Mental Status Exam Terms (83) Flashcards
Abstract reasoning
Ability to understand and conceptualize complex concepts
Thinking about ideas that are symbolic, comparative, or hypothetical
Acute Dystonic Reaction
Sustained Contraction of the musculature of the trunk or limbs (usually in the head & neck area) is most often medication-induced or caused by a stress reaction characterized by pain and stiffness. Also known as “tension myositis syndrome.” It is often accompanied by other physical symptoms such as fatigue, sleep disruption, disturbed digestion, headaches, and psychological symptoms such as anxiety and depression. Treatment typically involves cognitive-behavioral therapy, exercise and relaxation techniques, and medications.
Affect
The external expression of emotion visible to the clinician
1) Are the client’s responses & body language devoid of emotion?
2) Are their responses hyper-emotional?
3) Do the client’s responses change dramatically through the interview?
4) Are the responses appropriate to the client’s situation or what they are saying?
5) Does the client have poor eye contact?”
Akathisia
Motor restlessness, often localized to the muscles.
It ranges from a feeling of inner disquiet to an inability to sit or lie quietly, often secondary to neuroleptic medication. It can be treated with anticholinergic drugs, beta-blockers, and sedatives. Long-term therapy should begin with lifestyle modifications such as physical relaxation exercises or yoga to address the underlying causes of anxiety or tension. Counseling is also important to help manage emotions, stress, and life challenges that may contribute to motor restlessness.
Akinesia
Lack of physical movement, extreme immobility,
Alexithymia
Constricted emotional life, diminished ability to fantasize, & a virtual inability to articulate emotion.
Amnestic Disorder
- development of memory impairment
- causes impairment in social or occupational functioning
- due to pathology, substance-induced
Anhedonia
Inability to perceive or experience pleasure
Anterograde Amnesia
Inability to remember events after a specific point in time. It is a form of memory loss that can happen after an event, such as a blow to the head or a stroke. It affects your ability to remember new information and experiences, making it difficult to learn or recall new information. Symptoms include difficulty learning and recalling new facts, names, words, dates, events, and memories. Treatment includes cognitive-behavioral therapy
Appearance
Refers to the physical presentation of the client
May be noted as:
- well groomed
- immaculate
- unkempt
- thin/overweight
- descriptions of clothing and accessories (ex. wearing coat on warm day; dressed in professional attire)
- descriptions of notable features like tattoos or scars
Athetoid
Slow, continual movements
Movements may be automatic or purposeless. These movements include the body rolling from side to side, writhing hands or feet, or fingers curling or uncurling. Though they look as though they are voluntary movements, but are involuntary motions due to an underlying neurological disorder.
Behavior
Refers to the attitude the client presents with during interview
May be noted as:
- cooperative
- open
- engaged
- withdrawn
- hostile
- shy
- resistant
- defensive
- relaxed
Bizarre
Patently absurd, with no possible basis in fact.
Blocking
Blocking occurs when a speaker stops talking before they have reached their communication goal, leaving the other person with incomplete information and unable to respond. This can be done intentionally or unintentionally, but it is still a hindrance to effective communication. Blocking can take many forms, including changing topics without warning and providing too much detail on irrelevant points.
Broca’s Aphasia
1) Slow speech, hard to speak, but what they get out makes sense.
2) Word comprehension is intact & they may be able to nod or shake their head appropriately.
3) Repetition is impaired.
4) Reading is fair to good, writing is often impaired.
5) The location of the lesion is the posterior inferior frontal lobe.
Catalepsy
Wax-like responsiveness is where the client remains in any posture in which s/he is placed, even when unsupported physically by the therapist, for long periods. This is seen in clients who are severely depressed or have neurological damage, which can signify catatonia. The client may also maintain whatever facial expression s/he is wearing at the time, regardless of what emotions they might be feeling.
Catatonia
Two of the following:
1) Motoric immobility
2) Motor activity that is excessive & purposeless
3) Verbal or physical tics
4) Strange posture & movement
Catatonic Excitement
Agitated, purposeless motor activity, uninfluenced by external stimuli
Catatonic Posturing
Voluntary assumption of an inappropriate or bizarre posture
Catatonic Rigidity
Voluntary assumption of rigid posture held against all efforts to be moved
Catatonic Stupor
Markedly slowed motor activity, often to the point of immobility & seeming unawareness of surroundings
Choreiform
Rapid movements are rapid, jerky, nonrepetitive movements that often occur in the face, arms, and legs. They may be caused by certain diseases, such as Huntington’s disease or drug toxicity. Treatment can involve medications such as anticonvulsants, antipsychotics, and dopamine agonists to reduce movements.
Circumstantial
Marked by unnecessary details but eventually reaches the point
Clang Associations
Words or phrases are connected due to the characteristics of the words themselves (rhyming) rather than the meaning they convey. They are a type of sound-based mental association that involve linking words together due to their similar sounds rather than the ideas they represent. For example, “bee” could be linked with “knee” because they both contain the same long “e” sound.
Components of the MSE
1) General Appearance, Behavior & Attitude
2) Level of Consciousness & Orientation
3) Speech & Language
4) Mood & Affect
5) Thought Process, Content, & Perceptions
6) Memory & Cognition
7) Insight & Judgment
Compulsion
The irresistible urge to act on obsessive thoughts or impulses is characterized by an uncontrollable urge to perform certain actions, often repetitively. These are usually driven by anxiety or fear and can interfere with day-to-day functioning. Typical behaviors might include checking items multiple times, counting objects for no reason, washing hands excessively, or repeating phrases in one’s head.
Confabulation
A common symptom of various neurological and psychological disorders, including chronic alcoholism and dementia. It can manifest as the individual unconsciously making up answers to cover up memory impairment. In these cases, confabulation is an adaptive behavior that allows the person to feel more secure and comfortable in their environment by filling in “gaps” in their memory with plausible information.
Congruent
Client’s mood or thoughts matches their situation or feelings
Déjà Vu
A feeling that one has experienced a situation before, even though one hasn’t, and not usually pathological.
Delerium (Acute Confusional State)
-Clouding of consciousness
-Client is inattentive, incoherent, disoriented
-Confusion is worse at night when environmental stimuli are decreased
-Disturbance of consciousness, change in cognition that develops over a short period of time
-Can be due to a general medical condition or substance-induced
Delusion
1) Fixed, false beliefs that have no basis in reality
2) Not generally held by one’s culture
3) The client will not be dissuaded, despite evidence to the contrary.
Dementia
1) This is a general term for loss of memory, language, problem-solving, & other thinking abilities
2) It is severe enough to interfere with daily life
3) Alzheimer’s is the most common cause of dementia
Depersonalization
A type of hallucination in which a person perceives their body as unreal, floating, dead, or changing in size.
Derailment
A pattern of thought which goes from one topic to another in an unpredictable way. This type of thinking is often seen in people with schizophrenia, mania, or other mental health issues. Loose Associations can also be a sign of cognitive decline due to aging or injury. It can also be associated with substance abuse and social anxiety disorder
Derealization
A type of hallucination in which a person perceives their environment is unreal, & feels removed from the world. It is a form of dissociation and is often described as feeling like one is watching their own life from outside their body or being separate from the physical world. Symptoms may include changes in the perceptual filter, difficulty recognizing oneself in the mirror, feeling detached from emotions, or a
Descriptions of Affect
1) Flat/blunted -associated with depression
2) Labile - rapid-cycling bipolar or schizophrenia
3) Inappropriate responses may be a sign of intoxication, schizophrenia, organic brain disease
4) Be aware that poor eye contact may be cultural
Disorientation
Inability to correctly identify the current time, situation, place, or person.
Dysarthria
-articulation is difficult
-disordered speech sounds but language (grammar, word choice) is intact
Dysphonia
-difficulty using the voice for talking
-articulation & language are intact
Dysphoria
Unpleasant mood, such as: irritable, apprehensive, & dysthymic moods
Dysthymia
-Symptom of depression
-Low mood occurring for at least two years, along with at least two other symptoms of depression
Echolalia
Imitation of the speech or sound of another person, or repetition of the words of others
Echopraxia
Imitation of the movements of another person
Erotomanic
Conviction of another’s sexual interest or desire for the client.
Euphoric mood
An exaggerated sense of well-being & contentment
Euthymia
Living in a state of “normal” or “stable” moods
Examples of Abnormal Thought Content
1) Delusions
2) Ideas of reference
3) Ideas of influence
4) Obsessions, compulsions, phobias
5) Hypochondriacal symptoms
6) Thoughts of suicide/violence
Examples of Abnormal Thought Process
1) Perseverating
2) Derailment
3) Poverty of Thought
4) Flight of Ideas
5) Neologisms
6) Clang Associations
7) Loose Associations/Derailment
8) Tangential
9) Circumstantial
10) Blocking
Executive functioning
Complex cognitive abilities such as planning, prioritizing items on a list, performing multiple tasks
Eye contact
Noted as good, fleeting, sporadic, avoided, minimal
Factors that could affect the interpretation of Mental Status Exam
- known illness or health problems (alcoholism, renal disease)
- current medications w/side effects of depression or confusion
- client’s usual educational & behavioral level
- responses to personal history questions indicating current stress, drug use, sleep habits, etc
Flight of Ideas (FOI)
1) Thought races ahead of one’s ability to communicate them
2) Displayed by rapid verbalizations with the constant shifting of ideas that tend to be connected.
Fluency of Speech
Is the rate, flow, melody, & content of speech within normal limits? If not, suspect aphasia.
Ask the client to:
1) Word Comprehension: follow one or two-step commands.
2) Repetition: repeat “No ifs, and’s or but’s”
3) Naming: name the parts of a watch
4) Reading:t read a paragraph out loud
5) Writing: write a sentence
Folie à Deux
-Means madness for two.
-When two closely related people share a delusion.
-Usually the same family.
Formications
The sensation of bugs crawling on the client’s skin
Glasgow Coma Scale
Used to describe level of consciousness following traumatic brain injury:
- alert - awake or readily aroused, oriented
- lethargic (somnolent) - the client is not fully alert & drifts to sleep when not stimulated, answers questions, but thinking is slow & fuzzy
- obtunded - sleeps most of the time, difficult to arouse
- stupor or semi-coma - spontaneously unconscious, responds only to persistent & vigorous shake/pain
- coma - completely unconscious, no response to pain
Global Aphasia
-most common & severe
-spontaneous speech is absent or reduced to a few words or sounds due to a large lesion
Goal-Directed
Normal thinking consisting of sequential thoughts having a logical connection.
Grandiose
Conviction of elevated importance, power, or knowledge, or that one is, or has a special relationship with, a deity or famous person.
Hallucinations
Sensory perceptions in any modality which are internally generated.
Hallucinosis
A state in which the patient realizes the hallucinations are not real
How do you document suicide assessment?
-List risk factors & protective factors
-Hospitalize if high risk
Hypochondriacal Thinking
A consuming bodily concern without medical cause
Ideas of Influence
Overvalued ideas that one’s thoughts or behaviors are being controlled by someone or something else
Ideas of Reference
-Overvalued ideas
-The client is virtually, but not totally, convinced that objects, people, or events in the immediate environment have personal significance
-If delusional, the client would become certain of the reality of the ideas
Illusions
Mis-interpreted externally generated perceptions.
Incoherence
Incomprehensible speech in which the specific type of disturbed thinking is difficult to identify
Insight
Refers to the client’s understanding of their illness and need for therapy
Jamais vu
When a recognized or familiar situation is experienced as unfamiliar.
Judgment
Refers to the client’s awareness of consequences
Memory
Ability to recall information - may be assessed by asking about current events, sports, tv shows, what you ate for breakfast
Motor activity
Note the client’s body movements:
- facial expressions
- gait (how they walk)
- whether movements are fast, slow, average
- presence of tics or tremors
- physical reactions
Orientation
Consists of 4 elements: client’s awareness of self, place, time, and situation
Oriented X1, X2, X3, X4
Oriented X1
Oriented to person
Client knows their name and can recognize significant people
Oriented X2
Oriented to person and place
Client knows their name and where they are
Oriented X3
Oriented to person, place, and time
Client knows their name, where they are, and the date/day of week/time of year
Oriented X4
Oriented to person, place, time, and situation
Client knows their name, where they are, the date/day of week/time of year, and can explain what’s going on at the moment of the interview
Perceptual disturbances
Hallucinations, which can be:
- Auditory
- Visual
- Olfactory
- Gusatory
- Tactile
- Visceral
Sensorium
The client’s cognitive functioning - level and stability of consciousness - Their - affect - behavior - suicidal and homicidal ideation - judgment and insight are all important factors to assess during the initial assessment. I will also evaluate the client’s orientation and perception, as well as review their thought processes and any psychotic symptoms that may be present. It is essential to conduct a thorough mental status examination in order to properly diagnose.
Speech
Observe the client’s speech rate, volume, spontaneity, and coherence
Manic clients may speak very quickly and loudly
Depressed clients may speak very slowly or quietly
Thought content
What the client is thinking, including delusions, obsessions, and suicidal/homicidal ideation
Thought process
The client’s form of thinking, or how they express their ideas
Note the rate of thought - very fast is noted as “flight of ideas”
Note the flow of thought - is it goal-directed (with purpose) or disorganized (all over the place)?
Descriptors include: logical, tangential, circumstantial, closely or loosely associated
Working memory
Ability to maintain information temporarily
Example: remembering a phone number or address
