Mental Status Exam Lab Flashcards
Restless
An inability to remain at rest, difficulty in concentrating, not being able to relax or being constantly uneasy.
Psychomotor slowing
Slowing of physical movements. May involve slowed speech, de-creased movement, and impaired cognitive function. It is common in patients with melancholic depression and those with psychotic fea-tures.
Facial grimacing
A facial expression in which your mouth and face are twisted in a way that shows disgust, disapproval, or pain.
Tics or tremors
Tremors are purposeless, rapid, repetitive, highly stereotyped move-ments. They differ from tics in being both more constant and rhythmic, whereas tics are irregular. In addition, the movement of tremors is generally of smaller amplitude.
Tardive dyskinesia
A persistent extrapyramidal side effect that usually appears after pro-longed treatment and persists even after the medication has been discontinued. TD consists of involuntary tonic muscular contractions that typically involve the tongue, fingers, toes, neck, trunk, or pelvis.
Disheveled appearance Unkempt
Unkempt is an adjective that literally means “not well-combed.” Messy or untidy appearance.
Immaculately groomed and alert
Having a neat and pleasant appearance that is produced with care.
Lethargic
Lethargy causes you to feel sleepy or fatigued and sluggish. This sluggishness may be physical or mental
Impoverished speech
Poverty of speech that results from impairment in thinking that affects language abilities. More specifically, it involves using fewer words, answering only what is directly asked, and speaking in a way that may be vague, repetitive, or overly concrete.
Pressure of speech
When you have pressured speech, you have an extreme need to share your thoughts, ideas, or comments. The speech will come out rapidly, and it doesn’t stop at appropriate intervals. It’s difficult to un-derstand what’s being said during pressured speech.
It’s also not possible to carry on a conversation because the person with pressured speech will not stop long enough for another person to speak.
Verbose
Verbosity is the action of talking too much or in a too elaborate way. Speech that uses an excess of words.
Dysphonia
Disorders of the voice. Having an abnormal voice. Changes to the voice can occur suddenly or gradually over time. The voice can be described as hoarse, rough, raspy, strained, weak, breathy, or gravely. There may be voice breaks where the voice completely stops or cuts out. There may be pitch changes, either higher or lower for the patient. The patient may have a complete loss of voice for a period of time as well.
Dysarthria
Dysarthria occurs when the muscles you use for speech are weak or you have diffi-culty controlling them. Dysarthria often causes slurred or slow speech that can be dif-ficult to understand.
Common causes of dysarthria include nervous system disorders and conditions that cause facial paralysis or tongue or throat muscle weakness. Certain medications also can cause dysarthria.
Aphasia
Aphasia is a language disorder caused by damage in a specific area of the brain that controls language expression and comprehension. Aphasia leaves a person unable to communicate effectively with others. Loss of language ability.
Mood and
Affect:
What is the
relation-ship?
- Mood: sustained emotion experiences that is reported by the patient
- Affect: what we look like
- Mood is like the season and affect is what it looks like
Perceptions
the process or result of becoming aware of objects, relationships, and events by means of the senses, which includes such activities as recognizing, observing, and discriminating.
Hallucinations
The perception of a sensory experience for which no external stimulus exists (e.g., hearing a voice when no one is speaking).
Illusions
Misperceptions or misinterpretations of a real experience
Dissociations
Dissociation is a disconnection between a person’s thoughts, memories, feelings, ac-tions, or sense of who he or she is
Thought blocking
any experience where a person suddenly finds themselves unable to think, speak, or move in response to events that are happening around them
Word salad
a jumble of words that is meaningless to the listener – and perhaps to the speak-er as well – because of an extreme level of disorganization
Perseveration
The repetition of phrases or behaviour.
Echolalia
The pathological repeating of another’s words, often seen in catatonia.
Clanging
The stringing together of words because of their rhyming sounds, without regard to their meaning
Flight of ideas
A nearly continuous flow of accelerated speech, with abrupt changes from topic to topic that are usually based on understandable associations or plays on words.
Neologisms
Made-up words (or idiosyncratic uses of existing words) that have meaning for the person but a different or nonexistent meaning to others. This eccentric use of words represents disorganized thinking and interferes with communication.
Tangential
A departure from the main topic to talk about less important information: going off on tangents in a way that takes the conversation off topic.
Thought circumlocution
Talking without saying anything, the “ability” to put one word after another, quickly, without worrying that the message be consistent, has meaning or value.
Delusions
Alterations in thought content (what a person thinks about). Delusions are false fixed beliefs that cannot be corrected by reason.
Obsession
Thoughts, impulses, or images that persist and recur and cannot be dismissed from the mind. Obsessions often seem senseless to the individuals who experience them (ego-dystonic), and their presence causes severe anxiety.
What is a mental status exam?
Analogous to the physical examination in general medicine. The purpose is to evaluate an individual’s current cognitive, affective (emotional), and behavioural functioning.
What is involved in a mental status exam?
Appearance
Behaviour & Speech
Cognition & Mood
Thoughts
Perceptions
Safety
When assessing Appearance in an MSE, what do you observe?
Ethnicity
Distinguishing Marks
Weight, Height, nutritional status
Do they look their age?
What is their hygiene like?
Immaculately groomed?
Disheveled? Unkempt?
Appropriate dress for the weather?
Pupil dilation or constriction
When assessing Behaviour during an MSE, what are you observing for?
Speeded
Slowed
Unusual tics or movements (tardive dyskinesia)
Tremors
Are they engaged? How can you tell? Eye contact?
Have you established rapport? (Resistive, open)
Peculiar movement such as scannin the environment
What is the difference between extrapyramidal symptoms and tardive dyskinesia?
Extrapyramidal symptoms can affect how you move, and tardive dyskinesia is one form of EPS that mostly affects your face. Both EPS and tardive dyskinesia can be caused by antipsychotic medications.
When you are assessing for speech in an MSE, what are you observing for?
Rate, volume, tone
Poverty of speech
Pressured
Verbose
Dysphonia (damaged vocal cords)
Dystharia (difficult to understand: often due to stroke, brain injury, etc)
Aphasia (unable to comprehend: stroke)
Articulation
Organized (does it make sense? Do not assess content here.)
When assessing for cognition in an MSE, what are we asking and listening for?
Are they orientated to time, place, person?
LOC: drowsy, alert, confused
Any problems with memory?
Language, abstraction, attention and concentration, visual or spatial processing (these are usually part of mini mental)
General knowledge
Insight* (patient’s acknoweldgement and understanding of problems)
Judgment* (patient’s general problem-solving ability)
Fund of knowledge
When assessing for mood in an MSE, what are you look for and listening for?
Assess if Affect and Mood Congruent
Affect (what you see: emotional expression. A good way to assess is asking how they feel)
Range (restricted, flat, blunted, expansive)
Appropriateness
Stability
Mood (what they say their mood has been like and what you observe)
-How do they describe their mood (tone)
-Would they say it is severe, moderate, mild.
-Are they irritable?
- Does their mood fluctuate or is it stable?
When assessing for thought content, in terms of what they say, what are we listening for?
Delusions*
Magical Thinking
Phobia
Obsessions
Hypochondriasis
Depersonalization
Nihilistic ideas
What are we assessing for in an MSE regarding thought processes?
PROCESSES (how they say it)
Thought Blocking
Flight of Ideas
Confabulation
Neologism
Tangential
Circumstantial
Word Salad
Perseveration
Echolalia
Clanging
Thought circumlocution
What are we assessing for relative to Perceptions in an MSE?
These are the symptoms most often associated with mental illness. Out of touch with reality equates to being Psychotic.
Hallucinations
Visual
Auditory (most common of the hallucinations)
Olfactory
Gustatory
Somatic
-Illusions
-Dissociations (derealisation and depersonalization)
What are you assessing for in terms of safety during an MSE?
This is really part of Thought Content or Perceptions however it is important enough to highlight on its own.
Suicidal or Homicidal
Are they experiencing thoughts of harming self or others? If others, who?
How frequently are these thoughts occurring?
Is there an intent to act?
Do they have a plan?
The means and/or opportunity to carry out the plan?
Are there any **protective factors? ***
