Mental status exam Flashcards
The ______ is an essential part of every psychiatric patient’s clinical evaluation
You do part of one every time you talk to someone
describes the patient’s present state, not his or her past history of symptoms
mental status examination (MSE)
Steps to performing a mini mental exam
- Appearance, Attitude, and Behavior
- Speech
- Mood and Affect
- Thought Form/Process and Content
- Perception
- Sensorium/ Cognition
- Insight
- Judgment
A Snake Moves Toward Prey Silently In Jungles
- Appearance, Attitude, and Behavior
- Speech
- Mood and Affect
- Thought Form/Process and Content
- Perception
- Sensorium/ Cognition
- Insight
- Judgment
How do we describe appearance, behavior, attitude?
overall apperance, look for abnormalities
attitude: towards examiner; friendly or hostile
behavior: moving around, attentive, rocking, weeping
How would you describe the Speech aspect of pt when doing the MME
QUALITIES, not content: rate, rhythm, volume and tone
____ describes the patient’s subjective, internal state of feeling
____ describes the patients objective, external appearance of feeling.
Mood
Affect
What is the relationship between mood and affect?
Mood and affect are normally congruent, but may be incongruent in some psychiatric syndromes (e.g. patient with schizophrenia is laughing uncontrollably, but feels sad)
____is appropriate when it “fits” with the patient’s situation and feelings.
Affect
*Patients with psychotic disorders often have inappropriate affect (e.g., laughing when discussing recent death of mother). Comment on range, intensity and appropriateness
describes how the patient is thinking. Normal thought form is often described as “logical, linear, and goal-oriented
Thought form (or process)
Among the many abnormalities of thought form seen in psychiatric patients are:
_____ – mind frequently goes blank
______ – very little thought occurring
_______ – takes a long time to get to the point
________ – logical, but never gets to the point
Thought blocking
Poverty of thought
Circumstantiality
Tangentiality
___________ – logical connections between thoughts breaks down
___________ – thoughts are expressed through sounds (e.g. rhyming) rather than meaning
_______ – new words or phrases are invented
Loose associations (a.k.a. derailment)
Clang associations
Neologisms
_______ – being stuck on a single thought
________ – rapid jumping from thought to thought, often seen in mania
Normal thought form is often documented as “logical, linear, and goal-oriented”
Perseveration
Flight of ideas
refers to what the patient is thinking
Abnormal thought content needs to be explored and
documented
Thought content
_______– fixed, false beliefs impervious to disproof or argument. Many types (grandeur, persecution, somatic, paranoid, etc.)
_______ – belief that TV, radio, etc. are talking to or about patient
_______ – belief that another person or force is controlling some aspect of patients thoughts or behavior
Delusions
Ideas of reference
Ideas of Influence
_______ – upsetting, unstoppable thoughts
_________ – irresistible urge to act on
obsessional thoughts
_______ – irrational, troublesome fears
Obsessions
Compulsions
Phobias
___________ – consuming bodily concerns w/o medical cause, but not delusional
___________ – always inquire and document in careful detail, intervene if necessary
__________ – inquire and document in careful detail, intervene if necessary
Hypochondriacal symptoms
Thoughts of suicide
Thoughts of violence
Describe hallucinations and when you see them
Hallucinations are the most common type of perceptual disturbance, and are often seen in schizophrenia
Hallucinations are sensory perceptions in any modality (auditory, visual, tactile, olfactory, gustatory) that are internally generated. To patients, they are as real as the externally-generated perceptions everyone experiences
______ are misinterpretations of externally-generated perceptions, often vague
Illusions
Other perceptual disturbances include depersonalization, derealization, tunnel vision,::::
The absence of hallucinations should be confirmed and documented in any psychiatric evaluation
When present, hallucinations should be described in detail. “Hears voices” is not adequate
How do you describe Sensorium/ Cognitive Assessment
describes patient’s state of awareness and cognitive abilities, including:
Alertness – may be somnolent, obtunded, clouded, fluctuating, etc.
Orientation – to person, place, time, situation
Concentration – serial 7s or 3s, reverse spellings
Memory – immediate (retention and recall), recent, long-term
Calculation – everyday money questions work well
Fund of knowledge – e.g., geography, current events
More ways to assess for Sensorium
Abstract reasoning – e.g. interpretation of proverbs, similarities
Reading – doctor writes “close your eyes”, then patient reads and does it
Writing – patient is asked to write a complete sentence
Visuospatial ability – patient is asked to draw a clock face, interlocking pentagons, or a cube
Estimated intelligence – e.g. “above/below/about average”
A one-page, structured instrument that covers most of the previous “Sensorium” items
A numeric score is generated (30 points = no gross cognitive deficits)
Can be done in about 10 minutes, depending on patient
The Folstein Mini-Mental Status Exam (MMSE)
What’s the focus of MMSE
Emphasis is on cognition: a delirious patient will likely score low, but a psychotic patient may (or may not) do well
Is a relatively objective way of monitoring cognitive changes
is a broad term that can describe a patient’s capacity for self-reflection, awareness of illness, understanding of his or her present situation, etc.
is often lacking in patients with chronic psychotic disorders (e.g. schizophrenia), delirium, or severe personality disorders
Insight
refers to a patient’s capacity to make reasonable decisions
can be temporarily impaired (e.g., intoxication) or chronically impaired (e.g., dementia)
Judgment
Assessing Judgement
Questions to assess judgment can be asked in the MSE (e.g., “What would you do if you found a stamped, addressed letter on the ground next to a mailbox?”), but judgment or lack thereof is often evident in the patient’s recent behavior
Key for MSE
A thorough and well-documented MSE is a critical part of a psychiatric evaluation (you want the reader to be able to know exactly how the patient was)
Pertinent negatives (e.g. psychotic symptoms, suicidal/violent thoughts or impulses) are very important
Don’t confuse the MSE (present mental state) with the HPI (recent symptoms, behaviors, and events)
Find an organizational format you like for the MSE, learn it well, and stick with it
Clinical Disorders with symptoms
Axis I
Personality Disorders and Mental Retardation
Axis II
General Medical Conditions
Axis III
