Mental Status Exam Flashcards
List the components of the MSE.
- Appearance
- Behavior
- Mood
- Affect
- Speech
- Thought process
- Thought content
- Perception
- Cognition
- Judgment
- Insight
What are the important components of appearance?
- General
- Level of consciousness
- Body type
- Posture
- Clothes
- Grooming/hygiene
- Hair
- Nails
- Facial expression
- Eye contact
- Other: teeth, scars, tattoos, bruises, piercings
What are the important components of behavior?
- Psychomotor levels
2. Attitude towards interviewer
Behavior: What are some eg’s of psychomotor levels?
- Agitated or restless
- Calm
- Involuntary movement/mennerisms
- Slowed movements
- Paraplegia, etc
Behavior: What are some eg’s of attitude towards interviewer?
Cooperative? Compliant? Defensive? Aggressive? Manipulative? Disinterested? Provocative? Seductive? Suspicious? Frightened?
What is “mood”?
A sustained emotion as expressed by the pt
- General frame of mind
Mood: what are some clinical terms for types of mood that the pt might not use?
Dysthymic, dysphoric, euthymic, alexithymic (incapable of describing mood)
What is “affect”?
Moment-to-moment emotion (and outward expressions of emotion) as noted by the interviewer
How do you describe a “normal” affect?
“Full and appropriate,” congruent with mood
Affect: What are some things you should think about?
Eye contact, facial expression, posture, speech tone/rate, emotion at different pts in the interview
What are some steps down from “normal” affect described as?
- Constricted
- Blunted (similar to flat)
- Flat (absence of facial expressions)
What is a “guarded” affect?
You feel the other person is attempting to hide their feelings from you
What is “full but inappropriate” affect?
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.
What is a “labile” affect?
The emotions you sensed surprised you with both how rapidly they changed and their intensity
Describe the difference b/w mood and affect.
- 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).
What categories of speech should you consider?
- Quantity
- Tone
- Rate
- Volume
- Clarity
- Flow
- Fluency
- Impairments
What is “laconic” speech?
Brief, empty replies (a type of quantity)
Speech: What is prosody? Dysprosody?
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
Describe some “quantities” of speech.
Talkative, spontaneous, non-spontaneous, minimal, mute, laconic
Describe some “tones” of speech.
Monotonous, dysprosody, inflection
What is “pressured” speech?
Rapid and difficult-to-impossible to interrupt; a person with pressured speech will verbally run you over
Speech: what is “fluency”?
Ability to produce sentences of nl length, rhythm, and prosody; for clinical purposes a patient is either fluent or non-fluent
What does “Thought Process” describe?
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?
What is a “logical and sequential” thought process?
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
What is a “circumstantial” thought process?
Over inclusive of details that are irrelevant or marginally relevant to the point
What is a “tangential” thought process?
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.
What is a “flight-of-ideas” thought process?
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
What is a “looseness of association” thought process?
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
What is a “fragmentation” thought process?
Words and individual phrases are intact but the phrases are disconnected making sentences and ideas meaningless
What is a “verbigeration or palilalia” thought process?
Repetition of words or sounds
What is a “coprolalia” thought process?
Involuntary utterance of obscenities
eg “copulate”
What is a “echolalia” thought process?
Repetition of whole phrases or sentences
What is a “word salad” thought process?
Words are intact, but all sentence structure lost, including phrases
What is a “incoherance” thought process?
Unintelligible words; no phrases or sentence structure
What is a “neologism” thought process?
Words or phrases made up by the patient
List the eg’s of different types of thought processes
- Logical and sequential
- Circumstantial
- Tangential
- Flight-of-ideas
- Looseness of association
- Fragmentation
- Verbigeration/palilalia
- Coprolalia
- Echolalia
- Word salad
- Incoherence
- Racing thoughts
- Thought blocking
- Derailment
What are eg’s of the rate/flow of “thought processes”?
- Racing thoughts
- Thought blocking
- Derailment
- Perseveration
Thought Processes rate/flow: What is thought blocking?
Interruption of the train of thought before completion of the idea; may see momentary disruption of speech; words and sentences otherwise intact
Thought Processes rate/flow: what is perseveration?
Repetition of verbal responses despite changing questions
Thought Processes rate/flow: What is derailment?
Speech stops suddenly and then restarts having shifted to another topic
What are the different categories of “Thought Content”?
- Suicidal & homicidal ideation
- Delusions
- Obsessions & compulsions
- Derealization & depersonalization
- Phobias
Thought content: What are the different types of suicidal ideation?
- Thoughts of death
- Passive ideation (wants to die, w/o plan)
- Active ideation (wants to die, preferably today, w/ plan)
Thought content: What are delusions?
- Overvalued ideas?
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)
Thought content: What are some categories of delusions?
- Persecutory/paranoid
- Referential
- Grandiose
- Jealousy
- Erotomanic
- Somatic
- Bizarre
Thought content: What is a referential delusion?
Random events are of some special significance (the Cubs lost, that’s the signal for me to evacuate because the alien invasion is beginning)
Thought content: What is a somatic delusion?
Involves bodily functions or sensations
Thought content: What is a bizarre delusion?
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”
Thought content: bizarre delusions: what is thought withdrawal?
Thought insertion?
Though broadcasting?
Delusion of control?
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
Thought content: what is an obsession?
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
Thought content: what is a compulsion?
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
Thought content: what is derealization?
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
Thought content: what is depersonalization?
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.
What are things you should note w/r/t Perceptions?
- Illusions
- Hallucinosis
- Hallucinations (perceptions w/o stimulus)
Perceptions: what is hallucinosis?
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
Perceptions: what is formication?
formication: a sensation like insects crawling over the skin. (eg cocaine withdrawal)
What things should you assess in the ‘Cognition’ category?
- Oriented x4 (persons around them, place, time, situation)
- Concentration
- Memory
- Abstract thinking
- General fund of knowledge
Use MMSE (mini)
Cognition: What is the MMSE used for? How many questions is it?
- Screening for dementia
- 30 questions
Cognition: What are the categories of the MMSE?
- Orientation (10)
- Registration (3)
- Attn. & calculation (5)
- Recall (3)
- Language (5)
Cognition: how are concentration and attention assessed?
Serial 7’s calculations or spell world/earth forwards and then
backwards
Cognition:
- How is recent memory assessed?
- Remote memory?
- Recall?
- 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
Cognition: how is abstract thinking assessed?
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?
Cognition: how is general fund of knowledge assessed?
Name 5 past presidents, 5 large cities, 5 sports teams, etc. (take into account the pt’s educational level)
What is “judgment”?
- The ability to make and carry out plans c/w reality.
- The ability to control one’s actions
What is “insight”?
The degree of awareness and understanding that pt is ill.
Describe judgment w/r/t a suicidal pt who is planning on acquiring a gun and killing himself.
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.
Describe the judgment of an alcoholic who has been drinking and impulsively cuts his wrists
Poor judgment
To assess judgment, besides using an imaginary situation to see what s/he would do, what else should you ask?
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
What are the different levels of insight a pt can have?
- 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
What is intellectual insight?
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.
What is true emotional insight?
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
What are different ways to describe judgment & insight?
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)
