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Clinical Skills > Psych Mental Status exam > Flashcards

Psych Mental Status exam Flashcards

1
Q

5 main components

A

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

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2
Q

5 components to “appearance and behavior”

A 
level of consciousness
posture and motor behavior
dress grooming and personal hygiene
facial expression
manner, affect, and relationship to person place and thing
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3
Q

3 parts of posture and motor behavior

A

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

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4
Q

4 parts of dress grooming and personal hygiene

A

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

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5
Q

2 parts of facial expression

A

eye movements and eye contact

predominant facial expression (anxious, depressed, angry)

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6
Q

what is manner?

A

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

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7
Q

what two things do you look for when assessing manner?

A

1) . shifts or changes during interview and when

2) . keep track of own attitudes

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8
Q

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

A

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

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9
Q

what are you assessing in “relationship to surroundings “

A

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

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10
Q

5 parts of speech and language

A

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

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11
Q

S & L: quantity?

A

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

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12
Q

S & L: rate?

A

fast or slow

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13
Q

S & L: volume?

A

whispered, soft or loud

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14
Q

S & L: fluency?

A

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

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15
Q

what are circumlocutions?

A

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

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16
Q

what are paraphasias?

A

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”)

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17
Q

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

A

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

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18
Q

3 parts of thought process

A

productivity, continuity, and marked abnormalities

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19
Q

3 parts of productivity

A

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

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20
Q

what is flight of ideas?

A

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

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21
Q

6 parts to continuity of thought

A

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

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22
Q

define “logical and linear”

A

goal directed and relevant response directly answers question

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23
Q

define “circumstantial”

A

goal eventually reached but response is indirect and delayed

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24
Q

define “tangential”

A

response is misleading and irrelevant

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25
Q

define “looseness of association or derailment”

A

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

26
Q

define “thought blocking”

A

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

27
Q

define “preservation”

A

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

28
Q

6 parts of marked abnormalities

A

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

29
Q

what is neologism?

A

made up word, not understood, condensation of several words

30
Q

what is word salad?

A

incomprehensible mix of words and phrases

31
Q

what are clang associations?

A

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

32
Q

what is echolalia?

A

parrot like repetition of what another person says

33
Q

what is echopraxia?

A

repetition of another person’s movements

34
Q

what is confabulation?

A

fabrication of facts to hide memory impairment

35
Q

7 parts to thought content

A

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

36
Q

what are compulsions?

A

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

37
Q

what are obsessions?

A

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

38
Q

what are phobias?

A

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

39
Q

define “anxieties”

A

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

40
Q

define “feelings of unreality”

A

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

41
Q

define “feelings of depersonalization”

A

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

42
Q

define delusion

A

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

43
Q

7 types of delusions

A

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

44
Q

what is a somatic vs systematized delusion?

A

somatic- having a disease, disorder, or physical defect

systematized- a single delusion with many elaborations or a cluster of delusions around a single theme

45
Q

5 components of thoughts and perceptions

A 
thought processes
thought content
thought perceptions
insight and judgment
harmful inclinations- suicidal or homicidal ideation
46
Q

4 parts of thought perceptions

A

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

47
Q

what are illusions?

A

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

48
Q

what are hallucinations?

A

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;

49
Q

types of hallucinations

A

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

50
Q

hypnagogic vs hypnopomic hallucinations?

A

hypnagogic- in drowsy state preceding sleep

hypnopomic- semi conscious state before awakening

51
Q

what is insight?

A

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

52
Q

what is judgment?

A

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

53
Q

5 parts of cognitive functions and examples

A

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

54
Q

4 parts of higher cognitive functions

A

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

55
Q

what are the three D’s?

A

Deviance
Discomfort
Dysfunction

56
Q

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

A

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

57
Q

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

A

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

58
Q

what two things does orientation require?

A

memory and attention

59
Q

what is attention?

A

the ability to focus or concentrate

60
Q

what are the 5 levels of consciousness? define them all

A

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

61
Q

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

A

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

62
Q

what are three main types of mood? define them

A

Euthymic: normal
Dysthymic: depressed
Manic: elated

Clinical Skills (15 decks)

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