Mental Status Exam (Tobia) - 10/10/16

Question 1

MSE vs MMSE

Answer 1

Mental Status Examination:

• To assess patient’s current state of mind
• Routine part of the physical exam (“Now, I’d like to ask you a series of questions which will help me further evaluate your thinking, memory, and mood”)
• Can change from hour to hour
• “Slice of time”

Mini-Mental State Exam:

• Screening tool for Dementia
• Serial assessment for Delirium

Question 2

ABC STAMP LICKER

Answer 2

Appearance

Behavior

Cooperation

Speech

Thought

Affect

Mood

Perceptions

Level of consciousness

Insight

Cognitive (higher order)

Killer Endings (suicidal/homicidal ideations)

Reliability

Question 3

Catatonia

Answer 3

Marked behavioral (psychomotor) disturbance

1. Abnormal motor activity
   
   1. Decreased
      
      1. Moderate immobility: catalepsy
      2. Severe immobility: stupor
   2. Excessive (or peculiar)
      
      1. Simple: agitation
      2. Complex: mannerism, stereotypy (Rainman)
2. Decreased engagement
   
   1. Moderate: negativism
   2. Severe: mutism

Question 4

Speech Proper (Thought Process)

Answer 4

Speech: volume, articulation

If you choose to present as thought process, volume and articulation are NOT included

Question 5

Thought process:

• Disturbances of association
• Disturbances of rate and rhythm

Answer 5

Disturbances of association

• Normal
  
  • Goal directed
• Abnormal
  
  • Circumstantial (if you ask a patient a question and they go off somewhere in their mind but then eventually come back and provide you an answer)
  • Tangential (if a patient starts to gets back to answering the question)
  • Derailment
    
    • Flight of ideas
    • Looseness of associations (word salad)

Disturbances of rate and rhythm

• Prosody: does voice have normal lilt?
• Dyprosody: loss of normal rhythm

Question 6

Affect & Mood

Answer 6

Affect (in this moment)

• Type (your best guess at your patient’s mood)
• Intensity (average of all points)
  
  • Normal
  • Blunted (below normal)
  • Flat (way below normal)
• Range (area under the curve)
  
  • Normal
  • Constricted
• Change pattern (how quickly a person gets from a peak to a valley - slope of the line)
  
  • Over controlled
  • Labile
• Appropriateness
  
  • Mood congruent
  • La belle indifference

Mood (over prolonged period of time)

• “If you could describe how you feel in one word, what word would you choose?”

Question 7

Perceptual Disturbances

Answer 7

Hallucinations (seeing a ghost)

Illusions (misinterpration of a real environmental stimulus)

Question 8

Level of Consciousness

Answer 8

Awake

Alertness (Lethargy, Catalepsy, Stupor, Coma)

Orientation (Person, Place, Time)

Question 9

Cognition: DISCO

Answer 9

Working Memory Index

• Digit Span (STM, attention, recall)

Verbal Comprehension Index

• Information (LTM), general mental ability
• Similarities (how are these two things alike)
• Comprehension (social judgment - what should a person do if he sees smoke or fire in a store?)

Question 10

Reliability

Answer 10

A statment on the reliability of your findings

If reliable - the closing to your MSE presentation - “The above findings are considered reliable”

If unreliable - lead-in to your MSE presentation