Mental Status Examination Flashcards by Kate Carmie

Constructing a picture of the client’s current emotional state, mental capacity, and behavioral function

Mental Status Examination

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Conducted through interviews

Mental Status Examination

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What’s the appropriate body language?

(SOLER)
Sit squarely
Open Posture
Lean Forward
Eye Contact
Relax

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What’s the rationale of facing the client squarely?

Shows involved

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What’s the rationale of maintaining an open posture?

Makes patient feel engaged and welcome

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What’s the rationale of leaning forward?

Shows interest in what the client is saying

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What’s the rationale of eye contact?

Reflects that you are listening

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What’s the rationale of staying calm or relax in the process of body language?

reflects focus of interviewer

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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

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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

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The reason for seeking treatment

Chief Complaint

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Describes the precipitating events that lead to the chief complaint

History of Present Illness

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Factors that attribute the History of Present Illness

-Stressor
- Coping Mechanisms used
- Significant behavioral changes according to SO
- Condition on arrival

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Assess for initial onset or relapse

Psychiatric History

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What history are included in the Psychiatric History?

-History of psychosocial distress
- History of psychiatric condition

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Reveals any significant previous or current medical condition that contributed to the psychiatric condition

Medical History

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Medical History examples are

-Previous or current medical condition
-Medications (recent/current prescription, OTC herbal medications)
- Drug/Food Allergies
- Dietary restrictions

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Checks for any heredo-familial condition and family dynamics

Family History

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Part in Family History that helps focused on mental illness

Genogram

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Part in Family History that describes the significant relationships between family members

Family Dynamics

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In history, it has 5 kind of history

-Chief Complaint
- History of Present Illness
- Psychiatric History
- Medical History
- Family History

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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

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Types of General Description

Appearances
Attitude
Motor Activity
Speech Pattern

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Factors of attitude in the General Description

-Level of Cooperation
- Level of Friendliness
- Apathy
- Suspicious/ Guarded Behavior

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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

-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