Mental Status Exam Flashcards
What are the components of the MSE
Attention, memory, orientation, perceptions, though process/content, insight, judgment, affect, mood, language, higher cognitive functions
What is perceptual disturbance?
Not interpreting what is happening in the real world properly; having delusions
What is insight
Personal awareness and understanding
What is judgement
Evaluation of personal and external situations and their decision making
What is affect
Observable changes in the person; AKA wear their emotions on their sleeve; can’t tell this when a pt walks in
What about the pts language do you need to evaluate
Pace Rate Tone Level of coherence Proper structure and expression
What is higher function
Higher level of thinking, rationalization, and understanding
What percent of the US population is affected by serious mental illness
6%
What percent of US outpatients suffer from ANY mental illness
20-30%
What are the common mood disorders seen in primary care
Depression, bipolar, dysthymia
Why is it important to identify and treat mood disorders
These pts have suicide rates 8X higher than normal population
What are common anxiety disorders seen in primary care
Panic disorder, GAD, PTSD
What are common somatoform disorders seen in primary care
Conversion disorder, body dysmorphic, & pain disorder
What % of symptoms are unexplained by organic causes in studies of somatoform disorders
30%
What do mental disorders often emerge as? Give examples
Often emerge as somatic complaints such as fatigue, pain, palpitations, reproductive complaints, vertigo, MSK, HA, & GI
What do you always need to consider/rule out when pt presents with mental issue
Always first r/o organic and pharmacological causes
What should trigger a MSE being performed
Medically unexplained physical SxS High SxS count (somatic/all over) High severity of the complaint when organic causes are ruled out Chronic pain Recent stressor Difficult encounters Low self rating of health Frequent use of healthcare services Substance abuse Cognitive complaints of any sort
What is the difference between lethargy and obtundation
Obtundation is much more severe, pt is unconscious
When accessing posture and motor behavior what do you need to look for
Agitation, slowing, restlessness, expansive movements
What areas need to be evaluated when accessing pts appearance and behavior
Level of consciousness Posture & motor behavior Dress, grooming, personal hygiene Facial expressions Manner, affect, & relationship to persons/things
When accessing pts speech and language what do you need to note/look for
Rate
Articulation (dysarthria vs aphasia)
Fluency
When accessing a pts mood what is the red flag or main thing you need to note
Suicidal ideation (ideas, plans, attempts)
What are illusions & what are they seen with
They are misinterpretations of real stimuli
Occur with grief, PTSD, & schizophrenia
What are hallucinations and what are they seen with
They are non-real sensory perceptions
Occur with alcoholic psychosis & PTSD
When accessing cognitive function what is orientation, attention, remote memory, recent memory, and new learning ability
Orientation = where are they in time and space
Attention = ability to focus
Remote memory = occurs late in dementia
Recent memory = aka short term memory; impaired in amnesia, delirium, & dementia
New learning ability = use of new info recall (new address, word recall)
What are the higher cognitive functions
Information and vocabulary, calculation, abstract thinking, and constructional ability
When is calculation function deteriorated
Deteriorates in dementia
What does MMSE stand for
Mini mental status exam
What is the MMSE
Screening tool for cognitive dysfunction or dementia
What is the maximum points possible for the MMSE
30 points possible
What is the difficulty in scoring the MMSE
It may be affected by age and pt level of education
What is a “normal score” for an 18-69 y/o pt with a high school education
28-29
What is a “normal score” for an 18-69 y/o pt with a college level education
29
