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39 Cards in this Set

  • Front
  • Back
When is the mental status exam used?
- Objective part of the Psychiatric Examination
- Included in a medical H&P, but usually in a more brief form
- Used in neurological exams
- Performed on all psychiatric patients, regardless of the severity of their illness
- Equivalent to the “physical exam” for a psychiatric evaluation
Name the components of the mental status exam (10)
Affect & Mood
Sensorium: alertness, orientation, concentration, memory, knowledge
Thought Processes: form and content
What are the components of a psychiatric exam?
Identifying data, CC, HPI, PMH, Past psychiatric history, SH, Personal history, FH, MSE (mental status exam), diagnostic impression, recommendations
Whatis teh psychiatric diagnostic impression based on?
multiaxial format
AXIS I: Clinical Psychiatric Disorder
AXIS II: Personality Disorder; Mental Retardation
AXIS III: General Medical Diagnosis/Problems
AXIS IV: Psychosocial/Environmental Stressors
AXIS V: Global Assessment of Functioning (0‐100) - no one gets 100

The MSE if objective and can vary depending on day or time of day
Name some of the things you take into account with evaluation of appearance
- Body type: obese, skinny
- Clothes: casual, flamboyant, bizzare
- Grooming and Hygiene: disheveled
- Posture: rigid, slumped
- Young/Old
- Appearance of Health: sickly, frail
What to take into account when commenting on behavior ...
- Gait
- Level of Activity/Body Movements:hyperactivity, restlessness, pacing
- Abnormal Movements: tics, twitches
With you can see this with patients with anxiety or schizophrenia
psychomotor agitation
You will see psychomotor retardation in patients with ...
this is a common side effect of antipsychotic drugs ...
Some descriptors you will see with attitude ...
Apathetic – think depression
If abnormally guarded you want to think of
psychotic disorders
personality disorders
Some descriptors you will see with speech ...
- Rate: rapid, slow (depression), hesitant/halting (anxiety), pressured
- Quality: monotone, dysarthria, loud, whisper, mumbled
- Quantity: excessive, hyperverbal
If speech is abnormally pressured think ..
Bipolar mania
Some descriptors you will see with mood & affect ...
Depressed, Anxious, Irritable, Anxious, Euphoric, Labile (erratic), Confused, Frightened
Mood is described by the _______ while affect is described by the ______
mood- patient
affect- examiner
if mood and affect are not together this is labeled as
If patient often loses track of thoughts, but stays on general topic, provides irrelevant information this form of thought is called. Think of which disorders?

Think of:
Anxiety disorders
Delirium (if severe)
This form of thought is common with psychotic disorders such as schizophrenia. What does it mean?
Loose associations

Shifting of ideas with no logical connection -- patient unaware of this
Name this form of thought disorder: - Inappropriate responses to questions
- Patient loses track of questions
- Interviewer usually able to follow
Common in which disorders?

Mania & Schizophrenia
Describe flight of ideas. What disorder is this common with?
Thoughts move quickly from one idea to the next. Ideas usually associated in some way
- Usually seen with pressured speech in bipolar mania
Perseveration or repetition of words is common with what psychiatric disorders?
Traumatic brain injury
- also autism
You will see the following with what form of thought dysfunction?

Thoughts stop abruptly or responses are delayed - acute anxiety or schizophrenic patients
You will see the following with what form of thought dysfunction?

direct repetition of examiner’s words
Who will you see this in?
delirium, schizophrenia
Name it: Fixed, false belief, out of context with patient’s cultural beliefs. What types are there?

Nihilistic (me)
Bizarre (you)
This must be a part of every MSE if depression is suspected ...
Suicidal thoughts
Difference b/t suicidal ideation, attempt, gesture?
- ideation: thoughts of committing suicide- not thoughts of wishing one was dead
- attempt: serious possibly fatal act; w/o intervention individual would be dead
- gesture: usually not fatal, cry for help (cutting, personality disorders)
Over 50% of suicides are committed with ...

Medical conditions can be considered a suicide risk?

especially if they are prolonged and painful/progressive
Name some suicide risk factors
- plan
- pattern of behoavior that indicates an intention to leave life (make will, etc)
- strong family hx of suicide
- presence of gun
- being under the influence of EtOH/drugs
- severe unexpected loss
- isolation
- command hallucinations
- discharge from psych hospitals
- anxiety
- gut feelign
Name some protective factors against suicide
- good clinical care
- easy access to clinical interventions
- family/community support (pets too!)
- problem solving/conflict resolution skills
- cultural/religious beliefs against suicide
What to do in suicide assessment ...
list risk & protective factors
hospitalize if you feel they are at risk
level of risk - high, moderate, low, acute, chronic
If a patient mentions homicidal thoughts to you about another person you are not required to report this as it is a breach of confidentiality
False - Tarasoff vs Regents of U of Ca - duty to warn & protect
What are formications?
the feeling that insects are crawling on your skin - seen with cocaine or amphetamine intoxication
Contrast hallucinations & illusions
hallucinations - the shit is not really there

illusions are a misinterpretation of actual stimulus
What is confabulation?
Unconsciously making up answers to cover up memory impairment
Seen in: Chronic alcoholism & Dementia
With psychotic patients you should try to correct their delusions.
false- do not argue against or agree with
What is the Mini-mental status exam? When do you use it?
More comprehensive screening
– Usually done separate from MSE if cognitive disorder (dementia) is suspected
What categories are checked with the MMSE?
memory (recent, remote, recent past, immediate retention & recall, attention, concentration, abstract thought, insight & judgement, fund of knowledge, impulse control (from hx)