Test2-Mental Status Assessment-MJ Flashcards by Chigozie Emelue

When do you do a mental health assessment?

Anxious/depressed
Family concerned (memory or social changes)
Brain injury (trauma, tumor, stroke)
Aphasia (difficulty speaking)

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What does MSE stand for?

Mental status exam

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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

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What does the ABC of ABC STAMP LICKER stand for?

Appearance
Behavior
Cooperation

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What does the STAMP of ABC STAMP LICKER stand for?

Speech
Thought
Affect
Mood
Perception

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What does the LICKER of ABC STAMP LICKER STAND FOR?

LOC
Insight and judgement
Cognitive function
Knowledge base
Endings
Reliability

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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

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ABC: Behavior (general)

What are we looking for here?

Agitation
Hyperactivity
Psychomotor retardation

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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)

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ABC: Behavior (specific movement)

What are examples of common ticks?

Clearing throat, blinking really hard, shouting out obscenities

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ABC: Behavior (specific movement)

What is chorea?

Dance like movements

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What is sydenhams chorea caused by?

Untreated strep–this will go away eventually

*strep can also cause OCD (PANDAS)

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ABC: Cooperation

What does this mean?

The attitude toward the interviewer

- Indicates how accurate the assessment is

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STAMP: Speech

What do we look for in speech?

Amount of speech
Articulation (pronunciation)
Modulation (volume-changes in tone)
Latency

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What type of patients would have a long latency?

Patients with depression

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What type of patients would have a short latency?

Patients with mania

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What is pressure speech and who may talk like this?

Talking like words are bullets; bipolar patients

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What type of patients have increased amount of speech?

Mania
Anxiety
Personality disorders
Fluent aphasias

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What type of patients have decreased amount of speech?

Depression
Schizophrenia
Personality disorders
Dementia

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What two parts of the brain are involved with speech?

Wernicke and Broca’s area

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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)

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What happens if there is injury to Wernicke’s area?

You can’t understand language (W), but can still produce the words (Broca)

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What are the 3 types of aphasia?

Global, broca, and wernicke

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Which aphasia is this: The most common and severe form. Spontaneous speech is absent or reduced to a few stereotypes words or sound

Global

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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?

1. Alert 2. Lethargic 3. Obtunded 4. Stupor or semi-coma 5. 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