railroad worker from the mid-1800s who had a metal spike impale his prefrontal cortex. There are suggestions that the steel rod led to changes in his personality. A man who was a quiet, dependable railroad worker became a raucous, irritable drunkard. Later anecdotal evidence from his life suggests that he was able to support himself, although he had to relocate and take on a different career as a stagecoach driver.
A psychiatric practice to deal with various disorders was the prefrontal lobotomy. This procedure was common in the 1940s and early 1950s, until antipsychotic drugs became available. The connections between the prefrontal cortex and other regions of the brain were severed. The disorders associated with this procedure included some aspects of what are now referred to as personality disorders, but also included mood disorders and psychoses. Depictions of lobotomies in popular media suggest a link between cutting the white matter of the prefrontal cortex and changes in a patient’s mood and personality, though this correlation is not well understood.
Source: CNX OpenStax
Additional Materials (9)
The scope of embodied cognition 06.10.2021
A diagram showing the scope of embodied cognition and the intertwined relationship that arise between the sciences.
Image by John J. Madrid/Wikimedia
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What is Cognitive Neuroscience? | The Learning Brain | CPD: Cognitive Neuroscience
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Cognitive Disorders: Assessment and Testing – Psychiatry | Lecturio
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Strategies to Improve Cognitive Function | Memorial Sloan Kettering
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Aging and cognitive abilities | Processing the Environment | MCAT | Khan Academy
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Cognitive Abilities
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The scope of embodied cognition 06.10.2021
John J. Madrid/Wikimedia
What happens to your on brain when you're having brilliant ideas
rebe_zuniga
4:10
What is Cognitive Neuroscience? | The Learning Brain | CPD: Cognitive Neuroscience
CENTURY Tech/YouTube
6:23
Cognitive Disorders: Assessment and Testing – Psychiatry | Lecturio
Lecturio Medical/YouTube
8:50
Strategies to Improve Cognitive Function | Memorial Sloan Kettering
Memorial Sloan Kettering/YouTube
3:09
Aging and cognitive abilities | Processing the Environment | MCAT | Khan Academy
khanacademymedicine/YouTube
1:53
6 Effective Ways to Improve Cognitive Ability
Consumer Health Digest/YouTube
1:27
What Are Cognitive Skills and How Do They Work? - A BrainFit Resorts Production
BrainFit Resorts/YouTube
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Cognitive Abilities
GreggU/YouTube
Left Right Brain
Brain Lateralization
Image by Chickensaresocute/Wikimedia
Brain Lateralization
The oversimplification of lateralization in pop psychology. This belief was widely held even in the scientific community for some years. This picture demonstrates the lateralization of the human brain, which is divided into two hemispheres. The left brain controls functions that have to do with logic and reason, while the right brain controls functions involving creativity and emotion. source: http://en.wikipedia.org/wiki/File:Cerebral_lobes.png
Image by Chickensaresocute/Wikimedia
Everyday Connections Left Brain, Right Brain
Popular media often refer to right-brained and left-brained people, as if the brain were two independent halves that work differently for different people. This is a popular misinterpretation of an important neurological phenomenon. As an extreme measure to deal with a debilitating condition, the corpus callosum may be sectioned to overcome intractable epilepsy. When the connections between the two cerebral hemispheres are cut, interesting effects can be observed.
If a person with an intact corpus callosum is asked to put their hands in their pockets and describe what is there on the basis of what their hands feel, they might say that they have keys in their right pocket and loose change in the left. They may even be able to count the coins in their pocket and say if they can afford to buy a candy bar from the vending machine. If a person with a sectioned corpus callosum is given the same instructions, they will do something quite peculiar. They will only put their right hand in their pocket and say they have keys there. They will not even move their left hand, much less report that there is loose change in the left pocket.
The reason for this is that the language functions of the cerebral cortex are localized to the left hemisphere in 95 percent of the population. Additionally, the left hemisphere is connected to the right side of the body through the corticospinal tract and the ascending tracts of the spinal cord. Motor commands from the precentral gyrus control the opposite side of the body, whereas sensory information processed by the postcentral gyrus is received from the opposite side of the body. For a verbal command to initiate movement of the right arm and hand, the left side of the brain needs to be connected by the corpus callosum. Language is processed in the left side of the brain and directly influences the left brain and right arm motor functions, but is sent to influence the right brain and left arm motor functions through the corpus callosum. Likewise, the left-handed sensory perception of what is in the left pocket travels across the corpus callosum from the right brain, so no verbal report on those contents would be possible if the hand happened to be in the pocket.
Source: CNX OpenStax
Additional Materials (11)
Right Brain Dominant
An image showing a psychological division of the cerebral brain hemispheres
Image by ElisaRiva/Wikimedia
Left Right Cerebral hemispheres
The human brain is divided into two hemispheres–left and right. Scientists continue to explore how some cognitive functions tend to be dominated by one side or the other; that is, how they are lateralized.
Blue: Left cerebral hemisphere
Purple: Right cerebral hemisphere
Image by Polygon data were generated by Database Center for Life Science (DBCLS)/Wikimedia
The Left Brain Vs Right Brain Myth Explained | Curiosity
Video by Curiosity/YouTube
Do We Have Left or Right Brain Personalities?
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Are People Really Left-Brained or Right-Brained?
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Left Brain Right Brain is a MYTH
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Left Brain vs. Right Brain
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What's the Difference Between the Right Brain and Left Brain?
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The left brain vs. right brain myth - Elizabeth Waters
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How to do the Mental Status Exam | Merck Manual Professional Version
Video by Merck Manuals/YouTube
Right Brain Dominant
ElisaRiva/Wikimedia
Left Right Cerebral hemispheres
Polygon data were generated by Database Center for Life Science (DBCLS)/Wikimedia
6:43
The Left Brain Vs Right Brain Myth Explained | Curiosity
Curiosity/YouTube
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Do We Have Left or Right Brain Personalities?
Seeker/YouTube
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Are People Really Left-Brained or Right-Brained?
SciShow/YouTube
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Brain Lobes and Left and Right Hemispheres of the Brain
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Left Brain Right Brain is a MYTH
After Skool/YouTube
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Left Brain vs. Right Brain
Dana Foundation/YouTube
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What's the Difference Between the Right Brain and Left Brain?
Psych2Go/YouTube
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The left brain vs. right brain myth - Elizabeth Waters
TED-Ed/YouTube
5:44
How to do the Mental Status Exam | Merck Manual Professional Version
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Mental Status Exam
In the clinical setting, the set of subtests known as the mental status exam helps us understand the relationship of the brain to the body. Ultimately, this is accomplished by assessing behavior.