MSE & delirium/delusion Flashcards
Delusion
A false belief firmly maintained despite evidence to the contrary
Referential thinking
patients believe that the information they see or hear is meant directly for them
Components of mental status exam (5)
Appearance
behavior
speech
mood
affect
Thought process
Thought process is:
the assessment of the organization of the patient’s thoughts and ideas
Normal thought processes can be documented as (4)
logical, linear, coherent, goal oriented
Abnormal thought processes can be documented by as (3)
associations are not clear, organized, or coherent
Tangentiality
moves from thought to thought that may or may not relate in some way but NEVER gets to the point
Circumstantial
Provides unnecessary detail but eventually gets to the point (C- like circle)
Thought content:
refers to the themes that occupy the patient’s thoughts and perceptual disturbances
Examples of thought content: (3)
SI, HI, plan, visual hallucination, auditory hallucinations
Insight:
refers to the patient’s awareness and understanding of their own thoughts, feelings, behaviors, and presence of any mental health symptoms or conditions
Assessment for insight:
Insight is assessed by exploring the patient’s awareness of their mental health condition, including the ability to recognize their symptoms, acknowledge the need for treatment, and understand the impact of their conditions on their life. Exp: Do you believe you have a mental health condition and might need medications? Do you understand why you are taking medication or attending therapy sessions?
Judgement:
refers to the ability of the patient to make sound decisions evaluate the situation and anticipate the consequences of their actions based on social norms, cultural values, and personal goals
Assessment for judgement:
Judgment is typically evaluated through questions or hypothetical scenarios that assess the patient’s ability to weigh options, consider alternatives, and choose the most appropriate course of action
exp: what would you do if you found a wallet on the street? How would you handle a disagreement with a friend or family member?
Folsetin scale (MMSE)
quantitative evaluation of cognitive impairment and records cognitive changes over time in adults
can screen for dementia and measure progression over time
Assess for concentration/attention/calculation:
I would like you to count backward from 100 by sevens or do serial 7s or subtract seven from 100, or list all 12 months in reverse order
Assessment for orientation:
what is the year? season? Date? Day? month? Where are we now?
Registration and ability to learn new material:
Say the names of three unrelated objects clearly and slowly, allowing one second for each. after you say them, have the patient repeat back
Recall (memory)
Ask the patient if he or she can recall the three words you previously asked hin or her to remember *after 5 min
Fund of knowledge:
who is the president/governor
Other instruments for assessing level of cognition impairment (pg 281) (3)
Montreal Cognitive Assessment (MoCA)
Mini-cog
St. Louis university mental status examination (SLUM)
Risk factors for SI (12) pg. 163
Previous SI attempt
age 45 or older if male
age 55 or older if female
divorced, single, separated
white (caucasian)
living alone
Psychiatric disorder
physical illness
substance abuse
family hx of SI
recent loss
male gender
Normal range on MMSE
25-30
Mild cognitive impairment range MMSE
21-24
Moderate middle stage on MMSE
10-20
Severe late stage alzheimers MMSE
0-9
Mild range for SLUM (0-30)
21-26
Mild range for MoCA
18-25
PHQ-9 rates what? what is the moderate scale?
Depression
10-14 moderate
HAM D rates what? Moderate scale?
Depression/Anxiety 14-18
Beck rates what? moderate?
Depression
19-29
GAD moderate score
10-14
when someone has mild to moderate depression what is the intervention?
therapy/nothing
When someone has moderate and severe anxiety depression, the intervention is
medications and or therapy
If scoring on the depression scale fall on severe range intervention is
assess SI
Delirium (6)
acute onset, altered LOC, inattention, confusion, changes in cognition, poor prognosis
Delirium Prognosis
One year mortality rate is up to 40%
Treatment for delirium
antipsychotic agents
Best for agitated delirious
Haldol
Alcohol induced delirium tx choice
benzodiazepines
Tx for delirium and antispychotics
anxiolytics
non-pharmacological interventions for delirium (3)
safety needs fall risk
basic needs
familiarity in the room familiar person or photos
MSE for a preschooler you want to? (3-5yo)
listen and observe clues (dependent on clinical observation)
constructional apraxia and caused by
inability or difficulty to build, assemble, or draw objects
can be caused by lesions in parietal lobe after stroke or with Alzheimer
Stereognostic exam (stereognosis testing)
neurological assessment used to evaluate a person’s ability to recognize and identify objects by touch alone
stereognosis testing assess the integrity of ________
sensory pathways and processing in the brain esp in the parietal lobe which plays a role in somatosensory perception and spacial awareness
Dementia
group of disorders characterized by gradual development of multiple cognitive deficits
Progressive mental decline
dementia
irritability and personality changes is seen in
dementia
what vitamin levels should you check with dementia
b12 and folic acid
What can cause delirium in older adult patients that would not be noticed right away
infections such as UTIs
elderly comes in very confused, delirious, agitated what do you want to order to check for ? esp for elderly women
UA with culture and sensitivity
