msa Flashcards by Solano, Aijalhie R.

a person’s emotional and cognitive functioning. It should allow the person to function
socially and occupationally.

MENTAL STATUS

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being aware of one’s own existence, feelings, and thoughts, and aware of the environment.
This is the most basic of mental status functions.

Consciousness

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using voice to communicate one’s thoughts and feelings. The humanness of a person greatly
depends on his ability to communicate. Its loss has a great impact on the social dimension of a person’s life.

Language

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deal with the prevailing feelings. Affect is a temporary expression of feelings or state of
mind, whereas, mood is more durable with a prolonged display of feelings that depict the whole emotional
life.

Mood and Affect

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is the awareness of the outside world in relation to the self.

Orientation

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is the power of concentration, the ability to focus on one specific thing without being distracted
by many environmental stimuli.

Attention

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is the ability to lay down and store experiences and perceptions for later recall. Recent memory
evokes day-to-day event. Remote memory brings up year’s worth of experiences.

Memory

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an awareness of objects through the five senses

Perceptions

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what the person thinks — specific ideas, beliefs, use of words.

Thought Content

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is the way a person thinks, the logical train of thought.

Thought Process

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is pondering a deeper meaning beyond the concrete and literal.

Abstract Reasoning

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COMPONENTS OF MENTAL STATUS EXAMINATION :

ABCT

Appearance
Behavior
Cognitive functions
Thought processes and perceptions

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patient’s ______ helps to indicate his emotional and mental status. Specifically,
take note of the following:

APPEARANCE

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is erect and position is relaxed.

Posture

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Abnormal Findings

sitting on edge of chair, curled in bed, tense muscles, darting watchful eyes, frowning, restless
pacing (indicates anxiety or hyperthyroidism)

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Abnormal Findings

sitting slumped in chair, slow walk, dragging feet (indicate depression and some organic brain
disease)

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ab. finding sa grooming

Inappropriate dress, poor hygiene, lack concern with appearance (indicates and
severe Alzheimer’s disease)

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The patient is clean and well-groomed; hair is neat and clean; women have
moderate make-up or no make-up; men are shaved or beard or moustache is well groomed. Nails
are clean

Grooming and Hygiene

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is appropriate for setting, season, age, gender, and social group. Clothing fits and is put on
appropriately

Dress

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abf. dress

Provocative manner of dressing combined with bizarre makeup (indicates mental disorders like
schizophrenia, histrionic personality)

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abf. dress

Inappropriate dress (wearing three layers of clothing on a warm day)

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abf. level of consciousness

Lethargic (somnolent), obtunded (transitional state between lethargy and stupor), stuporous
(semi-coma), comatose (completely unconscious) (indicate neurologic disorders and systemic
conditions like hypoxia, hypoglycemia, overdose of medications, septicemia, hypovolemia)

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patient is awake, alert, aware of stimuli from the environment and within
the self, and responds appropriately to stimuli.

Level of Consciousness

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abf. facial expression

Flat, masklike facial expression (indicate depression and parkinsonism)

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look if appropriate to the situation and changes appropriately with the topic. There is comfortable eye contact unless precluded by cultural norm (eg. Direct eye contacts maybe viewed as a sign of disrespect in some cultures)

Facial Expression

The patient completes sentences, occasionally pausing to think.

speech

The pace of conversation is moderate, and stream of talking is fluent.

speech

The patient makes laryngeal sounds effortlessly and share conversation appropriately

speech

Dysphonia (abnormal volume, pitch), monopolized interview, silent, secretive, uncommunicative

abf. speech

Dysarthria (distorted speech), misuse of words, omits letters, syllables or words, repetitious abnormal patterns (echolalia, neologism), word choice is effortless and appropriate to educational level

abf. speech

judge by body language and facial expression and by asking directly, “How do you feel today?”, or “How do you usually feel?

Mood and Affect

– finding or failure in word search (aphasia)

Unduly long word abf. speech

Wide mood swings (manic disorder), bizarre mood (schizophrenia), flat affect (blunted), depersonalization (lack of ego boundaries), elation (joy and optimism, overconfidence, increased motor activity), euphoria, ambivalence, lability, inappropriate affect

abf. mood and affecr

t or f The mood should be appropriate to the person’s place and condition and change appropriately with topics. The person is willing to cooperate with the nurse.

Easily distracted, irrelevant replies to questions, confusion

abf. cognitive attention span

check the patient’s ability to concentrate by noting whether he or she completes a thought without wandering. Note any distractibility or difficulty attending to you.

Attention Span

oriented to three spheres (person, place and time)

Orientation

Disorientation (delirium, dementia)

abf. orientation cognitive

the Four Unrelated Words Test (a sensitive and valid memory test) Procedure: Pick 4 words with different semantics and phonetic. Ask for recall after 5 minutes, then at 10 minutes, and at 30 minutes. The normal response for patients under 60 years is an accurate three-or-four word recall after a 5, 10, and 30-minute delay.

New Learning

Impaired new learning (depression, anxiety)

abf. new learning

Score of zero or one-word recall (Alzheimer’s)

abf. new learning

Illogical, unrealistic thought processes, deviates from initial thought

abf. thought process

ask yourself, “Does this patient make sense?”, “Can I follow what the patient is saying?”… The way patient thinks should be logical, goal directed, coherent and relevant, and should complete a thought.

Thought Process

a patient exercises judgment if he or she can compare and evaluate the alternative in a situation and reach an appropriate course of action.

Judgment

round about expression, substituting a phrase when cannot think name of object

Circumlocution

coining of new word; invented word has no real meaning except for the person

Neologism

fabricates event to fill in memory gaps

Confabulation

sudden interruption in train of thought, unable to complete sentence, seems related to strong emotio

Blocking

word choice based on sound, not meaning, includes non sense rhymes and puns

Clang Association

imitation, repeats other’s words or phrases, often with a mumbling or mocking or mechanical tone

Echolalia

persistent repeating of verbal or motor response, even with varied stimuli

Perseveration

incoherent mixture of words, phrases and sentences; illogical, disconnected

Word Salad

abrupt change, rapid shifting from topic to topic, and practically continuous flow of accelerated speech; topics usually have unrecognizable associations or are plays on words.

Flight of Ideas

shifting from one topic to an unrelated topic; person seems unaware that topics are unconnected

Loosening Associations -

talks with excessive and unnecessary details, delays reaching point. Sentences have a meaningful connection but are irrelevant.

Circumstantiality

what the patient says should be consistent and logical

Thought Content

misperception of an actual existing stimulus, by any sense

Illusion

sensory perceptions for which there are no external stimuli; may affect any sense

Hallucination

the patient should be consistently aware of reality. The perception should be congruent with yours

Perceptions

firm, false beliefs; irrational

Delusion

unwanted, repetitive, purposeful act (ritual), drive to do it, behavior thought to neutralize or prevent discomfort or some dreaded event

Compulsion

unwanted, persistent thoughts or impulses; logic will not purge them from consciousness

Obsession

morbid worrying about his or her own health, feel sick with no actual basis for that assumption

Hypochondriasis

strong, persistent, irrational fear of an object or situation; feels driven to avoid it

Phobia

when the patient expresses feelings of sadness, hopelessness, despair or grief, it is important to assess any possible risk of physical harm to self.

Screen for Suicidal Thoughts

t or f It is quite difficult for beginning interviewer to question people about possible suicidal wishes. They usually fear invading privacy and may have their own normal denial of death and suicide. However, it is greater dangerous if this issue was not recognized and addressed. The patient may succeed in implementing plans for suicide.

- Prior suicide attempts - Depression, hopelessness, social withdrawal, running away - Self-mutilation - Hypersomnia, insomnia - Slowed psychomotor activity - Anorexia - Verbal suicide messages (defeat, failure, worthlessness, loss, giving up, desire to kill self) - Death themes in art, jokes, writing, behaviors) - Saying goodbye (giving away valuable personal belongingness)

abf. Screen for Suicidal Thoughts

Conduct even a brief examination of all older people admitted to the hospital.