Mental status examination

Question 1

what are unique characteristics of “the psychiatric patient “?

Answer 1

1. The difficult patient
2. Collateral data
3. Establishing rapport/ empathy
4. Safety considerations

Question 2

What are key points/ identifying data when introducing oneself with a psychiatric patient ?

Answer 2

1. Introduce yourself
2. Put the patient at ease
3. Establish rapport
4. Active listening
5. Demonstrate empathy
6. Name and age

Question 3

what are key principles in interpreting the chief complaint of a psychiatric patient ?

Answer 3

1. Put it in the patients own words
2. “what brings you in today?”
3. May not be the focus of treatment (the lights are flickering)
4. Use open ended questions
5. Observe the patient

Question 4

what are key principles in interpreting the history of present illness of a psychiatric patient ?

Answer 4

1. Elaboration of CC
   2.Start open ended and end more focused
2. Why now?
3. Current symptoms: onset, duration, chronology, precipitants, alleviators, treatments?
4. Recent stressors
5. More focused questioning to narrow diagnosis
6. Positives and negatives
7. Enoagsus on functional impairment from symptoms

Question 5

What are the “4 food groups” of psychiatric disorders?

Answer 5

1. Mood disorders
2. Anxiety disorders
3. Psychotic disorders
4. Substance use disorders

Question 6

How do you screen for mood disorders (depression)?

Answer 6

1.Screening for depression (intuitive)
a. Mood, appetite, energy, concentration, sleep,
self-worth, interest/motivation, suicidal ideations

Question 7

How do you screen for mood disorders (mania)?

Answer 7

1. Screening for mania-
   a. Increased energy, decreased NEED for sleep,
   irritability, increased activities, hedonism, racing
   thoughts and speech

Question 8

what is the difference between physiologic and psychological?

Answer 8

1. Physiologic: Processes or functions of the body
   ex: Panic attacks, hyper-arousal, fight or flight
2. Psychological: Mental and emotional processes, thoughts and behaviors.
   ex: excess worry, fear, apprehension, GAD, OCD

Question 9

what should you screen for in anxiety disorders?

Answer 9

Both physiological and psychological manifestations

Question 10

Anxiety disorders are usually a combination of what symptoms?

Answer 10

psychological and physiological
ex: panic disorder, social phobia

Question 11

How do you screen for psychotic disorders?

Answer 11

1. Screen for perceptual abnormalities
   ex: delusions, hallucinations
2. Screen for disordered thought processes
   a.mainly through mental status examination/observation

Question 12

Within perceptual abnormalities in psychotic disorders what does delusion mean?

Answer 12

fixed false beliefs not culturally sanctioned
ex: persecution, ideas of reference, jealousy, grandiosity, hyper-religiosity, somatic (thinking something wrong with the body)

Question 13

Within perceptual abnormalities in psychotic disorders what does hallucinations mean?

Answer 13

Hearing, seeing,feeling, tasting and smelling things in the absence of them
ex: auditory, visual, tactile, olfactory, gustatory (taste)

Question 14

How should you asses for substance abuse disorders?

Answer 14

Must rule out substance use disorders first
1. assess for current use early in interview, historical use later
2. How much how often last used

Question 15

What are major safety concerns in psychiatric patients ?

Answer 15

1. Suicidal ideation
2. Homicidal ideation
3. command hallucinations (violence)
4. Self injurious behaviors
5. inability to care for self
6. reckless impulsivity: promiscuity, dangerous use of substances

Question 16

what are key factors in collecting psychiatric history?

Answer 16

1. Data Driven:This emphasizes the importance of collecting information based on objective data rather than subjective impressions.
   2.Don’t Get Lost in the Details: While it’s crucial to obtain relevant information, it’s equally important not to become overwhelmed or bogged down by excessive details.
2. Avoid Excess Jargon: Encourages using clear and straightforward language when discussing past psychiatric history.

Question 17

what information should be collected when evaluating psychiatric history ?

Answer 17

1. Prior Diagnoses: Involves documenting any previous psychiatric diagnoses the patient has received.
2. Prior Treatments: Encompasses information about treatments the patient has received in the past, including medications and psychotherapy.
   a. Specific details such as what treatments were tried, what worked best, and any side effects experienced are essential for informing current treatment decisions.
3. Psychiatric Hospitalizations:
   Includes details about the patient’s history of psychiatric hospitalizations.
   a. the number of hospitalizations, reasons for hospitalization, and details about the first and most recent hospitalizations.

Question 18

what information should be collected about current medication and allergies ?

Answer 18

1. List of all medications
2. all otc and herbal remedies
3. Allergies: distinguish allergies from adverse reactions
   a. drug induced movements common with antipsychotics, are side effects no allergies

Question 19

what information should be collected about family psychiatric history ?

Answer 19

1. Blood relatives especially 1st degree
   a. includes parents, siblings, and children
2. Mental Illness, Emotional Problems, On Any Medications for Stress, Anxiety”:
   a. Advises to inquire broadly about mental health conditions in the family. Using terms like “mental illness” and “emotional problems” casts a wide net to capture various psychiatric conditions. ask about the use of medications for stress or anxiety.
3. Don’t Forget Suicide Attempts and Substance Abuse:
   Highlights the importance of specifically asking about suicide attempts and substance abuse within the family history.

Question 20

what information should be collected about developmental history ?

Answer 20

1. Trauma
2. Abuse: physical, emotional, sexual
3. should flow into social history

Question 21

what information should be collected about social history ?

Answer 21

Assessment of functioning in key areas
1. social: relationship, marriage, children, sexuality
2. occupational/academic: highest grade level achieved, job history, work status
3. Home environment: support network, lives with whom?
4. Military history
5. Legal history
6. Domestic violence
7. Religion
8. Values

Question 22

what information should be collected about substance use history ?

Answer 22

1. More in depth than ROS
2. include all recreational/ street drugs, herbal remedies, otc preparations, supplements, esp. caffeine, ephedra
3. Amounts, frequency, consequences
4. Most recent use

Question 23

what substances can be applicable to substance use disorder?

Answer 23

1. Alcohol
2. Marijuana
3. Stimulants (cocaine, amphetamines)
4. Hallucinogens (LSD, PCP)
5. inhalants
6. Sedative/Hypnotics (Benzo, barbs)
7. Opiates

Question 24

what is the mental status examination MSE?

Answer 24

can be divided into 2 sections
1. observational data
a. Most areas assessed while obtaining historical data (observed) Behavior
2. Formal cognitive testing: MMSE (mini-mental status exam)
a. requires more formal assessment thru use of cognitive screening tools

Question 25

what are the components of the MSE: Observational ?

Answer 25

1. Appearance: body habitus, nourishment, age, hygiene, dress 2. Behavior: attitude, relatedness, cooperativeness, psychomotor acitivat (nonverbal behavior), abnormal movements, eye contact 3. Speech: focus on quality of production, quality, quantity, rate, rhythm ,prosody observational representation of internal thought processes. 4. Mood: internal emotional tone, to assess must ask patient, happy, angry, nervous, fine 5. Affect: The way individuals display their emotions through facial expressions, body language, and overall demeanor. 6. Thought processes: how ideas are put together, a. linear: logical, goal directed b. tangential: never gets to the point, c. circumstantial: provides excessive and unnecessary details or includes tangential information the person eventually arrives at the main point or answer. 7. Thought content 8. Delusion 9. Insight: understanding and appreciation of their own illness/situation 10. Judgement: ability to make sound decisions

Question 26

what does looseness of associations mean

Answer 26

This term refers to a thought disorder where the connections between thoughts are not readily apparent to the listener. The person may express ideas that seem unrelated or loosely connected, making it challenging for others to follow the train of thought.

Question 27

what does flight of ideas mean ?

Answer 27

Flight of ideas is a specific type of thought disorder where thoughts are connected, but they occur rapidly and may be difficult for the listener to keep up with. It often involves a rapid and continuous flow of thoughts, often associated with heightened energy or excitement.

Question 28

what does clanging mean ?

Answer 28

Involves the use of words that rhyme or sound similar but are not logically connected in meaning. This can occur in the place of coherent speech.

Question 29

what does neologism mean?

Answer 29

The creation of new words or phrases that are idiosyncratic and not recognized or understood by others. It reflects a departure from conventional language use.

Question 30

what does derailment mean?

Answer 30

Initially, the person's thoughts may follow a linear path, but there is a repeated shift in focus, leading to tangential or unrelated ideas.

Question 31

what does the thought content part of the MSE observational mean?

Answer 31

Thought Content refers to the nature and substance of an individual's thoughts 1. Normal 2. Suicidal/ homicidal ideations 3. Perceptions a. Delusions B. Hallucinations C. Illusions

Question 32

what are the two most common tools in cognitive testing?

Answer 32

1. MSE 2. Fullstein

Question 33

What is the MMSE fullstein test ?

Answer 33

1. 30-Point Screening Tool: a set of questions and tasks that assess various aspects of cognitive function. The total score is 30 points, with higher scores indicating better cognitive function. 2. Orientation (10 pts): awareness assessment of time and place 3. Language functions(9 pts): reading, writing, naming, comprehension, repetition 4. registration and recall (3 pts) 5. Attention/ calculations (5 pts) 6. constructional praxis: visuospatial and constructional abilities. The person may be asked to copy a simple drawing or reproduce a geometric figure.

Question 34

What are interpretations of the MMSE scores?

Answer 34

1. Normal >24 or higher