Psych Mental Status exam Flashcards
5 main components
appearance and behavior, speech and language, mood, thought and perceptions, cognitive functions
5 components to “appearance and behavior”
level of consciousness posture and motor behavior dress grooming and personal hygiene facial expression manner, affect, and relationship to person place and thing
3 parts of posture and motor behavior
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
4 parts of dress grooming and personal hygiene
1) . global impression- appear their stated age, body habitus
2) . hygiene and grooming
3) . unusual features
4) . clothing, jewelry and hairstyle
2 parts of facial expression
eye movements and eye contact
predominant facial expression (anxious, depressed, angry)
what is manner?
patient’s relationship to interviewer and persons or things (friendly, cooperative, hostile)
what two things do you look for when assessing manner?
1) . shifts or changes during interview and when
2) . keep track of own attitudes
what is affect? what is one thing to look for when assessing affect?
outward manifestation/observable nature of a person’s emotions (flat, blunt, constricted, shallow, broad) ; if its congruent or incongruent with thought content
what are you assessing in “relationship to surroundings “
does the patient see or hear things that you don’t; seem to be having conversations with someone not there
5 parts of speech and language
1) . quantity
2) . rate
3) . volume
4) . fluency
5) . articulation of words
S & L: quantity?
talkative or silent, only responding to q’s or offering info
S & L: rate?
fast or slow
S & L: volume?
whispered, soft or loud
S & L: fluency?
monotone inflections (depression or schizophrenia) mumbled, slurred, stuttered, aphasic (hesitancies), spontaneous vs groping for word choice, circumlocutions, paraphasia
what are circumlocutions?
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
what are paraphasias?
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”)
what is important to do/remember when assessing mood? (3)
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
3 parts of thought process
productivity, continuity, and marked abnormalities
3 parts of productivity
1) . overabundance or paucity (lack of originality) of ideas
2) . rapid or slow thinking
3) . flight of ideas
what is flight of ideas?
accelerated change of topics in a very fast but generally coherent manner (associations are usually based on understandable associations)
6 parts to continuity of thought
1) . logical and linear
2) . circumstantial
3) . tangential
4) . looseness of association/derailment
5) . thought blocking
6) . perseveration
define “logical and linear”
goal directed and relevant response directly answers question
define “circumstantial”
goal eventually reached but response is indirect and delayed
define “tangential”
response is misleading and irrelevant
define “looseness of association or derailment”
speaker unaware, illogical, changes topic with oblique or no apparent connection
define “thought blocking”
sudden stopping in middle of sentence or thought, before completion of idea, appears as absence or deprivation of thought
define “preservation”
same response/persistent repetition to a variety of questions without ability to change (suggests temporal lobe dysfunction)
6 parts of marked abnormalities
1) . neologism
2) . word salad
3) . clang associations
4) . echolalia
5) . echopraxia
6) . confabulation
what is neologism?
made up word, not understood, condensation of several words
what is word salad?
incomprehensible mix of words and phrases
what are clang associations?
sound of word rather than meaning gives direction to subsequent associations (ex: the man drank beer, she was near, good cheer)
what is echolalia?
parrot like repetition of what another person says
what is echopraxia?
repetition of another person’s movements
what is confabulation?
fabrication of facts to hide memory impairment
7 parts to thought content
1) . compulsions
2) . obsessions
3) . phobias
4) . anxieties
5) . feelings of unreality
6) . feelings of depersonalization
7) . delusions
what are compulsions?
repetitive behaviors that a person feels driven to perform to prevent or produce some future state of affairs
what are obsessions?
recurrent, uncontrollable thoughts, images, or impulses that a patient considers unacceptable
what are phobias?
persistent fear of a stimuli the patient feels is irrational (spiders, snakes, the dark)
define “anxieties”
apprehension, fears, tension, or uneasiness that may be FOCUSED (phobia) or FREE-FLOATING (general sense of dread or doom)
define “feelings of unreality”
a sense that things in the environment are strange, unreal or remote
define “feelings of depersonalization”
a sense that one’s self is different, changed, or unreal (has lost identity or become detached from one’s mind or body)
define delusion
false, fixed beliefs that are not shared by other members of the person’s culture
7 types of delusions
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
what is a somatic vs systematized delusion?
somatic- having a disease, disorder, or physical defect
systematized- a single delusion with many elaborations or a cluster of delusions around a single theme
5 components of thoughts and perceptions
thought processes thought content thought perceptions insight and judgment harmful inclinations- suicidal or homicidal ideation
4 parts of thought perceptions
1) . false perceptions- based around the 5 senses
2) . illusions
3) . hallucinations
4) . depersonalization- feeling of being outside of your body
what are illusions?
false impressions which result from a real stimulus (ex seeing a chair in a dark room and thinking it is a person)
what are hallucinations?
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;
types of hallucinations
these can be auditory, visual, olfactory, gustatory, or tactile
hypnagogic
hypnopomic
hypnagogic vs hypnopomic hallucinations?
hypnagogic- in drowsy state preceding sleep
hypnopomic- semi conscious state before awakening
what is insight?
ability to be aware and understand one has a problem. able to review probable causes and arrive at tenable solutions
what is judgment?
ability to understand the outcomes of behavior and to act in a culturally acceptable way
5 parts of cognitive functions and examples
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
4 parts of higher cognitive functions
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
what are the three D’s?
Deviance
Discomfort
Dysfunction
what are the three stages of the clinical interview? describe each stage
1) . Inception- Introduction, rapport
2) . Reconnaissance- Let pt tell their story and Gather basic information
3) . Detailed Inquiry- Gather detailed information
what are the five components of the detailed inquiry? what three main things are you assessing during this part?
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
what two things does orientation require?
memory and attention
what is attention?
the ability to focus or concentrate
what are the 5 levels of consciousness? define them all
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
what is memory? what is the difference between short and long term?
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
what are three main types of mood? define them
Euthymic: normal
Dysthymic: depressed
Manic: elated
