Mental Status Examination Flashcards
Constructing a picture of the client’s current emotional state, mental capacity, and behavioral function
Mental Status Examination
Conducted through interviews
Mental Status Examination
What’s the appropriate body language?
(SOLER)
Sit squarely
Open Posture
Lean Forward
Eye Contact
Relax
What’s the rationale of facing the client squarely?
Shows involved
What’s the rationale of maintaining an open posture?
Makes patient feel engaged and welcome
What’s the rationale of leaning forward?
Shows interest in what the client is saying
What’s the rationale of eye contact?
Reflects that you are listening
What’s the rationale of staying calm or relax in the process of body language?
reflects focus of interviewer
What must be used in phrasing the questions?
-Use open ended questions
- Use direct questioning if unable to organize thoughts or is having difficulty with open-ended questions
-Focus on one behavior or symptom
-Use non-judgmental language and a matter of fact tone
Parts of MSE
-Identifying the data
- History
- General Description
- Emotion
- Thoughts Process and Content
- Sensorium and Cognition
- Judgment and Insight
- Self- Concept
- Roles and Relationships
The reason for seeking treatment
Chief Complaint
Describes the precipitating events that lead to the chief complaint
History of Present Illness
Factors that attribute the History of Present Illness
-Stressor
- Coping Mechanisms used
- Significant behavioral changes according to SO
- Condition on arrival
Assess for initial onset or relapse
Psychiatric History
What history are included in the Psychiatric History?
-History of psychosocial distress
- History of psychiatric condition
Reveals any significant previous or current medical condition that contributed to the psychiatric condition
Medical History
Medical History examples are
-Previous or current medical condition
-Medications (recent/current prescription, OTC herbal medications)
- Drug/Food Allergies
- Dietary restrictions
Checks for any heredo-familial condition and family dynamics
Family History
Part in Family History that helps focused on mental illness
Genogram
Part in Family History that describes the significant relationships between family members
Family Dynamics
In history, it has 5 kind of history
-Chief Complaint
- History of Present Illness
- Psychiatric History
- Medical History
- Family History
Appearance is included in the general description, what must be checked in the appearance?
-Check the type, condition, and appropriateness of clothing (for age, season, setting)
- Take note of the hygiene
- Observe posture and level of eye contact
- Note any evidence of scars, tattoos, or other distinguishing skin marks
Types of General Description
Appearances
Attitude
Motor Activity
Speech Pattern
Factors of attitude in the General Description
-Level of Cooperation
- Level of Friendliness
- Apathy
- Suspicious/ Guarded Behavior
Answers questions willingly
Cooperative
Refuses to answer questions
Uncooperative
Sociable and responsive
Friendly
Types of Aggressive
-Mild
-Moderate
- Severe
- Extreme
Type of aggressive that presents sarcastic
Mild
Types of aggressive that displays displacement
Moderate
Types of aggressive that makes threat or physical violence
Severe
Types of aggressive that shows physical acts of violence against others
Extreme
Refuses to participate in interview process
Apathy
-Continuously scan environment
- Questions motives of the interviewer
- Refuses to answer questions
Suspicious / Guarded Behavior
Types of Motor Activity in General Description
-Automatisms
- Waxy Flexibility
- Echopraxia
- Psychomotor retardation
Repeated purposeless behaviors often indicative of anxiety
Automatisms
Maintenance of posture or position over time even when it is awkward or uncomfortable
Waxy Flexibility
Involuntary repetition of the movements of another person
Echopraxia
Overall slowed movements
Psychomotor retardation
Psychomotor retardation defined as an overall slowed movements. What factors that contribute to the overall slowed movements
-Movements are very slow
- Thinking and speech are very slow
- Posture is slumped
A form of language impairment, affecting the production or comprehension of speech and the ability to read or write
Aphasia
Speed, volume, and tone
Speech Pattern
Aphasia means
-Difficulty forming words
- Use of incorrect words
- Difficulty thinking of words
Refers to the client’s pervasive and enduring emotional state
Mood
Is the outward expression of the client’s emotional state
Affect
What are the types of moods?
-Euthymic
- Depressed
- Irritable
- Anxious
- Elated
- Euphoric
- Fearful
- Guilty
- Labile
Neutral mood
Euthymic
Overwhelming feeling of sadness
Depressed
Easily annoyed and provoked to anger
Irritable
Demonstrates or verbalizes feelings of apprehension
Anxious
Expresses feelings of joy and intense pleasure
Elated
Grandiose sense of elation
Euphoric
Demonstrates or verbalizes feelings of apprehension associated with real or perceived danger
Fearful
Expresses a feeling of discomfort associated with real or perceived wrongdoing.
Guilty
Exhibits mood swings that range from euphoria to depression with no apparent stimuli
Labile
What are the types of affect?
-Congruent Affect
- Blunted Affect
- Flat Affect
- Inappropriate Affect
Outward emotional expression is consistent with mood.
Congruent Affect
Minimal outward expression is observed.
Blunted Affect
Absence of outward emotional expression
Flat Affect
Displays a facial expression that is incongruent with mood or situation.
Inappropriate Affect
Refers to how a person thinks
Thought Process
Is what the person thinks and says
Thought Content
are written reports of verbal interactions with clients.
Process Recordings
They are verbatim (to the extent that this is possible) accounts, written by the nurse or student as a tool for improving interpersonal communication techniques.
Process Recordings
What are the alterations in thought process?
-Flight of ideas
- Loose Associations
- Word Salad
-Circumstantiality
- Tangentiality
- Neologisms
- Clang Association
- Perseveration
- Verbigeration
- Echolalia
- Latency of Response
- Poverty of speech
- Mutism
-Repeated and rapid changing of the subject.
-Verbalizations are continuous and rapid, and flow from one to another.
Flight of ideas
Sudden shifting from one topic to another without any connection
Loose Associations
Words in succession without any connection or continuity of thought
Word Salad
-Detailed and lengthy talking about a subject.
-Verbalizations are lengthy and tedious, has numerous details but eventually gets to the point.
Circumstantiality
Verbalizations that are lengthy and tedious, never reach an intended point.
Tangentiality
Making up non-sensical-sounding words which only have meaning to client
Neologisms
Repetition of words that sound alike or rhyme but are otherwise not connected
Clang Association
Repetition of word or phrases in response to different questions
Perseveration
Obsessive repetition of random words without stimulus
Verbigeration
Parrot-like repetition of another’s words
Echolalia
Delayed response to a presented stimulus
Latency
Speaks very little and in monosyllables
Poverty of Speech
Does not speak at all
Mutism
A part of alterations in thought content that indicates fixed, false beliefs
Delusion
A belief that someone is out to get him or her in some way
Persecutory
An idea that he or she is all- powerful or of great importance
Grandiose
An idea that whatever is happening in the environment is about him or her
Reference
A belief that his or her behavior and thoughts are being controlled by external forces.
Control
A belief that he or she has a dysfunctional body part.
Somatic
A belief that he or she is dead, decomposed or annihilated, having lost one’s own internal organs or even not existing entirely as a human being.
Nihilistic
A belief that an individual’s partner is unfaithful.
Jealous
A belief that one has special religious power
Religious
A belief that others know about one’s sexual activity and that it causes illness
Sexual
Stopping abruptly in the middle of a sentence unable to continue the idea
Thought blocking
Verbalizing about a persistent thought or feeling that he or she is unable to eliminate from consciousness
Obsessions
Speaking in a way that indicates his or her words or actions have power
Magical Thinking
Persistent interpretation of the actions of others as threatening or demeaning
Paranoia
Thoughts about harming self
Suicidal Ideation
Thoughts about harming others
Homicidal Ideation
Irrational fears of a specific object or social situation
Phobias
-Responses contain very minimal information
- Vague responses or stereotypical cliches
Poverty of Content
Types of Sensory-Perceptual Alterations
-Hallucination
- Illusion
- Depersonalization
- Derealization
False sensory perceptions or perceptual experiences that do not really exist
Hallucination
Type of Hallucinations that pertains to hearing voices/sounds that do not exist
Auditory
Types of hallucinations that pertains to seeing images that do not exist
Visual
Types of hallucinations that pertains to feeling unrealistic sensations on the skin
Tactile
Types of hallucinations that pertains to smelling odors that do not exist
Olfactory
Types of hallucinations that pertains to false perception of unpleasant taste
Gustatory
Misinterpretation of a renal external stimuli
Illusion
The individual verbalizes feeling “outside the body”; visualizing him-or herself from afar
Depersonalization
The individual verbalizes that the environment feels “strange or unreal”. A feeling that the surroundings have changed
Derealization
Types of Sensorium and Cognition
-Orientation
- Memory
- Memory Alterations
- Testing for Confabulation
- Tests for ability to concentrate
- Test for abstract thinking
Refers to a person’s recognition of person, place, and time
Orientation
Time, place, person
Disorientation
Person, place, time
Re-orientation
Ability to store and retrieve information when needed
Memory
Short term memory assessment
-Let the patient memorize three random objects
-After about 5 minutes, let the patient recall the names you let him/her memorize.
Long-term Assessment
-Let the patient recall a significant historical event or any significant general information
Memory Alterations factors
-Retrograde Amnesia
-Anterograde Amnesia
-Confabulation
Inability to remember memories prior to onset of amnesia, but still able to learn new ones
Retrograde Amnesia
Inability to create new memories, leading to partial or complete inability to recall recent past memories, while long-term memories before onset remain intact
Anterograde Amnesia
Memory error characterized by production of fabricated, distorted, or misinterpreted memories about self or the world
Confabulation
-Participants listen to audio recordings of several lists of words centered around a theme, known as the critical word.
-The participants are later asked to recall the words on their list.
-If the participant recalls the critical word, which was never explicitly stated in the list, it is considered a confabulation.
Testing for Confabulation
DRM (Deese-Roediger-McDermott) Paradigm
What procedure is used to test for ability to concentrate?
Serial Sevens
Serial Sevens
-Begin with the number 100, subtract 7, subtract 7 again, and so on.
-Have the client repeat the days of the week backward.
-Have the patient repeat the months of the year backwards
Perform a three- part task
-Is the ability to make associations or interpretations about a situation or comments.
-Interpret a common proverb.
Test for Abstract Thinking
Refers to the ability to interpret one’s environment and situation correctly and to adapt one’s behavior and decisions accordingly.
Judgment and Insight
is the ability to understand the true nature of one’s situation and accept some personal responsibility for the situation.
Insight
Shift the responsibility for something to another object or person.
“Passing the buck”
Expecting problems to be solved with little or no effort
Poor Insight
Is the way one views self in terms of personal worth and dignity.
Self-Concept
Characteristics of Self-Concept
-Let the client describe himself or herself and what characteristics he or she likes and what he or she would change.
-Ask for usual coping strategies
