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Psychiatry > Mental Status Exam > Flashcards

Mental Status Exam Flashcards

1
Q

List the components of the MSE.

A
  • Appearance
  • Behavior
  • Mood
  • Affect
  • Speech
  • Thought process
  • Thought content
  • Perception
  • Cognition
  • Judgment
  • Insight
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2
Q

What are the important components of appearance?

A
  • General
  • Level of consciousness
  • Body type
  • Posture
  • Clothes
  • Grooming/hygiene
  • Hair
  • Nails
  • Facial expression
  • Eye contact
  • Other: teeth, scars, tattoos, bruises, piercings
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3
Q

What are the important components of behavior?

A
  1. Psychomotor levels

2. Attitude towards interviewer

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4
Q

Behavior: What are some eg’s of psychomotor levels?

A
  • Agitated or restless
  • Calm
  • Involuntary movement/mennerisms
  • Slowed movements
  • Paraplegia, etc
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5
Q

Behavior: What are some eg’s of attitude towards interviewer?

A

Cooperative? Compliant? Defensive? Aggressive? Manipulative? Disinterested? Provocative? Seductive? Suspicious? Frightened?

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6
Q

What is “mood”?

A

A sustained emotion as expressed by the pt

- General frame of mind

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7
Q

Mood: what are some clinical terms for types of mood that the pt might not use?

A

Dysthymic, dysphoric, euthymic, alexithymic (incapable of describing mood)

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8
Q

What is “affect”?

A

Moment-to-moment emotion (and outward expressions of emotion) as noted by the interviewer

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9
Q

How do you describe a “normal” affect?

A

“Full and appropriate,” congruent with mood

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10
Q

Affect: What are some things you should think about?

A

Eye contact, facial expression, posture, speech tone/rate, emotion at different pts in the interview

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11
Q

What are some steps down from “normal” affect described as?

A
  1. Constricted
  2. Blunted (similar to flat)
  3. Flat (absence of facial expressions)
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12
Q

What is a “guarded” affect?

A

You feel the other person is attempting to hide their feelings from you

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13
Q

What is “full but inappropriate” affect?

A

Eg the pt says he is happy but gives every appearance of being sad; or inappropriate in that the pt is laughing in the absence of the appropriate stimuli/context.

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14
Q

What is a “labile” affect?

A

The emotions you sensed surprised you with both how rapidly they changed and their intensity

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15
Q

Describe the difference b/w mood and affect.

A
  • Mood is analogous to the climate, affect to the weather that day.
  • Mood is analogous to an entire movie, affect to one scene in the movie.
  • Also, mood is what you hear (what the patient tells you), affect is what you see (your observations).
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16
Q

What categories of speech should you consider?

A
  • Quantity
  • Tone
  • Rate
  • Volume
  • Clarity
  • Flow
  • Fluency
  • Impairments
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17
Q

What is “laconic” speech?

A

Brief, empty replies (a type of quantity)

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18
Q

Speech: What is prosody? Dysprosody?

A

Prosody: variations in melody, intonation, pauses, stresses, intensity, vocal quality, and accents of speech.

Dysprosody: one or more of the prosodic fcns are either compromised or eliminated completely

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19
Q

Describe some “quantities” of speech.

A

Talkative, spontaneous, non-spontaneous, minimal, mute, laconic

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20
Q

Describe some “tones” of speech.

A

Monotonous, dysprosody, inflection

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21
Q

What is “pressured” speech?

A

Rapid and difficult-to-impossible to interrupt; a person with pressured speech will verbally run you over

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22
Q

Speech: what is “fluency”?

A

Ability to produce sentences of nl length, rhythm, and prosody; for clinical purposes a patient is either fluent or non-fluent

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23
Q

What does “Thought Process” describe?

A

Associations b/w thoughts; rate or flow of ideas.

  • Does the person you are interviewing make sense?
  • Does the patient answer your questions and get to the point?
  • Do they ramble?
  • Are you unable to follow their responses at all?
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24
Q

What is a “logical and sequential” thought process?

A

Pt answers the question or tells a story that goes from
topic to topic, point to point in a way that makes sense; words and sentence structure are clear; linkage between ideas are clear

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25
Q

What is a “circumstantial” thought process?

A

Over inclusive of details that are irrelevant or marginally relevant to the point

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26
Q

What is a “tangential” thought process?

A

Does not directly address the point or never finishes the original point; talks about topics brought to mind by internal or external stimuli; words, sentences, and ideas are understandable.

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27
Q

What is a “flight-of-ideas” thought process?

A

A type of tangential thought process in which the pt goes from topic-to-topic-to-topic in a fairly abrupt and rapid sequence; as a listener you may be able to follow the changes and see the connections or theme that links the topics; often seen with pressured speech

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28
Q

What is a “looseness of association” thought process?

A

Connection b/w ideas is not obvious, unclear or nonsensical; as a listener you cannot follow the topic changes or even make out the topics the patient is talking about; substantially impairs effective communication

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29
Q

What is a “fragmentation” thought process?

A

Words and individual phrases are intact but the phrases are disconnected making sentences and ideas meaningless

30
Q

What is a “verbigeration or palilalia” thought process?

A

Repetition of words or sounds

31
Q

What is a “coprolalia” thought process?

A

Involuntary utterance of obscenities

eg “copulate”

32
Q

What is a “echolalia” thought process?

A

Repetition of whole phrases or sentences

33
Q

What is a “word salad” thought process?

A

Words are intact, but all sentence structure lost, including phrases

34
Q

What is a “incoherance” thought process?

A

Unintelligible words; no phrases or sentence structure

35
Q

What is a “neologism” thought process?

A

Words or phrases made up by the patient

36
Q

List the eg’s of different types of thought processes

A
  • Logical and sequential
  • Circumstantial
  • Tangential
  • Flight-of-ideas
  • Looseness of association
    • Fragmentation
    • Verbigeration/palilalia
    • Coprolalia
    • Echolalia
    • Word salad
    • Incoherence
    • Racing thoughts
    • Thought blocking
    • Derailment
37
Q

What are eg’s of the rate/flow of “thought processes”?

A
  • Racing thoughts
  • Thought blocking
  • Derailment
  • Perseveration
38
Q

Thought Processes rate/flow: What is thought blocking?

A

Interruption of the train of thought before completion of the idea; may see momentary disruption of speech; words and sentences otherwise intact

39
Q

Thought Processes rate/flow: what is perseveration?

A

Repetition of verbal responses despite changing questions

40
Q

Thought Processes rate/flow: What is derailment?

A

Speech stops suddenly and then restarts having shifted to another topic

41
Q

What are the different categories of “Thought Content”?

A
  • Suicidal & homicidal ideation
  • Delusions
  • Obsessions & compulsions
  • Derealization & depersonalization
  • Phobias
42
Q

Thought content: What are the different types of suicidal ideation?

A
  • Thoughts of death
  • Passive ideation (wants to die, w/o plan)
  • Active ideation (wants to die, preferably today, w/ plan)
43
Q

Thought content: What are delusions?

  • Overvalued ideas?
A

Delusions: fixed false belief (not part of culture)

  • Overvalued ideas are less firmly held than delusions (Pt understands w/contrary evidence, even if they still hold their belief)
44
Q

Thought content: What are some categories of delusions?

A
  • Persecutory/paranoid
  • Referential
  • Grandiose
  • Jealousy
  • Erotomanic
  • Somatic
  • Bizarre
45
Q

Thought content: What is a referential delusion?

A

Random events are of some special significance (the Cubs lost, that’s the signal for me to evacuate because the alien invasion is beginning)

46
Q

Thought content: What is a somatic delusion?

A

Involves bodily functions or sensations

47
Q

Thought content: What is a bizarre delusion?

A

Clearly implausible, not understandable, not derived from ordinary life experience; often involves belief of loss of control over mind or body-“aliens are monitoring my thoughts”

48
Q

Thought content: bizarre delusions: what is thought withdrawal?
Thought insertion?
Though broadcasting?
Delusion of control?

A

i. thought withdrawal-belief that other people are taking away one’s thoughts
ii. thought insertion-belief that others are implanting thoughts into one’s head
iii. thought broadcasting-belief that one’s thoughts are known as if everyone can read the patient’s mind
iv. delusion of control-belief that one’s thoughts, feelings, behaviors are controlled by some external forces

49
Q

Thought content: what is an obsession?

A

Persistent ideas, thoughts, impulses, or images that are experienced as intrusive and inappropriate and cause marked anxiety and distress; the individual feels they “just have to” think these thoughts.
- Most common obsessions are about: contamination, self-doubt, orderliness, sexual imagery, aggressive/horrific impulses

50
Q

Thought content: what is a compulsion?

A

Repetitive behaviors or mental acts that are done to reduce anxiety or distress.
- Most common compulsions, often in response to the obsessive thoughts, involve: cleaning or washing, counting, checking, rituals, ordering, or repeating actions

51
Q

Thought content: what is derealization?

A

The perception that objects in the external world are strange and unreal; the size and shapes of objects may be bigger (macropsia) or smaller (micropsia),
people may seem unfamiliar or mechanical

52
Q

Thought content: what is depersonalization?

A

Alteration in the perception of oneself, or the experience of oneself, so that one feels detached as if one is an outsider observer or one’s mental processes or body; like one is living in a dream, or in a movie.

53
Q

What are things you should note w/r/t Perceptions?

A
  • Illusions
  • Hallucinosis
  • Hallucinations (perceptions w/o stimulus)
54
Q

Perceptions: what is hallucinosis?

A

A syndrome, usually of organic origin, characterized by more or less persistent hallucinations for example, alcoholic hallucinosis.
- Pt know that what he sees or hears is not real; sort of like having insight into one’s hallucinations

55
Q

Perceptions: what is formication?

A

formication: a sensation like insects crawling over the skin. (eg cocaine withdrawal)

56
Q

What things should you assess in the ‘Cognition’ category?

A
  • Oriented x4 (persons around them, place, time, situation)
  • Concentration
  • Memory
  • Abstract thinking
  • General fund of knowledge

Use MMSE (mini)

57
Q

Cognition: What is the MMSE used for? How many questions is it?

A
  • Screening for dementia

- 30 questions

58
Q

Cognition: What are the categories of the MMSE?

A
  • Orientation (10)
  • Registration (3)
  • Attn. & calculation (5)
  • Recall (3)
  • Language (5)
59
Q

Cognition: how are concentration and attention assessed?

A

Serial 7’s calculations or spell world/earth forwards and then
backwards

60
Q

Cognition:

  • How is recent memory assessed?
  • Remote memory?
  • Recall?
A
  • Recent memory: recent news events (past few months)
  • Remote memory: childhood data, important events, personal matters
  • Recall: able to recall 3 unrelated words 3-5 min later
61
Q

Cognition: how is abstract thinking assessed?

A

Can pt interpret proverbs, similarities & differences (how are a bush and a tree alike and different), or is his thinking concrete in which words and figures of speech are taken literally?

62
Q

Cognition: how is general fund of knowledge assessed?

A

Name 5 past presidents, 5 large cities, 5 sports teams, etc. (take into account the pt’s educational level)

63
Q

What is “judgment”?

A
  • The ability to make and carry out plans c/w reality.

- The ability to control one’s actions

64
Q

What is “insight”?

A

The degree of awareness and understanding that pt is ill.

65
Q

Describe judgment w/r/t a suicidal pt who is planning on acquiring a gun and killing himself.

A

His judgement is “poor”. Even though he made a plan that he can carry out, his plan is not c/w how our society defines reality.

66
Q

Describe the judgment of an alcoholic who has been drinking and impulsively cuts his wrists

A

Poor judgment

67
Q

To assess judgment, besides using an imaginary situation to see what s/he would do, what else should you ask?

A

It is equally, if not more important, to ask the patient what he would like to do, or to have done, in his current situation

68
Q

What are the different levels of insight a pt can have?

A
  • Complete denial of illness
  • Slight awareness of being sick and needing help but denying it at the same time
  • Awareness of being sick but blaming it on others, on external factors, or on organic factors
  • Awareness that illness is due to something unknown in the patient
69
Q

What is intellectual insight?

A

Admission that the pt is ill and that sx or failures in social adjustment are due to the pt’s own irrational feelings or
disturbances w/o applying that knowledge to future experiences.

70
Q

What is true emotional insight?

A

Emotional awareness of the motives and feelings w/in the pt and the important people in his or her life, which can lead to basic changes in behavior

71
Q

What are different ways to describe judgment & insight?

A

Good/intact, fair, or poor/impaired.
- Adding a brief explanation or reference to the HPI is a better idea.

(eg: Judgement-poor; intoxicated and impulsive; Insight-poor, multiple psych admissions, denies need for meds)

Psychiatry (16 decks)

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