Test2-Mental Status Assessment-MJ Flashcards
When do you do a mental health assessment?
- Anxious/depressed
- Family concerned (memory or social changes)
- Brain injury (trauma, tumor, stroke)
- Aphasia (difficulty speaking)
What does MSE stand for?
Mental status exam
What must you keep in mind when doing an MSE?
The MSE is only how they are acting in that one point of time. You have to continually assess
What does the ABC of ABC STAMP LICKER stand for?
Appearance
Behavior
Cooperation
What does the STAMP of ABC STAMP LICKER stand for?
Speech Thought Affect Mood Perception
What does the LICKER of ABC STAMP LICKER STAND FOR?
LOC Insight and judgement Cognitive function Knowledge base Endings Reliability
ABC: Appearance
What should we check for here?
- Posture
- Body movement
- Dress (appropriate clothing for weather, looking to see if it matches or if it is just usual, random pieces)
- Grooming/hygiene
ABC: Behavior (general)
What are we looking for here?
Agitation
Hyperactivity
Psychomotor retardation
ABC: Behavior (specific movement)
What are we looking for here?
- EPS (positive symptom)
- Ticks (positive symptom)
- Tremors (positive symptom)
- Chorea (positive symptom)
- Unchanging face (negative symptom)
- No eye contact (negative symptom)
ABC: Behavior (specific movement)
What are examples of common ticks?
Clearing throat, blinking really hard, shouting out obscenities
ABC: Behavior (specific movement)
What is chorea?
Dance like movements
What is sydenhams chorea caused by?
Untreated strep–this will go away eventually
*strep can also cause OCD (PANDAS)
ABC: Cooperation
What does this mean?
- The attitude toward the interviewer
- Indicates how accurate the assessment is
STAMP: Speech
What do we look for in speech?
- Amount of speech
- Articulation (pronunciation)
- Modulation (volume-changes in tone)
- Latency
What type of patients would have a long latency?
Patients with depression
What type of patients would have a short latency?
Patients with mania
What is pressure speech and who may talk like this?
Talking like words are bullets; bipolar patients
What type of patients have increased amount of speech?
Mania
Anxiety
Personality disorders
Fluent aphasias
What type of patients have decreased amount of speech?
Depression
Schizophrenia
Personality disorders
Dementia
What two parts of the brain are involved with speech?
Wernicke and Broca’s area
What happens if there is injury to Broca’s area?
You understand what is being said (Wernicke’s area), but have difficulty get the words out to respond the way you want (B)
What happens if there is injury to Wernicke’s area?
You can’t understand language (W), but can still produce the words (Broca)
What are the 3 types of aphasia?
Global, broca, and wernicke
Which aphasia is this: The most common and severe form. Spontaneous speech is absent or reduced to a few stereotypes words or sound
Global
Which aphasia is this: Expressive aphasia. The person can understand language but cannot express himself or herself using language
Broca
What aphasia is this: Receptive aphasia. The linguistic opposite of Broca aphasia. The person can hear sounds and words but cannot relate them to previous experiences
Wernicke
What aphasia is this: Comprehension is absent or reduced to only the person’s own name and a few select words.
Global
What aphasia is this: Characterized by confluent, dysarthria, and effortful speech. The speech is mostly nouns and verbs, with few grammatical filters, termed agrammatic.
Broca
What aphasia is this: Speech is fluent, effortless, and well articulated but has many paraphasia and made up words and often lacks substantive words
Wernicke
What aphasia is this: Repetition, reading, and writing are severely impaired. Prognosis for language recovery is poor
Global
What aphasia is this: Repetition and reading aloud are severely impaired. Auditory and reading comprehensions are surprisingly intact.
Broca
What aphasia is this: Speech can be totally incomprehensible. Often there is a great urge to speak. Repetition, reading, and writing also are impaired
Wernicke
STAMP: Thought PROCESS
What are thought processes?
What kind of questions needed to be asked?
The way in which ideas are organized
Ask open-ended questions
STAMP: Thought PROCESS (abnormal)
What are the 4 abnormal thought processes?
- Blocking/derailment
- Clang associations
- Echolalia
- Neologisms
STAMP: Thought PROCESS
DEFINE: sudden interruption in train of thought, unable to complete sentence, seems related to strong emotion
Blocking/derailment
STAMP: Thought PROCESS
DEFINE: word choice based on sound, not meaning, includes nonsense rhymes and puns
Clanging
*Basically rhymes that don’t make sense
STAMP: Thought PROCESS
DEFINE: Imitation, repeats others’ words or phrases, often with a mumbling, mocking, or mechanical tone
Echolalia
STAMP: Thought PROCESS
Define: coining a new word; invented word has no real meaning except for the person; may condense several words
Neologism
What are the 5 ways a speaker can try and get their message across (although sometimes it doesn’t make it there)
Normal thought process Circumstantial speech Tangental Flight of ideas Loose associations
What is a normal thought process?
Saying some thought and it is clearly understood by the other person
What is circumstantial speech?
Talking with excessive and unnecessary detail
- Delays reaching point
- Sentences have a meaningful connection but are irrelevant
Does circumstantial speech occur normally with some people?
Yes
What is tangental speech?
Never getting to the point of the comment
What are flight of ideas?
Abrupt change
- Rapid skipping from topic to topic
- Continuous flow of accelerated speech -Topics usually have recognizable associations or are play on words
What are loose associations?
- It is also called word salad
- Incoherent mixture of words, phrases, and sentences
- Illogical, disconnected, includes neologisms (a made up word)
Which type of thought process is seen most in bipolar patients?
Flight of ideas
What type of thought process is most severe?
Loose associations
STAMP: Thought CONTENT
What does the client talk about?
What themes develop?
Let the client do most of the talking!!
STAMP: Thought CONTENT (abnormal)
What are 4 abnormal thought contents?
Delusions
Overvalued ideas
Obsessions
Phobias
STAMP: Thought CONTENT
What happens when you try and talk a patient out of a delusion?
Delusions are false, fixed, ideas. You can’t talk a patient out of it. Don’t argue with them! They will get VERY ANGRY!
STAMP: Affect
What are the 8 affects?
Ashamed Angry Anxious Content Happy Interested Surprised Sad
What is the difference between affect and mood?
Affect is OBJECTIVE; it is what we see in them
Mood is SUBJECTIVE; we have to ask something along the lines of “how do you feel today?” to be able to determine their mood
STAMP: Affect
What are the 3 “other descriptions” for affect?
Appropriate/inappropriate (talking about death and giggling=inappropriate)
Blunted or flat (expressionless face)
Labile (changes a lot and quickly; these are dangerous patients)
STAMP: Mood
How do you determine this?
This is the clients own stated emotional state
STAMP: Perceptions
What are the 4 examples of perceptions?
Hallucinations
Illusions
Depersonalization
Derealization
STAMP: Perceptions
What are hallucinations?
Something that comes from nothing
STAMP: Perceptions
Are hallucinations only in some of the senses or in all of them?
ALL
STAMP: Perceptions
What are illusions?
See something but are mistaking it for something else
EX: Patient sees a coat stand and thinks it is some man standing with a gun
STAMP: Perceptions
What is depersonalization?
When you don’t feel real
STAMP: Perceptions
What is derealization?
You don’t feel as if the world around you is real
LICKER: LOC
What do we look for during LOC?
If the patient is alert, awake, and aware
Do they loose track of conversation
Are they falling asleep?
LICKER: LOC
What are the 5 LOC from most alert to least alert?
- Alert
- Lethargic
- Obtunded
- Stupor or semi-coma
- Coma
LICKER: LOC
Define: Not fully alert, drifts off to sleep when not stimulated; can be aroused to name when called in normal voice but looks drowsy; responds appropriately to questions or commands but thinking seems slow and fuzzy; inattentive; looses train of thought; spontaneous movements are decreased
Lethargic
LICKER: LOC
Define: Sleeps most of the time; difficult to arouse (needs shout or vigorous shake); acts confused when aroused; converses in monosyllables; speech may be mumbled and incoherent; requires constant stimulation for even marginal cooperation
Obtunded (transitional state between lethargy and stupor)
LICKER: LOC
Define: Spontaneously unconscious responds only to persistent and vigorous shake; has appropriate motor responses; otherwise can only groan, mumble, or move restlessly; reflex activity persists
Stupor or semi-coma
LICKER: Insight and judgement
What is insight?
Having awareness of one’s illness
LICKER: Insight and judgement
What is judgement?
Ability to evaluate options and make appropriate decisions
- Can be difficult to assess
- Ask questions like “what do you plan to do after you get out of this [mental] institute?
- Answering poorly indicated poor judgement
LICKER: Cognitive functioning
There are many tests that can be done to determine cognitive functioning, but one is the most important. What is it?
Short term memory-4 word recall
LICKER: Cognitive functioning
Describe the short term memory-4 word recall
- Highly sensitive and valid memory test
- Say to the person, “I am going to say 4 words. I want you to remember them. In a few minutes I will ask you to recall them.”
- Ask them to recall after FIVE MIN.
- To test duration of memory, ask them to recall at TEN MIN and THIRTY MIN
LICKER: Knowledge base
What is important here?
Knowing level of education and vocabulary of the patient
LICKER: Endings
What questions are important to ask at this step?
If there is any suicidal ideation or homicidal ideation
LICKER: Reliability
What is this?
The summary of quality of MSE
True or false: the aging adult decreases in knowledge and intelligence
FALSE; the aging adult does NOT decrease in knowledge and intelligence–>there may be a decrease in response times as aging occurs
When you are doing a LOC test, if a patient isn’t for sure on the right date it is, does that mean they are losing their consciousness?
No. Many times in the hospital dates and times just pass by. Use your judgement here
Dementia or delirium: slow chronic and irreversible; loosing your mind
Dementia
What is the most common form of dementia?
Alzheimer’s
Dementia or delirium: acute, sudden, reversible
Delirium
Is a mini-cog a sensitive or specific test?
It is BOTH a sensitive AND specific test
