The Mental Status Exam Flashcards
What is the “Mental Status Exam” and where does it fit in to the whole visit?
A description of the patient at a particular point in time
-> viewed as the “objective” physical exam in psychiatry
Takes place after the social / developmental history (last subjective finding), and before the assessment / plan
It’s the “O” of the SOAP note
What is the first part of the MSE and its overall goal?
Appearance and behavior
Goal is to objectively describe the patient well enough for someone else to identify them without seeing them
What are some of the components of appearance and behavior?
- Physical characteristics - sex/wt/apparent health
- Apparent vs chronological age
- Physical stigmata / descriptors - i.e. downs syndrome, tattoos
- Dress
- Grooming
- Posture
- Facial expression
- Eye contact
- Receptiveness to interviewing: are they cooperative, attentive, hostile, etc
List the 10 components of the MSE?
Appearance and behavior Psychomotor abnormalities Speech Mood Affect Thought Process Thought Content Sensorium and Intellectual Function Insight Judgment
What are the two general categories of psychomotor activity classification? What is the goal of this section?
- Retardation - slower
- Agitation - faster
To describe the amount / type of movement displayed by the patient
What is a decrease in spontaneous movement called?
Bradykinesia - with slowness of activity
What is the subjective feeling of restlessness called and what often causes this?
Akathisia
-> first generation antipsychotic drugs (early EPS after dystonia)
What is catalepsy?
Wavy flexibility -> an immobile position that is constantly maintained, often awkward
What abnormal body movements are often seen in intellectual disability or autism?
Stereotypies - fixed, repetitive patterns of physical action or speech
-> i.e. hand flapping or waving, body rocking, head banging
What is cataplexy?
Temporary loss of muscle tone, can be precipitated by emotion or a symptom of narcolepsy
What is tardive dyskinesia? Most common manifestation?
Involuntary, irregular choreoathetoid movements of head, limbs, or trunk.
- > Perioral movements most common, including protrusion of tongue, lateral jaw movements, face grimacing, and lip puckering
- > longterm use of antipsychotics
What are three qualities of speech?
Quantity
Quality
Rate
What is pressured speech?
Rapid speech which is increased in amount and difficult to interpret
-> if you try to interrupt it’s unlikely you’ll get a word in
What is Wernicke’s aphasia? Characteristics?
Receptive aphasia
- > Speech is fluent but comprehension is impaired
- > empty content of words / substitutions (i.e. word salad)
What is a neologism?
A statement which was just made up by Wernicke’s patients which is nonsensical
“new logic”
How does Broca’s aphasia differ from Wernicke’s?
Expressive aphasia
- > Speech is nonfluent, yet comprehension is intact
- > speech is often sparse or absent
- > patient becomes frustrated, much more effort is being put in than Wernicke’s
Is reading / writing impaired in Broca’s aphasia?
Yes, still somewhat, though less so than Wernicke’s
How is mood determined on the MSE?
Subjectively reported by patient as their pervasive and sustained emotion they experience
What is affect?
The outward expression of mood -> objectively observed
What are the components of affect which are clinically useful?
- Variability - does it fluctuate through the interview?
- Intensity - Dysphoric vs euthymic (normal) vs euphoric
- Appropriateness to mood - is their self-reported mood in congruence with their affect?
What are the types of dysphoric mood?
Flat -> most severe dysphoria
Blunted -> mood seems a little flatter than expect
Constricted -> almost normal but still clearly less intense in feeling
Give two examples of Affect abnormalities.
- Labile affect - rapid and abrupt change in emotional tone, unrelated to external stimuli (nothing happened to prompt it)
- Constricted or restricted affect - reduction in feeling intensity, not as severe as blunted
What is a “normal” thought process?
Linear and goal-directed
i.e. Ask a question -> get a direct, focused response
A speaker has no goal-directed associations and never gets to the desired end point when asked a question. How do you describe their speech?
Tangential
What is circumstantial speech?
Really detailed, long-winded answers before eventually reaching desired goal
-> like Craig
What is flight of ideas vs loose associations?
Flight of ideas - Rapid speech about one idea to the next, but generally the listener is able to follow the thought process because the thoughts are loosely connected
Loose associations - NO associations - flow of thoughts in a completely unrelated manner, listener cannot follow. Speech may even be incoherent.
What does word salad fall under?
Abnormal thought processes - jumbled words and phrases with no comprehensible meaning
What are the components of thought content?
Hallucinations, delusions, illusions, recurring themes, and suicidal / homicidal ideation
Define hallucination. How does this differ from illusion?
False sensory perception not associated with real external stimuli.
Illusion -> real external stimuli prompt a false sensory perception (thought you saw something you didn’t).
What is the most common type of hallucination, and give a subset of it?
Auditory - in primary psychiatric illness (i.e. schizophrenia). Usually voices.
Command hallucination: Voices give command which person feels obliged to obey or unable to resist
What are the two types of visual hallucinations and what is this common in?
- Formed images - i.e. people
- Unformed images - i.e. light flashes
Most common hallucination in psychosis due to another mental illness (i.e. Parkinson’s)
What hallucination is an uncinate seizure associated with?
Gustatory seizure
Give to more types of hallucination?
Olfactory
Tactile
What is formication?
A tactile hallucination of bugs crawling under the skin, often associated with substance withdrawal
What are the names for normal sensory hallucinations which happen when falling asleep or waking up?
Falling asleep - Hypnagogic
Waking up - Hypnopompic (hopping out of bed)
What is a delusion and its two types?
Fixed, false belief
- Bizarre - i.e. something that’s impossible
- Non-bizarre - technically possible but unlikely
Give two types of nonbizarre delusions?
- Grandiose - exaggerated idea of one’s importance, power, or identity
- Reference - interpreting casual incidents or events to have a direct personal reference to them (song on radio was played FOR them)
What are two types of recurring themes? What are these in general?
- Obsessions - irresistible thought or feeling which cannot be eliminated from consciousness - luke obsessing over gary
- Negative ruminations - i’m gonna die
These are topics so important that the interview seems to keep returning to it
What are the types of suicidal / homicidal thoughts?
Passive vs active
Thoughts vs plans
What are the components of sensorium and intellectual functioning?
Consciousness Orientation Attention and concentration Memory Abstraction Fund of knowledge
What are the states of consciousness?
Alert, drowsy, comatose
What are the three components of orientation?
Person, place, and time
What are some ways to test attention and concentration?
Serial 7’s - subtract backwards from 100 til I tell you to stop
Spelling a word backwards - which they know how to spell forwards
What are the three general memory types and how to test?
Immediate / working memory - repeat three words
Recent (within 24 hours) - recall last meal eaten
How is abstraction tested? What are the two types of thinking?
Give patient a proverb or ask for similarity or difference between objects
Concrete - give a literal answer to what proverb means
Abstract - give the moral / message of the proverb
What is fund of knowledge and how might it be assessed?
Testing to see if they know basic things -> i.e. who the last three presidents were
What is the definition of insight (a category of the MSE)?
Awareness or understanding of their own illness -> can range from denial to true emotional insight
How do you assess judgment?
It’s the patient’s ability to make and carry out plans and behave appropriately in social situations
-> can assess based on history or ask an imaginary scenario and ask what they would do.
