Psych Mental Status exam

Question 1

5 main components

Answer 1

appearance and behavior, speech and language, mood, thought and perceptions, cognitive functions

Question 2

5 components to “appearance and behavior”

Answer 2

level of consciousness
posture and motor behavior
dress grooming and personal hygiene
facial expression
manner, affect, and relationship to person place and thing

Question 3

3 parts of posture and motor behavior

Answer 3

1) . gait- normal, wide based, ataxic, festinating
2) . involuntary or abnormal movements- tremors, mannerisms, general restlessness
3) . overall state (continuum)- ridged, retarded, relaxed, agitated, hyperactive. combative

Question 4

4 parts of dress grooming and personal hygiene

Answer 4

1) . global impression- appear their stated age, body habitus
2) . hygiene and grooming
3) . unusual features
4) . clothing, jewelry and hairstyle

Question 5

2 parts of facial expression

Answer 5

eye movements and eye contact

predominant facial expression (anxious, depressed, angry)

Question 6

what is manner?

Answer 6

patient’s relationship to interviewer and persons or things (friendly, cooperative, hostile)

Question 7

what two things do you look for when assessing manner?

Answer 7

1) . shifts or changes during interview and when

2) . keep track of own attitudes

Question 8

what is affect? what is one thing to look for when assessing affect?

Answer 8

outward manifestation/observable nature of a person’s emotions (flat, blunt, constricted, shallow, broad) ; if its congruent or incongruent with thought content

Question 9

what are you assessing in “relationship to surroundings “

Answer 9

does the patient see or hear things that you don’t; seem to be having conversations with someone not there

Question 10

5 parts of speech and language

Answer 10

1) . quantity
2) . rate
3) . volume
4) . fluency
5) . articulation of words

Question 11

S & L: quantity?

Answer 11

talkative or silent, only responding to q’s or offering info

Question 12

S & L: rate?

Answer 12

fast or slow

Question 13

S & L: volume?

Answer 13

whispered, soft or loud

Question 14

S & L: fluency?

Answer 14

monotone inflections (depression or schizophrenia) mumbled, slurred, stuttered, aphasic (hesitancies), spontaneous vs groping for word choice, circumlocutions, paraphasia

Question 15

what are circumlocutions?

Answer 15

words or phrases are substituted for the word a person cannot remember; e.g., “the thing you block out your writing with” for an eraser

Question 16

what are paraphasias?

Answer 16

target words from a phrase are malformed (“I write with a den”), wrong (“I write with a branch”), or invented (“I write with a dar”)

Question 17

what is important to do/remember when assessing mood? (3)

Answer 17

1) . ask open ended questions
2) . need to know how deep, long and how much fluctuates
3) . ask family for help & don’t be afraid to ask about suicide thought

Question 18

3 parts of thought process

Answer 18

productivity, continuity, and marked abnormalities

Question 19

3 parts of productivity

Answer 19

1) . overabundance or paucity (lack of originality) of ideas
2) . rapid or slow thinking
3) . flight of ideas

Question 20

what is flight of ideas?

Answer 20

accelerated change of topics in a very fast but generally coherent manner (associations are usually based on understandable associations)

Question 21

6 parts to continuity of thought

Answer 21

1) . logical and linear
2) . circumstantial
3) . tangential
4) . looseness of association/derailment
5) . thought blocking
6) . perseveration

Question 22

define “logical and linear”

Answer 22

goal directed and relevant response directly answers question

Question 23

define “circumstantial”

Answer 23

goal eventually reached but response is indirect and delayed

Question 24

define “tangential”

Answer 24

response is misleading and irrelevant

Question 25

define "looseness of association or derailment"

Answer 25

speaker unaware, illogical, changes topic with oblique or no apparent connection

Question 26

define "thought blocking"

Answer 26

sudden stopping in middle of sentence or thought, before completion of idea, appears as absence or deprivation of thought

Question 27

define "preservation"

Answer 27

same response/persistent repetition to a variety of questions without ability to change (suggests temporal lobe dysfunction)

Question 28

6 parts of marked abnormalities

Answer 28

1) . neologism 2) . word salad 3) . clang associations 4) . echolalia 5) . echopraxia 6) . confabulation

Question 29

what is neologism?

Answer 29

made up word, not understood, condensation of several words

Question 30

what is word salad?

Answer 30

incomprehensible mix of words and phrases

Question 31

what are clang associations?

Answer 31

sound of word rather than meaning gives direction to subsequent associations (ex: the man drank beer, she was near, good cheer)

Question 32

what is echolalia?

Answer 32

parrot like repetition of what another person says

Question 33

what is echopraxia?

Answer 33

repetition of another person's movements

Question 34

what is confabulation?

Answer 34

fabrication of facts to hide memory impairment

Question 35

7 parts to thought content

Answer 35

1) . compulsions 2) . obsessions 3) . phobias 4) . anxieties 5) . feelings of unreality 6) . feelings of depersonalization 7) . delusions

Question 36

what are compulsions?

Answer 36

repetitive behaviors that a person feels driven to perform to prevent or produce some future state of affairs

Question 37

what are obsessions?

Answer 37

recurrent, uncontrollable thoughts, images, or impulses that a patient considers unacceptable

Question 38

what are phobias?

Answer 38

persistent fear of a stimuli the patient feels is irrational (spiders, snakes, the dark)

Question 39

define "anxieties"

Answer 39

apprehension, fears, tension, or uneasiness that may be FOCUSED (phobia) or FREE-FLOATING (general sense of dread or doom)

Question 40

define "feelings of unreality"

Answer 40

a sense that things in the environment are strange, unreal or remote

Question 41

define "feelings of depersonalization"

Answer 41

a sense that one's self is different, changed, or unreal (has lost identity or become detached from one's mind or body)

Question 42

define delusion

Answer 42

false, fixed beliefs that are not shared by other members of the person’s culture

Question 43

7 types of delusions

Answer 43

1) . persecution 2) . gandeur 3) . jealousy 4) . of reference- person believes external events, objects or people have unusual personal significance (radio or TV giving instructions to that person) 5) . ideas of influence- being controlled by outside force (broadcasting) 6) . somatic 7) . systematized

Question 44

what is a somatic vs systematized delusion?

Answer 44

somatic- having a disease, disorder, or physical defect | systematized- a single delusion with many elaborations or a cluster of delusions around a single theme

Question 45

5 components of thoughts and perceptions

Answer 45

``` thought processes thought content thought perceptions insight and judgment harmful inclinations- suicidal or homicidal ideation ```

Question 46

4 parts of thought perceptions

Answer 46

1) . false perceptions- based around the 5 senses 2) . illusions 3) . hallucinations 4) . depersonalization- feeling of being outside of your body

Question 47

what are illusions?

Answer 47

false impressions which result from a real stimulus (ex seeing a chair in a dark room and thinking it is a person)

Question 48

what are hallucinations?

Answer 48

a subjective external stimuli the patient hears or sees that others do not hear or see (perceptual disturbance with NO external stimulus) and that the patient may not recognize as false;

Question 49

types of hallucinations

Answer 49

these can be auditory, visual, olfactory, gustatory, or tactile hypnagogic hypnopomic

Question 50

hypnagogic vs hypnopomic hallucinations?

Answer 50

hypnagogic- in drowsy state preceding sleep | hypnopomic- semi conscious state before awakening

Question 51

what is insight?

Answer 51

ability to be aware and understand one has a problem. able to review probable causes and arrive at tenable solutions

Question 52

what is judgment?

Answer 52

ability to understand the outcomes of behavior and to act in a culturally acceptable way

Question 53

5 parts of cognitive functions and examples

Answer 53

1) . orientation- person, place or thing 2) . attention- digit span, serial 7's, spelling backwards 3) . remote memory- historical data 4) . recent memory- few months to weeks 5) . new learning ability- tests memory of 4 words after 5 minutes

Question 54

4 parts of higher cognitive functions

Answer 54

1) . information and vocabulary- sign of person's intelligence 2) . constructional ability- copy figures or draw a clock 3) . abstract thinking- proverbs and similarities 4) . calculations- can be used as sign of dementia or aphasia

Question 55

what are the three D's?

Answer 55

Deviance Discomfort Dysfunction

Question 56

what are the three stages of the clinical interview? describe each stage

Answer 56

1) . Inception- Introduction, rapport 2) . Reconnaissance- Let pt tell their story and Gather basic information 3) . Detailed Inquiry- Gather detailed information

Question 57

what are the five components of the detailed inquiry? what three main things are you assessing during this part?

Answer 57

1). Present Illness- Symptoms and related symptoms; Differential dx 2). Previous Psychiatric Illness/Behavioral Problems (plus Previous Psychiatric Tx) 3). Family Hx- Family members, psychiatric illness 4). Social Hx- Educational and Occupational Hx, Military Hx 5). Legal Hx Assess: a). Presentation b). Insight, Judgment, Motivation for Tx c). Assets/Liabilities

Question 58

what two things does orientation require?

Answer 58

memory and attention

Question 59

what is attention?

Answer 59

the ability to focus or concentrate

Question 60

what are the 5 levels of consciousness? define them all

Answer 60

Alert: the patient is awake and aware Lethargic: you must speak to the patient in a loud forceful manner to get a response Obtunded: you must shake a patient to get a response Stuporous: the patient is unarousable except by painful stimuli (sternal rub) Coma: the patient is completely unarousable

Question 61

what is memory? what is the difference between short and long term?

Answer 61

Memory- the process of recording and retrieving information Short-term memory covers events or memories that occurred minutes to days before Long-term memory covers events or memories that occurred months to years before

Question 62

what are three main types of mood? define them

Answer 62

Euthymic: normal Dysthymic: depressed Manic: elated