Patient Assessment, MSE

Question 1

MSE: Purpose

Answer 1

objective assessment in psychiatry (equivalent to physical exam in medical units)

what is happening in that point of time

Question 2

Mental Status Evaluation

Answer 2

an objective review of the pt’s cognitive functioning

structured

objective

Question 3

Chief Complaint

Answer 3

quote what the pt reports prompted them to seek tx

Question 4

HPI

Answer 4

history of present illness

• onset of symptoms
• types of symptoms (auditory hallucinations, etc)
• how severe the symptoms are (amount of distress)
• whether there is a trigger
• aggravating or relieving factors
• do the symptoms affect ADL’s

Question 5

Essential Questions

Answer 5

• what has been happening over the past couple of weeks that brought you into the hospital?
• have there been any events that you think caused your problem or made it worse?
• do you have any history of treatment for this problem?

Question 6

Components of MSE

Answer 6

appearance
speech
cognition
motor
mood/affect
thought process
thought content
insight/judgement

Question 7

Appearance

Answer 7

• is the pt dress appropriately? appropriately for the weather?
• is the pt appropriately groomed?
• unpleasant odors
• posture
• what does the makeup look like?

Question 8

Speech

Answer 8

rate, volume, latency of response (take a long time to respond to you), quality

normal: normal rate and volume

abnormal:
- rate: rapid (anxiety), slow (depressed), pressured (mania)
- volume: soft, normal, loud
- quality: thoughtful or disconnected
- neologisms: made up words
- word salad: words exist (actual words) but are thrown together
- echolalia: repeats words from interviewer
- perseveration: persistent adherence to a single idea or topic

Question 9

Motor

Answer 9

normal: no evidence of abnormal movements

abnormal:
- psychomotor agitation/restlessness
- psychomotor retardation
- fidgety
- involuntary tics
- grimacing (pain?)
- abnormal movements
- tremor

Question 10

Mood and Affect

Answer 10

mood: “xxx” ALWAYS in the pt’s words
- ask them how they are feeling
- does mood change?

affect: is what is objectively observed
- does the mood match the affect?
- normal: full/broad
- differences:
- -flat: more associated with depression (no change in facial expression)
- -blunted: associated with psychosis (no change in facial expression)
- -labile: extreme changes in persons affect (a lot of ups and downs in a persons mood or objectively when looking at affect)
- -inappropriate/no congruent: ex) person is suicidal, but they are laughing and joking through talking to you
- -restricted: stoic/ or one facial expression that doesn’t change a lot when talking to them

Question 11

Thought Process

Answer 11

normal: linear and logical

abnormal:
- circumstantial: circle thought process where they do eventually answer the question but takes a long time to get there)
- tangential: doesn’t answer the question, just go off on a different thought
- loose associations: goes from topic to topic in ways that don’t make sense (seen w/ schizophrenia)
- flight of ideas: rapid jump from topic to topic, topics related minimally
- thought blocking: interruption of thinking, question is met w/ complete silence which could be though blocking

Question 12

Thought Content

Answer 12

Delusions: fixed false beliefs (can be bizarre- implausible)

Grandiose: exaggerated belief of one’s own importance

Persecution/paranoid: revolve around thought of being harmed or conspired against by another person or agency (harassing, spying, spreading rumors)

Ideas of Reference: type of delusion
-believe that you are getting messages from an external source (person on tv is speaking to you)

Religious

Somatic: ex) belief that one is pregnant when they are not, or belief that they have parasites when they don’t

Assessment of suicide or harm toward others

Perceptions:

• hallucinations: sensory perceptions in the absence of an external stimulus (auditory, tactile, visual, olfactory)
• illusions: originate from true sensory stimuli but are misprocessed

Question 13

Cognition

Answer 13

orientation: alert and oriented to person, place, time, and situation

immediate and delayed recall: immediate and five-minute recall intact for 3/3 objects

attention/concentration: spell nurse backwards, subtraction

abstraction: “what does it mean when people say don’t cry over spilled milk?”
- abnormal: concrete, unable to conceptualize abstract ideas (ex: response = it means you don’t cry w/ no further interpretation)

Question 14

Judgement

Answer 14

ask questions where the answers will give you insight into the ability to make rational judgement

poor
improving
good

Question 15

Insight

Answer 15

what is your understanding of why you are receiving treatment?

what is their understanding of their illness?