mental status assessment Flashcards
mental disorder
person’s response is much greater than expected reaction to traumatic life event
- significant behavioral or psychological pattern associated with distress
organic disorder
due to brain disease
- delerium, dimentia, alcohold, drug intoxication
psychiatric mental illness
anxiety disorder, schizophrenia
mental status exam
inferred through assessment of an individual’s behaviors
- consciousness: aware of one’s own existence, feelings, and thoughts and aware of environment.
- language: voice used to communicate thoughts and feelings.
- mood and affect: temporary expression of feelings and durable, prolonged display of feelings
- orientation: awareness of objective world in relation to self
- attention: concentration, ability to focus
- memory: ability to lay down and store experiences
- abstract reasoning: pondering a deeper meaning
- thought process: way a person thinks, logical train of thought
- preceptions: awareness of objects through 5 senses
children MSE
by school age most children can sit and concentrate for a period of time
- age 7 - thinking becomes more logical and systematic and child is able to reason and understand
- age 12-15 = abstract thinking and thinking of hypothetical situations
Behavior Checklist: used for kids 7-11 who have outgrown developmental checklist
DENVER II: detects developmental delays in infants and preschoolers for: gross motor, language, fine motor, social skills
aging adult MSE
takes longer for brain to process info
- recent memory decreases, remote memory does not
- age related changes in sensory can affect perception
- always check sensory status first, this can cause misdiagnosis if not checked 1st
GLASGOW COMA SCALE: useful for testing consciousness
- general orientation is good
MINI COG: 3 item recall test and clock drawing
- grief can interfere with MSE
Components of MSE
APPEARANCE: posture, body movements, dress, hygiene
BEHAVIOR: facial expression, speech, mood and affect
COGNITION: orientation, attention span, recent and remote memory, new learning
THOUGHT PROCESSES: thought process, thought content, perceptions, anxiety disorders, depression, suicidal thoughts,
MMSE
mini mental status exam
- used to demonstrate worsening or improvement over time.
- concentrates on cognitive functioning, not mood or process
levels of consciousness
- Alert: awake or readily aroused, oriented, fully aware of external and internal stimuli
- lethargic, somnolent: not fully alert, drifts to sleep, arounsed by name or but looks drowsy, thinking seems slow and fuzzy
- obtunded: sleeps most of time, difficult to arouse, monosylabus, mumbled speech
- stupor or semi-coma: spontaneously unconscious, responds to only persistent or various shaking,
- Coma: completely unconscious, no response to pain or to external or internal stimuli
* Delirium: clouding of consciousness, inattentive, incoherent convos, impaired recent memory,
full mental exam is needed when:
- initial screening suggests anxiety or depression
- family members are concerned
- known brain lesions
- aphasia
- symptoms psychiatric illness
ABCT
Appearance, behavior, cognition, thought process
additional tests for patients with apasia
- word comprehension - point and identify
- reading - read and then do what it says
- writing - write subject and verb
delirium vs. dimentia
delirium: acute, reversible, identifiable factor for change in mental status (alcohol, drugs, oxygenation,
dimentia: progressive, not sudden, alzheimers. can result in death
Speech Disorders
- dysphonia: voice; difficulty talking with normal pitch and volume, due to laryngeal disease, voice horse or whispered but in tact
- dysarthria: ariculation; distorted speech sounds, unintelligible, basic language in tact
- Apasia: language comprehension and production; secondary to brain damage. true language disturbance.
mood and affect abnormalities
- flat affect: lack of emotion, no expression or feelings, voice monotonous
- depresson: sad, gloomy, dejected
- depersonalization: loss of identity, feels estranged, “i don’t feel real”
- elation: joy and optomism, overconfidence,
- euphoria: excessive well being
- anxiety: worried, uneasy unknown anticipation of unknown danger
- fear: worried, uneasy, apprehensive
- irritability: annoyed, easily provoked, impatient
- rage: furious, loss of control
- ambivalence: love and hate towards self or other
- lability: rapid shift of emotions
abnormalities of thought process
- blocking: unable to complete full thought
- confabulation: fabricates events to fill in memoey
- neologism: coining a new word
- circumlocution: round-about expression, substituting a phrase when one word can be used
- circumstantiality: excessive and unnecessary detail, delays reaching point
- flights of ideas
- word salad: incoherent mix of words
- echolalia: imitation, repeats others’ words or phrases. mumbling, mocking, mechanical tone
abnormalities of thought content
- phobia: stong, persistent, irrational fear of an object or situation
- hypochondriasis: morbid worrying about health
- obession: unwanted, persistent thoughts or impulses
- compulsion: unwanted, repetitive purposeful act
- delusions: firm, fixed, false beliefs
abnormalities of perception
- hallucination: sensory perceptions but no external stimuli
* illusion: misperception of an actual existing stimulus, folds of bed sheets appear animated
schitzophrenia
two or more in one month: delusions, hallucinations, disordered speech, gross disorganization, negative symptoms
- dysfunction at work, interpersonal relations, self care
- signs last at least 6 months
delerium
disturbance of consciousness, change in cognition, short period of time
dementia
memory impairment, aphasia, apraxia, agnosia, disturbance in executive functioning
amnestic disorder
memory impairment with abets of other significant cognitive impairment
- impair social or occupational functioning
major depressive episode
5 or more symptoms: depressed mood, diminished interest or pleaseure in most daily activities, weight loss, insomnia, psychomotor agitation, fatigue, dimished ability to think, thoughts of death
manic episode
2 weeks, two years, or bipolar is manic symptoms followed by depression
panic attack
intense fear or discomfort
agoraphobia
anxiety about being in places or situations from which escape might be difficult. situations are avoided (travel)
panic disorder
unexpected panic attacks, concern about more attacks, change in behavior
