Neuro 2 - Jewell - Mental Status Exam

Front 1

What are the components of the mental status exam?

Back 1

Sensorium = level of alertness and awareness
Behavior = appearance, behavior, speech
Emotion = mood and affect
Perception = perceptual abnormalities
Cognition = Thought process and content, insight and judgement, memory, intellectual functioning

Front 2

Define the Purpose of te Mental status exam

Back 2

PURPOSE = A way to examine neuropsychiatric functioning

Comprehensive description of a pts. appearance, behavior, thinking feeling etc. (SBEPC = Sensorium, Behavior, Emotion, Perception, Cognition)

Front 3

In what context is the mental status exam meaningful?

Back 3

Meaningful only in the context of other baseline data (hx, PE, Neurologic exam)

Front 4

How is the mental status exam performed?

Back 4

Observation

Asking relevant questions to elicit symptoms that usually cannot be observed (hallucinations, paranoid ideation, mood)

Perform Cognitive screening tests (ex = Mini mental status exam)

Front 5

What are the parts of the pt interview?

Back 5

Content = overtly communicated info ie factual = Hx, meds, current living arrangements - Use CLOSED-ENDED QUESTIONS

Process = How communications occur ie feelings, innuendos, behaviors, open ended questions, based on OBERVATION of pt

Front 6

What do we look for in the General Appearance of someone we're doing a mental status exam on?

Back 6

grooming, hygiene, body odor, approriate dress, apparent age, health, weight, dysmorphic features

Front 7

What do we look for in the Attitude toward examiner of someone we're doing a mental status exam on?

Back 7

Cooperative, friendly, guarded, suspicious, hostile

Front 8

What do we look for in the Behavior of someone we're doing a mental status exam on?

Back 8

eye contact, posture, facial expression, mannerisms, stereotypy, compulsions

Front 9

What do we look for in the Motor Activity of someone we're doing a mental status exam on?

Back 9

Overactivity = agitation, hyperactivity, tremor
Under-activity = psychomotor retardation, bradykinesia
Abnormal movements = tics, dyskinesia, dystonia, chorea, myoclonus, asterixis
ABNORMAL INVOLUNTARY MOVEMENT SCALE (AIMS)
Catatonia = mutism, catalepsy, negativism, rigidity, catatonic excitement or stupor, posturing

Front 10

What needs to be done on every pt on a neuroleptic drug?

Back 10

AIMS = Abnormal Involuntary Movement Scale

Front 11

How do we Dx Catatonia?

Back 11

Any TWO of the following:
Motor Immobility, motor excitement, Negativism or Mutism, posturing, stereotypies or mannerism, echolalia (parroting) or echopraxia (miming)

Front 12

Define Catalepsy

Back 12

A feature of Catatonia = waxy flexibility

Front 13

Define Cataplexy

Back 13

Sudden loss of muscle tone leading to collapse, related to narcolepsy

Front 14

What are some of the things we look at when analyzing a pts speech?

Back 14

Spontaneity, Fluency, Rate, Tone, Volume, Amount, Other = Aphasia, Dysarthria, Dysphonia

Front 15

Difference between mood and affect?

Back 15

Mood = what pt tells us they feel (mood = climate)

Affect = Observe expression of emotion determined by observation (affect = weather)

Front 16

See graphs depicting normal mood vs flat/constricted/blunted mood vs. labile mood vs. exspansive mood

Back 16

do it.

Front 17

Define Thought

Back 17

Ability to organize, coherently associate, and effectively use info and ideas

Front 18

What are the subdivisions of thought?

Back 18

Production of thought, Form of Thought, Content of thought

Front 19

Define production of thought

Back 19

Abundance of thought as evidenced by a person's interactional capabilities

Front 20

What are the Disturbances of thought?

Back 20

Poverty of thought, Flight of Ideas, Thought Blocking (abrupt cessation of thinking: mind goes blank)

Front 21

Define Form of thought

Back 21

Manner in which thoughts are connected or associated

Front 22

What are some of the Disturbances in thought process?

Back 22

Circumstantiality (excessive detail but gets to point), Tangentiality (never gets to point), Looseness of associations (ideas loosely connected), verbigeration (meaningless repetition of words/ideas), Word salad (incoherent collection of words/phrases), Neologisms (creation of new words), Clang associations (rhyming/punning, no logical connection)

Front 23

What are some of the Disturbances in thought content we can see in pts?

Back 23

Preoccupations and Delusions

Front 24

Define preoccupations

Back 24

obsessions, compulsions, phobias, suicidal/ homicidal ideation, hypochondriacal symptoms

Front 25

Define Delusions

Back 25

Fixed, false belief

Bizarre, systematized, nihilistic, somatic, paranoid, grandiose, ideas of reference, thought insertions, withdrawal/broadcasting

Front 26

List some types of Delusions

Back 26

Grandiose, Paranoid, Persecutory, Delusions of Control, Ideas of Reference, Thought Broadcasting, Religious

Front 27

Define Circumstantial thought

Back 27

many unnecessary details, eventually gets to point

Front 28

Define Tangential Thought

Back 28

Connections between thoughts apparent

Never gets to original point of message

Front 29

Define Loose Associations

Back 29

Jumping from subject to subject

Ideas or words tenuously connected

AKA derailment

Front 30

Define Flight of ideas

Back 30

Rapid movement between subjects

Ideas connected, though often by rhyming or other thread

No coherent theme apparent due to rapid production

Front 31

Define Perceptions

Back 31

Sensory Experiences

Front 32

What are some Perceptual Disturbances?

Back 32

Halluncinations (nonpatholgic = hypnogogic/hypnocampic = something to do with sleep OR can be pathologic = auditory, visual, tactile, olefactory, gustatory, somatic)

Derealization = when you feel like None of this is real

Illusion = misinterpretation of real stimuli

Front 33

During the cognitive exam, how do we test level of alertness?

Back 33

Observation

Front 34

During the cognitive exam, how do we test Orientation?

Back 34

Person, Place, Time, Situation

ASK FOR BIRTH DATE and NAME

Front 35

Define Attention

Back 35

Ability to focus and direct cognitive processes

Front 36

Define Concentration

Back 36

Ability to focus and sustain attention for a period of time

Front 37

How do we test Attention and Concentration?

Back 37

Counting backward by serial 7's, spell WORLD backward, months of year backward

Front 38

How do we test ability to pay attention/registration and short term memory in the mental status exam?

Back 38

Ask pt to repeat 3 words we say, then ask them to repeat the same 3 words at a later time to see if they're able to recall them

Front 39

Deficits in Language indicate what?

Back 39

Dysfunction of nervous system (aphasias, alexia, agraphia etc)

Front 40

How do we test Language?

Back 40

Observation of speech, repetition of phrase, naming items, comprehension, reading, writing, animal-naming test

Front 41

What are the pre-requisites for the Constructional ability test?

Back 41

intact vision, motor coordination, strength, praxis, tactile sensation

Front 42

What are some of the tests we do to test Constructional Ability?

Back 42

Copy 3D Square, clock drawing test, copy intersecting pentagons, copy Rey-Osterrieth figure

Front 43

Define general fund of knowledge/intellect

Back 43

Another part of mental status exam that only provides an estimate of intelligence

Front 44

Define Abstraction ability

Back 44

Ability to manipulate info in the absence of concrete stimulus

Front 45

Define Insight

Back 45

Ability to appreciate current circumstances and needs

Front 46

Define Judgement

Back 46

Ability to anticipate outcomes and form strategies

Front 47

How is the Folstein Mini-Mental Status Exam different from a mental status exam?

Back 47

The Folstein is not as all-inclusive as the mental status exam

Mental Status exam includes components from Folstein Mini-mental status exam