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Psychiatry > The Mental Status Exam > Flashcards

The Mental Status Exam Flashcards

1
Q

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

A

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

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2
Q

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

A

Appearance and behavior

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

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3
Q

What are some of the components of appearance and behavior?

A
  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
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4
Q

List the components of the MSE?

A 
Appearance 
Behaviour
Speech
Mood
Affect
Perception
Thought Form
Thought Content
Insight
Cognition
Judgement
*Suicidality, Impression and Plan then normally noted in Banksia
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5
Q

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

A
  1. Retardation - slower
  2. Agitation - faster

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

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6
Q

What is a decrease in spontaneous movement called?

A

Bradykinesia - with slowness of activity

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7
Q

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

A

Akathisia

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

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8
Q

What is catalepsy?

A

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

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9
Q

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

A

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

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10
Q

What is cataplexy?

A

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

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11
Q

What is tardive dyskinesia? Most common manifestation?

A

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
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12
Q

What are three qualities of speech?

A

Rate
Volume
Tone

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13
Q

What is pressured speech?

A

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

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14
Q

What is Wernicke’s aphasia? Characteristics?

A

Receptive aphasia

  • > Speech is fluent but comprehension is impaired
  • > empty content of words / substitutions (i.e. word salad)
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15
Q

What is a neologism?

A

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

“new logic”

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16
Q

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

A

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
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17
Q

Is reading / writing impaired in Broca’s aphasia?

A

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

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18
Q

How is mood determined on the MSE?

A

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

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19
Q

What is affect?

A

The outward expression of mood -> objectively observed

20
Q

What are the components of affect which are clinically useful?

A
  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?
21
Q

What are the types of dysphoric mood?

A

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

22
Q

Give two examples of Affect abnormalities.

A
  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
23
Q

What is a “normal” thought process?

A

Linear and goal-directed

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

24
Q

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?

A

Tangential

25
Q

What is circumstantial speech?

A

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

26
Q

What is flight of ideas vs loose associations?

A

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.

27
Q

What does word salad fall under?

A

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

28
Q

What are the components of thought content?

A

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

29
Q

Define hallucination. How does this differ from illusion?

A

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).

30
Q

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

A

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

31
Q

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

A
  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)

32
Q

What hallucination is an uncinate seizure associated with?

A

Gustatory seizure

33
Q

Give to more types of hallucination?

A

Olfactory

Tactile

34
Q

What is formication?

A

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

35
Q

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

A

Falling asleep - Hypnagogic

Waking up - Hypnopompic (hopping out of bed)

36
Q

What is a delusion and its two types?

A

Fixed, false belief

  1. Bizarre - i.e. something that’s impossible
  2. Non-bizarre - technically possible but unlikely
37
Q

Give two types of nonbizarre delusions?

A
  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)
38
Q

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

A
  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

39
Q

What are the types of suicidal / homicidal thoughts?

A

Passive vs active

Thoughts vs plans

40
Q

What are the states of consciousness?

A

Alert, drowsy, comatose

41
Q

What are the three components of orientation?

A

Person, place, and time

42
Q

What are some ways to test attention and concentration?

A

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

43
Q

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

A

Immediate / working memory - repeat three words

Recent (within 24 hours) - recall last meal eaten

44
Q

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

A

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

45
Q

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

A

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

46
Q

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

A

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

47
Q

How do you assess judgment?

A

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.

Psychiatry (22 decks)

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