Mental Status Flashcards
Level of Arousal/Alertness
The physiological and psychological state of being awake and reactive to stimuli.
Level on consciousness can be imparied with brainstem damage of the derebral hemisphere and thalamus aswell as toxic or metrabolic factors.
Rate the level of consciousness
Level of Consciousness (arousal)
- Alertness - speak to person normally and they will respond fully to the appropriate stimuli
- Lethargy - speak to person loudly and call their. They will appear drowsy, respond to questions but sleep
- Obtundation - shake person gently, person will open eyes and respond slow and seem confused
- Stupor - Apply a painful stimuli such a pinch, person will only respond from sleep from painful stimuli
- Coma - apply repeated painfuil stimuli, no response from person
The Glascow Coma Scale
The GCS quantifies the level of consciousness follwing an injury to the brain and used to assess head injury.
Scores range from 3-15 and a score under 8 would apply to an unconscious person.
Attention and Orientation
Test of attention:
- Ask patient to spell a short word forwards and backwards (world)
- Name the months
- Count back from 100 by 7
Impaired attention and cooperation can occur in many focal brain lesions, this is not an intelligence test.
Test Orientation:
- Ask for the pt’s name, address and date and time. Shows awareness and requires memory, congition and attention.
A&Ox3 means alert and orientated to person,place and time.
Memory
Recent memory:
- Get the pt to recall 3 items (shoe, cat, house) after a 5 minute delay. Get them to repeat after given it.
Remote Memory:
- get the pt to talk about a past verifiable personal event
unable to recall a memeory can be due to impaired attention. If they cant recall after 5 minutes it can indicate limbic system.
Loss of memory after incident is anterograde amnesia and just before indicdent is retrograde amnesia.
Memories are made from info passing from brainstem to temporal lobes and consolidated in the diencephalon.
Language
Test Spontaneous Speech
- Ask a question and note for fluency, rate, abundance and errors
Test Comprehension:
- Point to things - get pt to name
- Ask pt to point to objects - where is the door?
- Give the patient a sentence and ask him to repeat - no ifs ands or buts
Things to Identify:
- Hesitencies in speech - stroke
- Monotone inflections - depression
- Circumlocutions -replacement of words for things they cant remember
- Paraphasia - words are malformed or invented
Broca’s aphasia - difficulty expressing but understands
Wernicke’s aphasia - talks but does not make sense
Calculations, Right-Left Confusion, Finger Agnosia and Agraphia
If all 4 are impaired then its called Gerstmanns Syndrome.
- Acalculia - inability to do simple calculations
- Right-Left Confusion - trouble identifying right and left
- Finger Agnosia - problem naming and identifying each digit
- Agraphia - issues writing name or sentence
Apraxia
Test Apraxia:
- Get patient to perform a task - pretend to brush your teeth
Inability to follow motor commands due to higher order planning disorder. Pt performs task awkwardly and minimally.
Neglect and Constructions
Hemineglect is an abnormality in the attention to one side of the universe and not due to a primary sensory or motor disorder
- Visual Neglect or Extinction - place fingers in each visual field of the pt and wiggle and get them to tell you which ones are wiggling, single, double, hemineglect is same side.
- Tactile Neglect or Sensory Neglect - close eyes and touch one point at the time and get the patient to point to where they were touched. then touch both sides and ask if one or two
- Sensorimotor Neglect Test - Ask them to draw a clock with all the numbers or get them to copy a drawing
Sequencing Task and Frontal Release Signs
Pt has trouble changing from one action to another.
- Manual alternating sequence task - Draw square and triangles, has trouble changing and continues to draw.
Frontal lobe lesions causing primitive reflexes:
- Grasp reflex - forced grip with palm contact
- Suck reflex - sucking response when palate is touched
- Snout reflex - pursed lip when pt’s upper lip is tapped
- Palmonental reflex - stoke the thenar eminance and look for lower lip movement
Logic and Abstraction
Analogies, logic - get the pt to interpret proverbs, dont count your chickens before they hatch. Ask comprehension questions - how are oranges and apples similar.
Logic, coherence ands relevance of pt’s thoughts. dysfuction of higher order cortex
Abnormal Thought Process
Note presence of any of the following:
- Compulsions - repeatative behaviors
- Obsessions - uncontrollable thoughts
- Phobias - Persistent fears
- Anxiety - apprehension
- Delusions - false belief
- Delusion of persecution - conspiracry theories
Mood
Observable mood is expressed though facial expression, body and voice. Sustain by the pt
- Euthymic - Normal
- Dysthymic - Depressed
- Manic - Elated
Often psychologcal in origin and imbalances may be due to toxic or metabolic abnormalities.
