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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candid, congenial, cooperative, defensive, engaging, guarded, hostile, irritable, open, relaxed, resistant, shy, withdrawn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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Mood & affect (mental status exam): potential abnormal dx
mood disorder schizo substance use
26
motor activity (mental status exam): potential abnormal dx
akathisia: anxiety, drug OD/withdrawal, medication effect, mood disorder, Parkinsonism, PTSD, schizo
27
Motor Activity (mental status exam): what to assess
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
28
Attention(mental status exam)
ability to focus based on internal or external priorities
29
Attention (mental status exam): sample questions
count by 7s or 5s | spell word backwards
30
Mood/affect (mental status exam) sample questions
how is your mood? have you felt sad/discouraged lately? have you felt energized/out of control lately?
31
Attention (mental status exam): potential abnormal diagnosis
``` ADHD delirium dementia mood disorder psychotic disorder ```
32
Executive Functioning(mental status exam)
ordering and implementation of cognitive functions necessary to engage in appropriate behaviors
33
executive functioning (mental status exam): what to assess
testing each cognitive function involved in completing a task
34
Executive Functioning (mental status exam): questions to ask
clock drawing test (draw a clock w/ hands set to 11:10 | trail-making test (ask to alternate # w/ letters in ascending order)
35
Executive Functioning (mental status exam): abnormal dx
``` delirium dementia mood disorder psychotic disorder stroke ```
36
Gnosia(mental status exam)
ability to name objects and their function
37
Gnosis (mental status exam): questions to ask
show common object and ask to ID and how its used
38
Gnosis (mental status exam): abnormal dx
advanced dementia | stroke
39
Language (mental status exam)
verbal or written communication
40
language (mental status exam): what to assess
appropriateness of conversation, rate of speech (>100 words/min, <50 words/min abnormal), reading/writing education level appropriate
41
memory (mental status exam)
recall of past events
42
language (mental status exam: abnormal dx
rapid/pressure speech: mania slow/impoverished speech: delirium, depression, schizo inappropriate conversation: personality disorder, schizo inappropriate reading/writing: dementia, depression, previous stroke
43
memory (mental status exam): what to assess
declarative: recall of recent and past events procedural: ability to complete learned tasks w/o conscious thought
44
memory (mental status exam): questions to ask
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
memory (mental status exam): abnormal dx
``` short-term deficit: motivation ADHD dementia inattention substance use ```
46
orientation (mental status exam)
ability of patient to recognize their place in time and space
47
orientation (mental status exam): what to assess
time, space, person
48
orientation (mental status exam): what to ask
what year/month/day/time is it? what city/building/floor/room are you in? what is your name? where were you born?
49
orientation (mental status exam): abnormal dx
``` amnesia delerium dementia mania previous stroke severe depression ```
50
praxis (mental status exam)
ability to carry out intentional motor acts
51
praxis (mental status exam): what to assess
apraxia: inability to carry out motor acts; deficits may exist in motor or sensory systems, comprehension, or cooperation
52
praxis (mental status exam): questions to ask
could you show me how to use this tool?
53
praxis (mental status exam): abnormal dx
delirium dementia intoxication stroke
54
prosody (mental status exam)
ability to recognize the emotional aspects of language
55
prosody (mental status exam): what to ask
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
prosody (mental status exam): abnormal dx
autism developmental delay mood disorder schizo
57
thought content (mental status exam)
what the pt is thinking
58
thought content (mental status exam): what to assess
``` delusions hallucinations homicidality obsessions phobias SI ```
59
thought content (mental status exam): what to ask
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
thought content (mental status exam): abnormal dx
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
Thought processes (mental status exam)
organization of thoughts in a goal-oriented pattern
62
thought processs (mental status exam): what to assess
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
thought processes (mental status exam): what to ask
generally apparent throughout the encounter
64
thought processes (mental status exam): abnormal dx
``` anxiety delirium dementia depression schizo substance use ```
65
visuospatial proficiency (mental status exam)
ability to perceive and manipulate objects and shapes in space
66
visuospatial proficiency (mental status exam): what to ask
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
visuospatial proficiency (mental status exam): abnormal dx
delerium dementia stroke
68
4 Cognitive Screening Tools
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
testing for aphasia
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
abnormalities in thought processes
``` circumstantiality derailment flight of ideas neologisms incoherence blocking confabulation preservation echolalia clanging ```
71
abnormalities of thought content
``` compulsions obsessions phobias anxieties feelings of unreality feelings of depersonalization delusions ```
72
circumstantiality
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
derailment (loosening of associations)
tangental speech w/ shifting topics that are loosely connected or unrelated pt is unaware of lack of association abnormal dx: schizo. mania, psychotic
74
flight of ideas
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
neologisms
invented or distorted words, words w/ new and highly idiosyncratic meanings abnormal dx: schizo, psychotic, aphasia
76
incoherence
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
blocking
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
confabulation
fabrication of facts or events in response to questions, to fill in the gaps from impaired memory abnormal dx: Korssakoff syndrome from alcoholism
79
Perseveration
persistent repetition of words or ideas | abnormal dx: schizo, psychotic
80
Echolalia
repetition of words and phrases of others abnormal dx: mania, schizo
81
Clanging
speech w/ choice of words based on sound taster than meaning as in rhyming and punning abnormal dx: schizo, mania
82
compulsions
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
obsessions
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
phobias
persistent irrational fears accompanied by a compelling desire to avoid the provoking stimulus abnormal dx: anxiety
85
anxieties
apprehensive anticipation of future danger or misfortune accompanied by feelings of worry, distress, and/pr somatic symptoms of tension abnormal dx: anxiety
86
feelings of unreality
sense that the environment is strange unreal to remote abnormal dx: psychotic
87
delusions
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
feelings of depersonalization
sense that one's self of identity is different changed unreal, lost or detached from one's mind abnormal dx: psychotic
89
abnormalities of perception
illusions | hallucinations
90
Illusions
misinterpretations of real external stimuli such as mistaking rusting leaves for the sound of voices abnormal dx: grief, delirium, PTSD, schizo
91
Hallucinations
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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