The Mental Status Exam

Question 1

What is the “Mental Status Exam” and where does it fit in to the whole visit?

Answer 1

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

Question 2

What is the first part of the MSE and its overall goal?

Answer 2

Appearance and behavior

Goal is to objectively describe the patient well enough for someone else to identify them without seeing them

Question 3

What are some of the components of appearance and behavior?

Answer 3

1. Physical characteristics - sex/wt/apparent health
2. Apparent vs chronological age
3. Physical stigmata / descriptors - i.e. downs syndrome, tattoos
4. Dress
5. Grooming
6. Posture
7. Facial expression
8. Eye contact
9. Receptiveness to interviewing: are they cooperative, attentive, hostile, etc

Question 4

List the 10 components of the MSE?

Answer 4

Appearance and behavior
Psychomotor abnormalities
Speech
Mood
Affect
Thought Process
Thought Content
Sensorium and Intellectual Function
Insight
Judgment

Question 5

What are the two general categories of psychomotor activity classification? What is the goal of this section?

Answer 5

1. Retardation - slower
2. Agitation - faster

To describe the amount / type of movement displayed by the patient

Question 6

What is a decrease in spontaneous movement called?

Answer 6

Bradykinesia - with slowness of activity

Question 7

What is the subjective feeling of restlessness called and what often causes this?

Answer 7

Akathisia

-> first generation antipsychotic drugs (early EPS after dystonia)

Question 8

What is catalepsy?

Answer 8

Wavy flexibility -> an immobile position that is constantly maintained, often awkward

Question 9

What abnormal body movements are often seen in intellectual disability or autism?

Answer 9

Stereotypies - fixed, repetitive patterns of physical action or speech
-> i.e. hand flapping or waving, body rocking, head banging

Question 10

What is cataplexy?

Answer 10

Temporary loss of muscle tone, can be precipitated by emotion or a symptom of narcolepsy

Question 11

What is tardive dyskinesia? Most common manifestation?

Answer 11

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

Question 12

What are three qualities of speech?

Answer 12

Quantity
Quality
Rate

Question 13

What is pressured speech?

Answer 13

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

Question 14

What is Wernicke’s aphasia? Characteristics?

Answer 14

Receptive aphasia

• > Speech is fluent but comprehension is impaired
• > empty content of words / substitutions (i.e. word salad)

Question 15

What is a neologism?

Answer 15

A statement which was just made up by Wernicke’s patients which is nonsensical

“new logic”

Question 16

How does Broca’s aphasia differ from Wernicke’s?

Answer 16

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

Question 17

Is reading / writing impaired in Broca’s aphasia?

Answer 17

Yes, still somewhat, though less so than Wernicke’s

Question 18

How is mood determined on the MSE?

Answer 18

Subjectively reported by patient as their pervasive and sustained emotion they experience

Question 19

What is affect?

Answer 19

The outward expression of mood -> objectively observed

Question 20

What are the components of affect which are clinically useful?

Answer 20

1. Variability - does it fluctuate through the interview?
2. Intensity - Dysphoric vs euthymic (normal) vs euphoric
3. Appropriateness to mood - is their self-reported mood in congruence with their affect?

Question 21

What are the types of dysphoric mood?

Answer 21

Flat -> most severe dysphoria
Blunted -> mood seems a little flatter than expect
Constricted -> almost normal but still clearly less intense in feeling

Question 22

Give two examples of Affect abnormalities.

Answer 22

1. Labile affect - rapid and abrupt change in emotional tone, unrelated to external stimuli (nothing happened to prompt it)
2. Constricted or restricted affect - reduction in feeling intensity, not as severe as blunted

Question 23

What is a “normal” thought process?

Answer 23

Linear and goal-directed

i.e. Ask a question -> get a direct, focused response

Question 24

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?

Answer 24

Tangential

Question 25

What is circumstantial speech?

Answer 25

Really detailed, long-winded answers before eventually reaching desired goal -> like Craig

Question 26

What is flight of ideas vs loose associations?

Answer 26

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.

Question 27

What does word salad fall under?

Answer 27

Abnormal thought processes - jumbled words and phrases with no comprehensible meaning

Question 28

What are the components of thought content?

Answer 28

Hallucinations, delusions, illusions, recurring themes, and suicidal / homicidal ideation

Question 29

Define hallucination. How does this differ from illusion?

Answer 29

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).

Question 30

What is the most common type of hallucination, and give a subset of it?

Answer 30

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

Question 31

What are the two types of visual hallucinations and what is this common in?

Answer 31

1. Formed images - i.e. people 2. Unformed images - i.e. light flashes Most common hallucination in psychosis due to another mental illness (i.e. Parkinson's)

Question 32

What hallucination is an uncinate seizure associated with?

Answer 32

Gustatory seizure

Question 33

Give to more types of hallucination?

Answer 33

Olfactory | Tactile

Question 34

What is formication?

Answer 34

A tactile hallucination of bugs crawling under the skin, often associated with substance withdrawal

Question 35

What are the names for normal sensory hallucinations which happen when falling asleep or waking up?

Answer 35

Falling asleep - Hypnagogic | Waking up - Hypnopompic (hopping out of bed)

Question 36

What is a delusion and its two types?

Answer 36

Fixed, false belief 1. Bizarre - i.e. something that's impossible 2. Non-bizarre - technically possible but unlikely

Question 37

Give two types of nonbizarre delusions?

Answer 37

1. Grandiose - exaggerated idea of one's importance, power, or identity 2. Reference - interpreting casual incidents or events to have a direct personal reference to them (song on radio was played FOR them)

Question 38

What are two types of recurring themes? What are these in general?

Answer 38

1. Obsessions - irresistible thought or feeling which cannot be eliminated from consciousness - luke obsessing over gary 2. Negative ruminations - i'm gonna die These are topics so important that the interview seems to keep returning to it

Question 39

What are the types of suicidal / homicidal thoughts?

Answer 39

Passive vs active | Thoughts vs plans

Question 40

What are the components of sensorium and intellectual functioning?

Answer 40

``` Consciousness Orientation Attention and concentration Memory Abstraction Fund of knowledge ```

Question 41

What are the states of consciousness?

Answer 41

Alert, drowsy, comatose

Question 42

What are the three components of orientation?

Answer 42

Person, place, and time

Question 43

What are some ways to test attention and concentration?

Answer 43

Serial 7's - subtract backwards from 100 til I tell you to stop Spelling a word backwards - which they know how to spell forwards

Question 44

What are the three general memory types and how to test?

Answer 44

Immediate / working memory - repeat three words Recent (within 24 hours) - recall last meal eaten Remote /longterm memory (events from a person's life) - recall date of birth or number of siblings -

Question 45

How is abstraction tested? What are the two types of thinking?

Answer 45

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

Question 46

What is fund of knowledge and how might it be assessed?

Answer 46

Testing to see if they know basic things -> i.e. who the last three presidents were

Question 47

What is the definition of insight (a category of the MSE)?

Answer 47

Awareness or understanding of their own illness -> can range from denial to true emotional insight

Question 48

How do you assess judgment?

Answer 48

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.