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N507 Exam 1 > (5) Mental Status > Flashcards

(5) Mental Status Flashcards

1
Q

Appearance & Behavior (mental status exam)

A 
body habits
eye contact
interpersonal style
style of dress, hygiene
posture & motor behavior
level of consciousness
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2
Q

Appearance & Behavior(mental status exam):

what to assess

A

Appearance: attention to detail, attire, distinguishing features (tats, scars), grooming, hygiene

Behavior: candid, congenial, cooperative, defensive, engaging, guarded, hostile, irritable, open, relaxed, resistant, shy, withdrawn

Eye contact: fleeting, good, none, sporadic

Level of consciousness (lethargic - drowsy, open eyes, look @ you, respond, fall asleep vs. obtunded - open eyes, look @ you, respond slowly, confused; also stupor or coma)

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3
Q

Mood & Affect (mental status exam)

A

Mood: subjective report of emotional state by patient

Affect: objective observation of patient’s emotional state by the physician

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4
Q

Mood & Affect (mental status exam):

what to assess

A 
body movements/making contact with others
facial expressions (tearful, smiles, frowns)

How is your mood?
Have you felt sad/discouraged?
Have you felt energized or out of control lately?

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5
Q

Motor Activity(mental status exam)

A

facial expressions
movements
posture

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6
Q

Personality Disorders: 3 main classes

A

A. Odd/Eccentric
B. Dramatic/Emotional/Erratic
c. Anxious/Fearful

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7
Q

Personality: Odd/Eccentric

A
  • Paranoid: distrust/suspicious
  • Schizoid: detachment from social relations w/ restricted emotional range
  • Schizotypical: eccentricities in behavior and cognitive distortions; acute discomfort in close relationships
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8
Q

Personality Disorders: Dramatic, Emotional, or Erratic

A
  • Antisocial: disregard/violation of rights of others
  • Borderline: instability in interpersonal relationships, self-image, affective regulation; impulsivity
  • Histrionic: excessive emotionality and attention seeking
  • Narcissistic: persisting grandiosity, need for admiration and lack of empathy
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9
Q

Personality Disorders: Anxious or Fearful

A
  • Avoidant: social inhabitation, feelings of inadequacy and hypersensitivity to negative evaluation
  • Dependent: submissive and clinging behavior related to an excessive need to be taken care of
  • Obssessive-compulsive: preoccupation with orderliness, perfectionism, control
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10
Q

Attention

A

ability to focus or concentrate over time on a particular stimulus or activity - an inattentive person is early distracted and may have difficulty giving a hostly or responding to questions

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11
Q

Memory

A

process of registering or recording info, tested by asking for immediate repetition of material, followed by storage or retention of info
(recent/short term & long term)

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12
Q

Orientation

A

awareness of personal identity, place, time; required memory and attention

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13
Q

Perceptions

A

sensory awareness of objects in the environment and their interrelationships (external stimuli) also refers to internal stimuli such as dreams or hallucinations

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14
Q

Thought Processes

A

the logic, coherence,and relevance of the patient’s thought as it leads to selected goals; how people think

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15
Q

Insight

A

awareness that symptoms or disturbed behaviors are normal or abnormal; ex: distinguishing between daydreams and hallucinations that seem real

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16
Q

Judgment

A

process of comparing and evaluating alternatives when deciding on a course of action; reflects values that may or may not be based on reality and social conventions or norms

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17
Q

Affect

A

fluctuating pattern of observable behaviors that expresses subjective feelings or emotions through then of voice, facial expressions, and demeanor

flat, blunted, labile, inappropraite

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18
Q

Mood

A

more pervasive and sustained emotion that colors the person’s perception of the world (affect is to mood as weather is to climate)

euthymic (normal), elevated, dysphoric (unpleasant, sad, anxious, irritable)

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19
Q

Language (level of consciousness)

A

complex symbolic system for expressing, receiving, and comprehending words

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20
Q

higher cognitive functions

A

assessed by vocabulary, fund of info, abstract thinking, calculations, construction of objects that have 2 or 3 dimensions

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21
Q

Compulsions, obsessions, phobias, and anxieties are seen in:

A

mood disorders

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22
Q

neurocognitive disorders

A

delirium

dementia

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23
Q

parts of mental status exam

A 
Appearance & behavior
Speech & language
Mood
Thoughts & Perceptions
Cognition (memory, attention, info & vocabulary, calculations, abstract thinking, constructional activity)
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24
Q

Appearance & behavior (mental status exam): potential dx if abnormal

A

disheveled: depression, schizo/psychotic, substance use
irritable: anxiety
paranoid: psychotic
poor eye contact: depression, psychotic
provocative: personality disorder or trait
decreased grooming: depression, schizo, dementia
increased grooming: OCD

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25
Q

Mood & affect (mental status exam): potential abnormal dx

A

mood disorder
schizo
substance use

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26
Q

motor activity (mental status exam): potential abnormal dx

A

akathisia: anxiety, drug OD/withdrawal, medication effect, mood disorder, Parkinsonism, PTSD, schizo

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27
Q

Motor Activity (mental status exam): what to assess

A

akathisia: excessive motor activity (pacing, wringing of hands, inability to sit still)
bradykinesis: psychomotor retardation (slowing of physical/emotional reactions)
Catalonia: immobility w/ muscular rigidity or inflexibility

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28
Q

Attention(mental status exam)

A

ability to focus based on internal or external priorities

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29
Q

Attention (mental status exam): sample questions

A

count by 7s or 5s

spell word backwards

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30
Q

Mood/affect (mental status exam) sample questions

A

how is your mood?
have you felt sad/discouraged lately?
have you felt energized/out of control lately?

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31
Q

Attention (mental status exam): potential abnormal diagnosis

A 
ADHD
delirium
dementia
mood disorder
psychotic disorder
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32
Q

Executive Functioning(mental status exam)

A

ordering and implementation of cognitive functions necessary to engage in appropriate behaviors

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33
Q

executive functioning (mental status exam): what to assess

A

testing each cognitive function involved in completing a task

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34
Q

Executive Functioning (mental status exam): questions to ask

A

clock drawing test (draw a clock w/ hands set to 11:10

trail-making test (ask to alternate # w/ letters in ascending order)

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35
Q

Executive Functioning (mental status exam): abnormal dx

A 
delirium
dementia
mood disorder
psychotic disorder
stroke
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36
Q

Gnosia(mental status exam)

A

ability to name objects and their function

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37
Q

Gnosis (mental status exam): questions to ask

A

show common object and ask to ID and how its used

38
Q

Gnosis (mental status exam): abnormal dx

A

advanced dementia

stroke

39
Q

Language (mental status exam)

A

verbal or written communication

40
Q

language (mental status exam): what to assess

A

appropriateness of conversation, rate of speech (>100 words/min, <50 words/min abnormal), reading/writing education level appropriate

41
Q

memory (mental status exam)

A

recall of past events

42
Q

language (mental status exam: abnormal dx

A

rapid/pressure speech: mania
slow/impoverished speech: delirium, depression, schizo
inappropriate conversation: personality disorder, schizo
inappropriate reading/writing: dementia, depression, previous stroke

43
Q

memory (mental status exam): what to assess

A

declarative: recall of recent and past events
procedural: ability to complete learned tasks w/o conscious thought

44
Q

memory (mental status exam): questions to ask

A

when is your birthday?
what are your parents names” where were you born”
where were you on 9/11?
ask pt to repeat 3 words immediately and again in 5 minutes
ask pt to sign name while answering unrelated questions

45
Q

memory (mental status exam): abnormal dx

A 
short-term deficit: motivation
ADHD
dementia
inattention
substance use
46
Q

orientation (mental status exam)

A

ability of patient to recognize their place in time and space

47
Q

orientation (mental status exam): what to assess

A

time, space, person

48
Q

orientation (mental status exam): what to ask

A

what year/month/day/time is it?
what city/building/floor/room are you in?
what is your name? where were you born?

49
Q

orientation (mental status exam): abnormal dx

A 
amnesia
delerium
dementia
mania
previous stroke
severe depression
50
Q

praxis (mental status exam)

A

ability to carry out intentional motor acts

51
Q

praxis (mental status exam): what to assess

A

apraxia: inability to carry out motor acts; deficits may exist in motor or sensory systems, comprehension, or cooperation

52
Q

praxis (mental status exam): questions to ask

A

could you show me how to use this tool?

53
Q

praxis (mental status exam): abnormal dx

A

delirium
dementia
intoxication
stroke

54
Q

prosody (mental status exam)

A

ability to recognize the emotional aspects of language

55
Q

prosody (mental status exam): what to ask

A

repeat “why are you hear” with multiple inflections and ask pt to ID emotion
ask pt to say the same sentence w/ different emotional inflections

56
Q

prosody (mental status exam): abnormal dx

A

autism
developmental delay
mood disorder
schizo

57
Q

thought content (mental status exam)

A

what the pt is thinking

58
Q

thought content (mental status exam): what to assess

A 
delusions
hallucinations
homicidality
obsessions
phobias
SI
59
Q

thought content (mental status exam): what to ask

A

DO YOU…
have thought/images in head that cannot get out?
have irrational/excessive fears?
think people are trying o hurt you?
think people are talking behind your back?
think people are stealing from you?
think life isn’t worth living?
see things that upset you?
see/hear/taste/smell/feel things that aren’t there?
hear or see something others don’t?
think about hurting others?
think about hurting yourself? how would you?
think the world would be better off without you?

60
Q

thought content (mental status exam): abnormal dx

A

delusions: fixed delusions, mania, psychotic disorder/depression
hallucinationsL delirium, dementia. mania. schizo, severe depression, substance abuse
homicidality: mood disorder, personality disorder, psychotic
obsessions: OCD, PTSD, psychotic
phobias: anxiety, PTSD
SI: depression, PTSD, substance use

61
Q

Thought processes (mental status exam)

A

organization of thoughts in a goal-oriented pattern

62
Q

thought processs (mental status exam): what to assess

A

circumferential: pt goes through multiple related thought before arriving at the answer to a question
disorganized thought: pt moves from one topic to another w/o organization or coherence
tangential: pt listens to question and begins discussion related thought, but never arrives at the answer

63
Q

thought processes (mental status exam): what to ask

A

generally apparent throughout the encounter

64
Q

thought processes (mental status exam): abnormal dx

A 
anxiety
delirium
dementia
depression
schizo
substance use
65
Q

visuospatial proficiency (mental status exam)

A

ability to perceive and manipulate objects and shapes in space

66
Q

visuospatial proficiency (mental status exam): what to ask

A

ask pt to copy intersecting pentagons or a 3D cube on paper

draw a triangle and ask pt to draw the same shape upside down

67
Q

visuospatial proficiency (mental status exam): abnormal dx

A

delerium
dementia
stroke

68
Q

4 Cognitive Screening Tools

A
  1. Addenbrooke’s Cognitive Examination (attention, executive functioning, language, memory, orientation, visuospatial proficiency - 20 min)
  2. Mini-Cog (executive functioning, memory, visuospatial proficiency - 5 min)
  3. Mini-Mental State Examination (attention, language, memory, orientation, visuospatial proficiency - 10 min)
  4. Montreal Cognitive Assessment (attention, executive functioning, language, memory, orientation - 10 min)
69
Q

testing for aphasia

A

word comprehension (follow one and two stage commands)
repetition (repeat “no ifs ands or buts”)
naming (name parts of a watch)
reading comprehension (read paragraph aloud)
writing (write a sentence

70
Q

abnormalities in thought processes

A 
circumstantiality
derailment
flight of ideas
neologisms
incoherence
blocking
confabulation
preservation
echolalia
clanging
71
Q

abnormalities of thought content

A 
compulsions
obsessions
phobias
anxieties
feelings of unreality
feelings of depersonalization
delusions
72
Q

circumstantiality

A

mildest thought disorder, consisting of speech w/ unnecessary detail, indirection, and delay in reaching the point
some topics may have a meaningful connection
many people w/o mental disorders have this

abnormal dx: obsessions

73
Q

derailment (loosening of associations)

A

tangental speech w/ shifting topics that are loosely connected or unrelated
pt is unaware of lack of association

abnormal dx: schizo. mania, psychotic

74
Q

flight of ideas

A

an almost continuous flow of accelerated speech w/ abrupt changes from one topic to the next
changes are based on understandable associations, plays on words, distracting stimuli but ideas aren’t well connected

abnormal dx: mania

75
Q

neologisms

A

invented or distorted words, words w/ new and highly idiosyncratic meanings

abnormal dx: schizo, psychotic, aphasia

76
Q

incoherence

A

speech that is incomprehensible and illogical w/ lack of meaningful connections, abrupt changes in topic, or disordered grammar or word use
flight of ideas when severe may produce incoherence

abnormal dx: psychotic, schizo

77
Q

blocking

A

sudden interruption of speech in mid sentence or before the idea is completed, attributed to losing the thought
occurs in normal people
abnormal dx: schizo

78
Q

confabulation

A

fabrication of facts or events in response to questions, to fill in the gaps from impaired memory

abnormal dx: Korssakoff syndrome from alcoholism

79
Q

Perseveration

A

persistent repetition of words or ideas

abnormal dx: schizo, psychotic

80
Q

Echolalia

A

repetition of words and phrases of others

abnormal dx: mania, schizo

81
Q

Clanging

A

speech w/ choice of words based on sound taster than meaning as in rhyming and punning

abnormal dx: schizo, mania

82
Q

compulsions

A

repetitive behaviors that the person feels driven to perform in response to an obsession aimed at preventing or reducing anxiety or a dreaded event/situation
these behaviors are excessive and unrealistically connected to the provoking stimulus

abnormal dx: anxiety

83
Q

obsessions

A

recurrent persistent thoughts, images, or urges experienced as intrusive and unwanted that the person tried to ignore suppress or neutralize w/ other thoughts or actions
abnormal dx: anxiety

84
Q

phobias

A

persistent irrational fears accompanied by a compelling desire to avoid the provoking stimulus

abnormal dx: anxiety

85
Q

anxieties

A

apprehensive anticipation of future danger or misfortune accompanied by feelings of worry, distress, and/pr somatic symptoms of tension

abnormal dx: anxiety

86
Q

feelings of unreality

A

sense that the environment is strange unreal to remote

abnormal dx: psychotic

87
Q

delusions

A

false fixed personal beliefs that are not amenable to change in light of conflicting evidence
-persecutory, grandiose, jealous, erotomania (in love w/ individual), somatic (body fx), unspecified

abnormal dx: psychotic, delirium, severe mood, dementia

88
Q

feelings of depersonalization

A

sense that one’s self of identity is different changed unreal, lost or detached from one’s mind

abnormal dx: psychotic

89
Q

abnormalities of perception

A

illusions

hallucinations

90
Q

Illusions

A

misinterpretations of real external stimuli such as mistaking rusting leaves for the sound of voices

abnormal dx: grief, delirium, PTSD, schizo

91
Q

Hallucinations

A

perception like experiences that seem real but unlike illusions lack actual external stimulation
person may or may not recognize as false
-auditry, visual, olfactory, gustatory, tactile, somatic
(false perceptions associated w/ dreaming, falling asleep, awakening aren’t classified as hallucinations)

abnormal dx: delirium, dementia, schizo, PTSD, alcoholism

N507 Exam 1 (10 decks)

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