Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
23 Cards in this Set
- Front
- Back
|
Nervous System- Mental Status Examination by Eitel
|
Nervous System- Mental Status Examination by Eitel
|
|
|
What is the Mental Status Exam?
|
Examination of neuropsychiatric functioning
Comprehensive description of a patient’s appearance, behavior, thinking, feeling, etc. Meaningful only in the context of other baseline data (e.g., history, physical / neurologic exam) Ex. Tearful patient may be reacting to stress or pain, be depressed, have neurological disease, or other cause The MSE ≠ MMSE |
|
|
How does one perform a MSE ?
|
By observation
i.e., many areas assessed while obtaining the history e.g., speech, behavior, affect By asking relevant questions to elicit symptoms that usually cannot be observed e.g., hallucinations, paranoid ideation, mood By performing cognitive screening tests e.g., MMSE, other bedside tests |
|
|
Content and Process of the Patient Interview
|
Content:
Overtly communicated information Factual (e.g.) -History of illnesses, Medications, Current living arrangements Close ended questions Process: How the communications occur Includes feelings, innuendos, and behaviors Open ended questions Based on observation of patient |
|
|
Components of The Mental Status Exam
|
General appearance, attitude, and behavior
Motor activity Speech Mood and affect Thought process (form) and content Perception Cognitive function Insight and judgment |
|
|
General Appearance, Attitude, and Behavior
|
General appearance:
Grooming, hygiene, body odor Appropriateness of dress Apparent age, health, weight, dysmorphic features… Attitude toward examiner: Cooperative, friendly, guarded, suspicious, hostile… Behavior: Eye contact, posture, facial expression… Mannerisms, stereotypy, compulsions, echopraxia… |
|
|
Motor Activity
|
Overactivity:
Psychomotor agitation, hyperactivity, tremor Underactivity: Psychomotor retardation, bradykinesia Abnormal movements: Tics, dyskinesia, dystonia, chorea, myoclonus, asterixis… Catatonia: Mutism, catalepsy, negativism, rigidity, catatonic excitement or stupor, posturing |
|
|
Speech
|
Spontaneity (self initiation of speech):
Nonspontaneous (speaks only when asked), mutism Fluency: Stuttering, effortful (as in Broca’s aphasia), cluttering (jerky) Rate: Pressured speech (rapid and difficult to interrupt), slowed Tone: Dysprosody (loss normal speech melody) Volume: Excessively soft or loud Amount: Decreased production (poverty of speech), monosyllabic Increased production Other: Aphasia, dysarthria, dysphonia |
|
|
Mood and Affect
|
Mood: sustained emotion
Determined by patient report (subjective) Part of the history e.g., depression, elation, anger… Affect: observed expression of emotion Determined by observation (objective) Part of the MSE e.g., full range, constricted, blunted, flat, inappropriate, mood congruent / incongruent |
|
|
Thought.. what is it and what can it be subdivided into?
|
Ability to organize, coherently associate, and effectively use information and ideas
Can be subdivided into: Production of thought Form of thought (thought process) Content of thought |
|
|
Production of Thought
|
Refers to the abundance of thought as evidenced by a person’s interactional capabilities
Disturbances of thought production: Poverty of thought (decreased production) Flight of ideas (thoughts race ahead of one’s ability to communicate them) Thought blocking (abrupt cessation of thinking; “mind goes blank”) |
|
|
Form of Thought (thought process)
what are some disturbances? |
The manner in which thoughts are connected or associated
Disturbances in thought process: Circumstantiality (excessive detail but gets to point) Tangentiality (never gets to point of message) Looseness of associations (ideas loosely connected) Verbigeration (meaningless repetition of words/phrases) “Word Salad” (incoherent collection of words/phrases) Neologisms (creation of new words) Clang associations (rhyming/punning; no logical connection) |
|
|
Content of Thought is what the person is thinking.
What are disturbances in thought content? |
Disturbances in thought content:
Preoccupations Obsessions, compulsions, phobias Suicidal / homicidal ideations Hypochondriacal symptoms Delusions – fixed, false belief Bizarre, systematized, nihilistic, somatic, paranoid, grandiose Ideas of reference Thought insertions / withdrawal / broadcasting |
|
|
Perception are sensory experiences.
What are some disturbances? |
Perceptual disturbances:
Hallucinations (perception w/o a stimulus) -Nonpathological: hypnagogic, hypnopompic -Pathological: Auditory, visual, tactile, olfactory, gustatory, somatic, kinesthetic Derealization, depersonalization, déjà vu… Illusions (misinterpretation of real stimuli) |
|
|
Cognitive Examination
|
Level of consciousness (alertness)
Orientation: (ask for their name) Attention and concentration (spell world backwards) Memory: immediate, short-term, long-term (repeat words) Language Constructional ability Fund of knowledge, calculations, Insight, judgment, impulse control |
|
|
Orientation items in the MMSE
|
name and birth date
|
|
|
Attention and Concentration
bedside tests: |
Attention: Ability to focus and direct cognitive processes
Concentration: ability to focus and sustain attention for a period of time Bedside tests: Digit span, counting backward 65 to 49, serial sevens, serial three’s, WORLD backward, months of year backward |
|
|
Language
Tested By: |
Includes both the comprehension of word meanings and the ability to express them through speaking or writing
Highly lateralized – usually left hemisphere Deficits indicate dysfunction of the nervous system (e.g., aphasias, alexia, agraphia, etc.) Tested by: Observation of speech; MMSE: repetition of phrase, naming items, comprehension, reading, writing; Animal-Naming Test; FAS Test |
|
|
Constructional Ability
MMSE test: |
Prerequisites: intact vision, motor coordination, strength, praxis, and tactile sensation
Non-dominant hemisphere – perceives overall form (parietal) Dominant hemisphere – discerns detail Test: Copy 3-D square; clock drawing test; MMSE: copy intersecting pentagons |
|
|
Other Cognitive Functions
|
General fund of knowledge / Intellect:
Only an estimate of intelligence Abstraction ability: Ability to manipulate information in the absence of concrete stimulus Insight: Ability to appreciate current circumstances and needs Judgment: Ability to anticipate outcomes and form strategies. |
|
|
Formal Neuropsychological Testing
|
Standardized cognitive testing
Performed by a clinical neuropsychologist Takes several hours to complete a variety of carefully selected tests based on the nature of the problem that is being evaluated Examples: WAIS-III, Wechsler Memory Scale, Wisconsin Card Sort, Stroop interference task, Halstead-Reitan battery, etc. |
|
|
Summary Points
|
The mental status exam is an important part of any physical exam and is critical for psychiatric evaluation.
Both the content and the process of the interview reveal important information about a patient’s mental status. We evaluate mental status by observation of the patient and attempting to elicit tasks of brain function. The mental status exam is meaningful only in the context of other baseline data. |
|
|
MMSE vs MSE
|
MSE: stuff we talked about. done on everybody.
MMSE: done to patients to determine dementia. scored from 1-21 and scored based on how they answer. |
