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128 Cards in this Set
- Front
- Back
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Appearance - 9 items
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Level of consciousness, attentiveness, apparent age, position/posture, attire, cleanliness/grooming, eye contact, physical abnormality, facial expression. Plus other striking/bizarre identifying features, e.g. goiter, limp, jaundice, diaphoresis, birthmark
MSE 14 |
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Level of consciousness - name 5 levels of increasingly subnormal alertness
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drowsy, lethargic, obtunded, stuporous, comatose
MSE 15 |
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hypervigilance/hyperaroused - clinical associations (name 5)
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mania, anxiety, paranoia, hyperthyroidism, ingestion of sympathomimetic drugs (cocaine, amphetamines, etc.)
MSE 15 |
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Subnormal alertness vs. normal sleep
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patients can be fully aroused from normal sleep. Not so with drowsy/lethargic/obtunded/stuporous/comatose states
MSE 15 |
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Drowsiness
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synonymous with sleepiness or hypersomnia and is characterized by mental slowing, yawning, poor energy, tendency to fall asleep when not stimulated
MSE 15 |
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Lethargy/obtundation
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states representing degrees of more marked drowsiness and low energy (than "drowsy"). At mild end, they merge with drowsiness, and at severe end with stupor
MSE 15 |
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Stupor vs. coma
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stupor is appropriate term for those patients who occasionally emerge into brief periods of wakefulness to speak in response to very loud noises or painful stimuli
Coma - state of unconsciousness from which patients cannot be aroused, even by repeated or noxious stimulation MSE 15 |
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Clouding of consciousness
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Nonspecific phrase describing all degrees of diminished alertness
MSE 15 |
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Persistent vegetative state
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May last for years after severe brain injury. Sleep-wake cycles present, open eyes may follow moving objects. Patient cannot otherwise respond to the environment, mental activity appears to be entirely absent.
MSE 15 |
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Locked-in syndrome
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Neurologic lesions that prevent motor or vocal expression may result in this state, which appears similar to a persistent vegetative one - but in this, the patient presumably retains conscious intelligence.
MSE 15 |
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Akinetic mutism, coma vigile
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Wakeful-appearing, but unresponsive individuals.
Ambiguous terms that should be avoided MSE 15 |
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Differential for decreased alertness
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sleep deprivation
Sign of underlying physical disturbance, including drug intoxication (e.g. alcohol, barbiturates, sedative/hypnotics, antidepressants), cerebral edema, postictal state, concussion, CNS infection, large/acute structural brain lesions, delirium, myxedema. Look for fluctuating alertness in delirium MSE 15 |
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Attentiveness to examiner
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Patients normall attend to the examiner and are interested in the examination. Lack of insight, hostility, apathy may be conveyed by the patient who is overtly bored and uninterested
MSE 16 |
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Attentiveness - Distractibility
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Inability to screen out irrelevant stimuli, such as noises outside room. Seen in ADD, mania, organic mental disorders (including delirium). Assess capacity for attention and concentration in distractible patients
MSE 16 |
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Internal preoccupation
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Episodic inattentiveness to interviewer whenever patient becomes distracted by intrusive thoughts or hallucinations, seen in severe depression and various psychotic disorders
MSE 16 |
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Attentiveness in autism
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patients may exhibit profound lack of interest in social interactions and ignore the examiner, being engaged instead in play with inanimate objects or in self-stimulatory behaviors
MSE 16 |
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Apparent age
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Patients may appear older than actual age, possibly due to poor physical health due to medical illness, alcohol abuse, depression, life-style wrought with excessive hardships, such as homelessness. Premature balding/graying may affect self-esteem. Patients may appear older/younger than they are, e.g. adolescent w/ pseudomaturity due to inadequate parenting; mid-life crisis.
MSE 16 |
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Apparent age - descriptors
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"appears stated age" "appears older/younger than stated age" "prepubertal" "young adult" "elderly-appearing"
MSE 16 |
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Position/posture
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position - location of patient's body in space (e.g. lying sitting, kneeling, etc.)
Posture - arragement of body parts (e.g. slumped, cross-legged, leaning, arms akimbo, etc.) Position/posture are important in context of MSE, as are changes in these during interview MSE 16-7 |
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Attire/Grooming
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Reflect socioeconomic status, occupation, self-esteem, interest in life, socialization, motivation/ability to present oneself in appropriate way for interview
Expectations should be modified depending on setting - e.g. unshaven, uncombed, dressed in pajamas expected in medically ill inpatients, but not in outpatients MSE 17 |
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Attire/grooming - aspects to note
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hairstyle, cleanliness, nails, facial hair, clothing, oral hygiene, body odor
MSE 17 |
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Significance - unkempt/unclean appearance
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may indicate depression, mania, schzophrenia, organic mental disorder (e.g. dementia, delirium); or may signal patient unterested in impressing examiner or is resistant to idea of seeing psychiatrist
MSE 17 |
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Significance - bizarre makeup
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often indicates psychosis (e.g. lipstick smeared across lower face rather than lips alone)
MSE 17 |
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Significance - fastidious grooming
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OCD, narcissism
of course, fastidiousness is not necessarily pathologic MSE 17 |
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Significance - clothing incongruous for gender
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may indicate sexual identity issues or psychosis
MSE 17 |
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Significance - hair changes, baldness
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may reflect nutritional abnormalities, radiation, chemotherapy, trichotillomania
MSE 17 |
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Significance - bizarre haircuts, shaving head
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may reflect psychosis. Head-shaving sometimes precedes other self-destructive acts
MSE 17 |
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Significance - cigarette-induced yellow/brown discoloration and burns of fingers
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Common amongst chronically mentally ill, clue to smoking habits and self care
MSE 17 |
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Descriptors - Clothing
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unkempt, disheveled, neatly dressed
MSE 18 |
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Eye contact - significance/associations
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poor eye contact - suspicious, coy, denying situation/emotion, cultural (e.g. Islamic)
Staring - hostile patients seeking to unnerve examiner, confused/intellectually impaired patients lacking self-awareness Downward - depression Unexpected directions - hallucinating patients responding to internally produced stimuli Initially, appropriate to follow patient's lead MSE 18 |
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Physical characteristics
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tattoos, needle marks, scars from suicide attempts or self-mutilation (common on anterior forearms), skin lesions/discoloration, facial markings, obesity/thinness, sweating, handicaps, amputated limbs.
Demographic descriptors Odors - alcohol, feces, urine; medical causes (e.g. fetor hepatis, ketone breath, anaerobic cellulitis), odor from lack of bathing wheezes, coughs, teeth grinding MSE 18 |
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Facial Expressions
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sad, happy, angry, surprised, bored, irritated, disgusted, confused, anxious, pained
Pts with R hemispheric lesions may have impaired expression of emotions and difficulty recognizing others' facial expressions MSE 18-9 |
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Attitude descriptors
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Cooperative, uncooperative, hostile, guarded, suspicious, regressed, friendly, trusting, preoccupied, arrogant, sarcastic, facetious, flippant, vigilant, threatening, impatient, childlike
MSE 19 |
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Lack of cooperation - significance
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may reflect personality disturbance, distraction by physical/mental distress, impaired alertness, impaired attentiveness, impaired memory, psychopathology, disinhibited behavior, impaired judgment, anger, inept/insensitive interviewing
MSE 19 |
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Examples/significance of uncooperative behavior: resistance, regression, vigilance, suspiciousness
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Resistance - increased early on, when dealing with stranger. Regression - seen in children dealing with stress, adults adopting sick role to receive attention and dispensations from responsibilities
Guarded - avoids self-disclosing statements Vigilant - hyperalert Suspicious - avoids self-disclosure, also questions examiner MSE 20 |
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Resistance
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conscious/unconscious attempt to withhold information or affect from examiner.
Psychodynamic significance - attempt to avoid exploration of sensitive/conflicted material MSE 20 |
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Manipulation
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Seen in personality disorders; for achieving own ends
Antisocial - appears charming, but circumvents answering questions that would reveal illicity drug use, illegal behavior Histrionic - may be seductive as way to gain control of interview Borderline - idealization/devaluation; splitting MSE 20 |
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How to respond to uncooperative states in patient?
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These are evidence of poor alliance/rapport. Should be addressed directly. Might suggest the information provided is unreliable/incomplete. May signal need for examiner's protection. Concerns about confidentiality may need to be addressed
MSE 20-1 |
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Cooperative
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alert, attentive, tries to communicate relevant information to examiner, including by answering questions
MSE 19 |
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Acitivity
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record information about patient's activity, behavior, repetitious/excessive examples of the same.
MSE 21 |
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Movement disorders/characteristics to note in MSE
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Paresis, paralysis, pseudoparalysis, cataplexy, alterations in muscle strength/tone, akinesia, hypokinesia, bradykinesia, altered accessory movements, festinating gait, masked facies, psychomotor retardation/agitation, abulia, catatonia, restlessness, akathisia, hyperactivity
MSE 21-3 |
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Paresis, paralysis
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facial/limb weakness (paresis) or paralysis seen in brain-damaged individual
In Myasthenia gravis and periodic paralysis, patients may present with alterations in muscle strength/tone MSE 21 |
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Pseudoparalysis
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seen in conversion disorder
MSE 21 |
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cataplexy
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patient experiences sudden, involuntary, termporary loss of muscle tone; may drop to floor. In some cases, only certain body parts, such as eyelids, may lose muscle tone. Intact consciousness. Assoc. with narcolepsy; due to REM sleep that intrudes into wakefulness. Often precipitated by laughter, fright, or emotional stress
MSE 21, 32 |
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Akinesia
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patient's tendency toward lack of motion, generally of a body part, despite intact motor strength
Fewer accessory movements than in normals (e.g. swinging of arms when walking) and automatic movements (e.g. blinking, swallowing, periodic postural adjustment) MSE 21-2 |
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Hypokinesia
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similar to, but less severe than, akinesia
Fewer accessory movements than in normals Most suggestive of parkonian syndrome; also seen in extreme depression, catatonia, epilepsy, diseases affecting supplementary motor cortex MSE 22 |
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Bradykinesia
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these patients move, but execute movements much more slowly than normal
Most suggestive of EPS, as in parkonian syndrome; also seen in extreme depression, catatonia, epilepsy, diseases affecting supplementary motor cortex MSE 22 |
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Parkinsonian symptoms
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hypokinesia/bradykinesia, resting tremor, decreased accessory moevements, difficulty initiating or changing movement, festinating gait, masked facies
MSE 22 |
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Accessory movements
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Decreased when there's a lack of associated automatic movements, e.g. absence of arm swing while walking - very common manifestation of EPS. Its presence is evidence of antipsychotic compliance. Difficulty in initiating/changing movement, e.g. rising from chair
MSE 22 |
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Festinating gait
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begins with small, slow initial steps, gradually accelerates as though the patient is propelled forward. May have difficulty stopping
MSE 22 |
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Masked facies
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reflects bradykinesia/akinesia of muscles of facial expression and of eye closure, resulting in reduced/absent expression, hence relatively fixed masklike facial appearance. Can be confused with blunted affect, esp. as both likely to occur in schizophrenic patients who are treated with antipsychotics
MSE 22 |
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Psychomotor retardation
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physical slowing attributed to psychologic, as opposed to overtly physical, causes.
Sometimes used interchangeably with bradykinesia Seen in depression and dementia; often accompanied by slowed mentation, slowed speech, or abulia MSE 22 |
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Abulia
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reduced spontaneity, increased latency of speech and action, decreased response to stimuli, accuracy but terseness in verbal output. Slow in performing simple cognitive tasks, such as counting backward.
MSE 22 |
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Catatonia; clinical associations
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can be construed as an extreme form of psychomotor retardation
May occur in schizophrenia, depression, mania, conversion disorder, delirium MSE 22 |
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Psychological vs. organic causes of decreased activity
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Catatonia and depression-induced psychomotor retardation should be distinguished from the physical causes of akinesia/hypokinesia/bradykinesia, including parkinsonism, coma, brainstem and mesial-frontal cerebrovascular accidents, hydrocephalus, hypothyroidism, neuroleptic malignant syndrome
MSE 22-3 |
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Hyperactivity
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seen in ADD, mania. Pt may be unable even to sit in one place during the interview
Anxious people are often restless, as are those with restless leg syndrome or neuroleptic-induced akathisia MSE 23 |
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Restlessness
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Restlessness can be manifested by legs jiggling around and other fidgeting, and the patient may ask if the interview is over yet
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Akathisia; differential diagnoses (4)
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A feeling of motoric restlessness, particularly of the legs, usually a side effect of neuroleptics. Subjective experience. May appear to tremble nervously, shake their legs (even when sitting), or keep getting up to walk around. Attempts to remain still are likely to increase discomfort. Should be differentiated from anxiety, psychotic agitation, agitated depression, restless leg syndrome
MSE 23, 31 |
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Psychomotor agitation
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general increase in physical activity associated with psychiatric disorders, such as agitated depression, delirium, mania; hyperactivity may be caused by a known physical factor, such as intoxication with a stimulant drug
MSE 23 |
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Tremor; what body parts? Greater amplitude when? Extinguished when? types (3)
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oscillating movements occurring in relatively consistent rhythm. Evident most frequently in distal body parts, particularly hands. Not infrequently asymmetric. Greater amplitude during stress, abolished by sleep. Categorized by when it occurs - postural activities, during action, with intention, during rest. If doesn't fall neatly into one of these, describe thoroughly in MSE
MSE 23 |
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Resting tremor: fineness, frequency, characteristic, DDx (4)
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coarse, low frequency 3-8Hz, evident at rest. Disappears temporarily during movement, thus little interference with purposeful movements.e.g. pill-rolling. Associated with parkinsonism, may be seen in NMS, neurosyphilis, Wilson's
MSE 23 |
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Postural/action tremors
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absent when body is relaxed, present when body is actively maintained in a given posture, such as with arms outstretched. Frequency as low as in resting tremor, as high as 10+Hz. DDx: benign familial ("essential") tremor, hyperthyroidism, drug tox (Li, stimulants, antidepressants, bromide, bismuth), EtOH/sedative-hypnotic w/d, neurosyphilis, anxiety. Also seen in neuroleptic-induced/idiopathic parkinsonism.
MSE 23-4 |
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Intention Tremor - where in movement? Damage in what part of brain? DDx?
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occurs during most demanding phases of action, e.g. when honing in on target in touching nose. Can interfere with fine motor movements, but not evident during rest or maintenance of a stable posture. Caused by dz of cerebellum or its connections; may be evident with cerebellar or brainstem tumor or vascular accident, MS, Wernicke's encephalopathy, Wilson's dz, certain drug intoxications (e.g. EtOH, sedatives, phenytoin)
MSE 24 |
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Athetoid vs. choreiform movements
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Athetoid - snakelike writhings of tongue, face, or extremities. They are slow and twisting
Choreiform - also can be writhing, but usually coarser, jerkier, more discrete than athetoid movements. Can be brief, involuntary movements that interrupt the situation in an inappropriate way. Neither is as rhythmic and regular as are resting tremors. Chorea may disappear at rest. MSE 24 |
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Hemiballismus; damage to what part of brain?
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related to chorea, far rarer, more violent, flinging/flailing movement of an extremity, usually only on one side of body. Typically result of brain infarction or hemorrhage involving subthalamic nucleus of brainstem
MSE 24 |
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Hemiballismus and Chorea - similarities
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Hemiballismus more extreme. Both may disappear at rest. Described separately, but may occur together. As they may be embarrassing, patient may try to cover up these movements by completing the motions as seemingly purposeful actions, such as primping hair or straightening a shirt
MSE 24, 33 |
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Choreoathetoid movements, DDx (8)
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Term that encompasses both chorea and athetosis - seen in Huntington's Dz, rheumatic dz (Sydenham's chorea), tardive dyskinesia, Wilson's dz, hepatic encephalopathy, treatment with Dopamine agonists, aging (senile chorea), Li/amphetamine/phenytoin/estrogen toxicity, and others.
MSE 24, 32 |
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Tardive dyskinesia
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associated with chronic neuroleptic drug use. Most commonly involves face, especially mouth and tongue. Movements can be gross and disfiguring, more frequently subtle. Choreiform movements often observed occurring spontaneously, but may be more evident if patients are asked to perform actions such as walking, resting with arms supported, opening/closing mouth, protruding tongue.
Volitional movement of one area of body may unmask or aggravate dyskinesia in affected area - movements of hands and fingers when ambulating, movements of tongue if patient opens mouth while performing fine hand manipulations. TD often measured serially to track its progression or response to intervention. AIMS commonly used to quantify severity MSE 24-5 |
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Dystonia
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Involuntary increases in muscle tone that resuilt in sustained contortions that case patient to remain in distorted position.
Has relationship to choreoathetoid movements, but movement/posture is sustained for longer duration and more likely to involve large muscles of torso. MSE 25 |
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Acute dystonias
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most frequently seen dystonia in psych population, usually side effect of antipsychotic drugs
Common presentations: twisting of neck/back, oculogyric crisis, torticollis, opisthotonos. Tongue/throat muscles may be involved, disrupting talking, swallowing or breathing. MSE 25 |
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Treatment/duration of acute dystonias
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promptly reversed by anticholinergic drugs or benzos
Painful and frightening to patient, confusing to practitioner, who can mistake them for mannerisms of schizophrenia. Last from few seconds to (untreated) over an hour MSE 25 |
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Acute dystonias vs. tetany
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tetany is a painful, cramplike spasm, often of a peripheral limb muscle, such as carpopedal spasm, seen in C. tetani poisoning and alkalotic states
MSE 25 |
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Oculogyric crisis
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eyes rolling up under upper eyelids
e.g. of acute dystonia MSE 25 |
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Torticollis
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rotation and tilting of head
e.g. of acute dystonia MSE 25 |
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Opisthotonos
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backward arching of neck and back
e.g. of acute dystonia Caused by common causes of dystonia; also seen in C. tetani poisoning MSE 25 |
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Chronic dystonias
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reversable, but recurrent abnormalities of posture
MSE 25 |
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Fixed dystonias
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irreversible abnormalities of postures
MSE 25 |
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Blepharospasm
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repeated spasmodic closure of the eyelids
Probably a localized TD Tics or TD can have a simillar appearance MSE 25 |
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Tardive dystonia
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quite similar to tardive dyskinesia, with more sustained (at least several seconds) and less jerky movements (such as facial grimaces)
MSE 25 |
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Causes of acute/chronic dystonias (7)
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antipsychotic medication toxicity, Huntington's dz, parkinsonism, Wilson's dz, hypoxic brain damage, kernicterus, Hallervorden-Spatz dz
MSE 25 |
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Automatic movements ("automatisms")
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unconsciously initiated, involuntary movements; simple or complex; usually purposeless; can appear bizarre. Consciousness impaired during it - pt may be unresponsive or overtly confused, even after activity abates. Typically no memory of activity, except in repeating what witnesses describe. Can include complex behaviors, e.g. undressing, continuing driving. Purposeful, organized violence not characteristic of automatisms, though during it, pts may confusedly push away or strike at persons attempting to restrain them. Most suggestive of complex partial seizures. More complex behaviors almost always manifestations of epilepsy. Simple automatisms may occur in fugue states and catatonia
MSE 26 |
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Tics vs. purposeful activities
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tics distinguished by repetiveness, patient's inability consistently to resist them
MSE 26 |
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Tics - definition
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involuntary movements or vocalizations that range from simple to complex
MSE 26 |
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Tics - Result or suppression
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requires much effort and produces anxiety that is relieved when the tic occurs
MSE 26 |
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Tics - examples
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common simple tics are blinking, facial grimacing, neck jerks, shoulder shrugging, throat clearing, jerking movements of extremities. Most patients have individualized repertoire of tics limited to one to several stereotyped, repetitive movements.
MSE 26 |
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Tics - seen in whom?
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Tics can and do afflict individuals in apparently good psychiatric health. Emerge most frequently, though usually transiently, in prepubescent children. Associated with OCD, caffeinism, stimulant drug use, Tourette's, postencephalitic states
MSE 26 |
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Tourette's
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AKA Gilles de la Tourette's. Among most severe of tic disorders; as it progresses, the repertoire of physical/vocal tics and other repetitive behaviors and obsessiosn grows.
MSE 26 |
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Palilalia
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compulsive repetition of pt's own words
Tic MSE 26 |
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Echolalia
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compulsive repetition of words of others
tic MSE 26 |
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Coprolalia
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compulsive vocalization of profanity and obscenities
Tic MSE 26 |
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Stereotypy/stereotyped behavior
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repeated purposeless behaviors not under voluntary control. Should be reserved for nonvolitional repeated behaviors that are more complex than tics, but, unlike automatisms, are not associated with altered consciousness. E.g. rocking of a child with pervasive developmental disorder
MSE 26-7 |
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Mannerisms
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consistent, characteristic, distinctive, apparently purposeful, highly stylized ways of doing things. May seem exaggerated or bizarre, as in schizophrenia. E.g. pt may habitually pirouette counterclockwise before sitting. Unlike tics, stereotypes, automatisms, mannerisms largely under voluntary control and not accompanied by altered consciousness.
MSE 27 |
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Compulsions
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subset of mannerisms. Any odd and repetitive complex behavior is a mannerism and may be a compulsion. Compulsions are actions that parallel obsessions and may be their motoric product. Unwanted, ego-dystonic. Often recognized by patient as unreasonable. Attempts to voluntarily stop or suppress them are unsuccessful, cause anxiety that is relieved by succumbing to compulsive act. Act is stereotyped, often ritualistic, often quite trivial
MSE 27 |
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Compulsion vs. habit, etc.
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A compulsion must be stereotyped, ritualistic, and essentially irresistible. Ask pt if he is aware of the behavior, if it has happened in other circumstances, and whether he would like to stop doing it, but cannot. If answer is "yes" to all three, behavior is probably a compulsion - further inquiry should be made regarding accompanying thought content and presence of obsessions
MSE 28 |
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Perseveration
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incapacity for or difficulty in shifting from one task to another. Typically verbal, as in inappropriate repetition of a word or phrase (aka verbigeration), but also physical (motor), as in repeatedly performing previously requested task while failing to initiate more recently requested task.
MSE 28-9 |
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Perseveration - implications
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dysfunction of prefrontal cortex. Seen in head injuries, strokes, tumors, dementias, other degenerative dz affecting this brain area. Encountered in schizophrenia, especially in catatonic patients.
MSE 29 |
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Posturing
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sustaining apparently purposeless, nonresting position. In catatonia, pt may hold a position for hours without moving. Also occurs in complex partial seizures
MSE 29 |
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Echopraxia
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uncontrolled mimicking of another's movements and posture (vs. perseveration - repetition of one's own movements)
MSE 29 |
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Catalepsy/waxy flexibility
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a limb or other body part is kept in any position, even ridiculous, in which another person places them. Vital signs may also be slowed. Seen in catatonic states, such as in schizophrenia
MSE 29, 32 |
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Catatonic excitement
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hyperactive episode of catatonic patient. In it, pt may display remarkable examples of many motor abnormalities, including mannerisms, verbigeration, motor perseveration, echolalia. This state is potentially dangerous if the agitation is suddenly/uncontrollably expressed. Symptoms such as posturing or catalepsy most classically associated with schizophrenia, but are nonspecific and have been reported in bipolar psychoses, hysteria, hypnosis, dementia, physical brain disturbances such as epilepsy or certain drug intoxications.
MSE 29 |
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Abulia - appearance? Resembles?
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described as inert, uncaring, undriven. May resemble depression, though these pts will typically not cry or report feeling sad
MSE 30 |
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Abulia - seen in what psych conditions
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schizophrenics, brain-injured pts with injuries to frontal lobes or basal ganglia
MSE 30 |
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Agitation - presentation, causes
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general term used to describe pt seeming emotionally distressed, cannot sit still or attend, gives evidence of heightened tension. May result from wide variety of underlying conditions, including acute grief, generalized anxiety, heart or thyroid disease, medical crisis, drug intoxication/withdrawal, cognitive dysfunction, mania, and psychosis
MSE 30 |
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Aggression
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behaviors/attitudes that reflect rage, hostility, and the potential for physical or verbal destructiveness.
MSE 30 |
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Aggression - two paths to its manifestation
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May be volitionally planned or due to poor impulse control
MSE 30 |
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Aggression vs. assertiveness
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assertiveness - socially appropriate means of limit-setting and self-definition
Aggression - expression of negative affect meant to assault, harm, or manipulate another person, animal, or object in some way MSE 30 |
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Aggressive behavior - psych d/o associations
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Aggressive behavior may occur in antisocial and borderline personality disordered pts and in frontal lobe-impaired pts; in part related to an inability to empathize with others; in demented, psychotic or delirious patients who erroneously perceive other persons as intending to harm them; in brain-injured patients who have lost impulse control or have poor social judgment; in conduct- and intermittent explosive disordered children. In the personality disorders, it is usually volitional/intentional; in others, more related to thought disorder or organically reduced impulse control
MSE 30-1 |
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Akinesia - associated deficits
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associated slowing of mentation (abulia)
MSE 31 |
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Akinesia - clinical associations
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Associated with psychotic states, extreme depression, catatonia, epilepsy, movement disorders such as parkinsonism (including that induced by antipsychotic drugs).
MSE 31 |
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Akinesia - lesions that cause it
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Lesions of supplementary motor cortex and hydrocephalus can produce akinesia and mutism.
MSE 31 |
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Akinesia - DDx
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Differentiate akinesia from paralysis
MSE 31 |
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Apathy - Definition, DDx, clinical associations
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lack of emotions or desire, a feeling of uninvolvement, or not caring. The outward manifestation of apathy may be confused with that of abulia. Apathy occurs most often in depression and schizophrenia
MSE 31 |
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Hypoactive catatonia
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Person is immobile and maintains peculiar postures for long periods of time. Limbs either rigid or flexible when moved passively by examiner. Pts may be echopraxic, and are generally mute, though may be echolalic or have verbigeration. May be excessively excited underneath the emotionally unresponsive and motorically statuesque exterior; they may become combative.
MSE 32 |
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Catatonic excitement
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patients show markedly high degree of activity which is usually purposeless and associated with abnormalities such as grimacing, posturing, or automatisms
MSE 32 |
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Catatonia DDx
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partial complex seizures, viral encephalitis, severe parkinsonism, NMS, delirium, lesions of the mesial frontal region, neurosyphilis
MSE 32 |
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Cogwheel rigidity
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Finding of involuntary resistance to passive flexion/extension and pronation/supination or rotational movements around a joint. Ratcheting sensation (of alternating muscle tension and relaxation) is felt by examiner
MSE 32 |
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Cogwheel rigidity clinical associations
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rigidity of parkinsonism, often accompanies bradykinesia. Also occurs as an extrapyramidal side effect from antipsychotic drugs
MSE 32 |
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Choreiform movements - damage to what brain structure
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Thought to reflect basal ganglia dysfunction; can be a manifestation of basal ganglia infarction, tumors, or calcification
MSE 32 |
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Coma - cause, DDx
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usually due to severe bihemispheric or brainstem reticular formation dysfunction, on a structural or metabolic basis. Must be differentiated from conversion, catatonic stupor, or locked-in syndrome
MSE 33 |
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Locked-in syndrome; due to lesion where?
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patient is awake and aware, but unable to activate muscles other than those controlling vertical eye movements and/or eye closure; due to pontine tegmental lesions
MSE 33 |
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Compulsion
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unwanted ego-dystonic impulse to perform certain motor behaviors. Patient usually realizes behavior is unreasonable
MSE 33 |
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Causes of disinhibited behavior
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ethanol intoxication, schizophrenia, sometimes in context of lesions of the brainstem or thalamus
MSE 33 |
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Dystonia
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Occurs rarely in parkinsonism, more frequently as extrapyramidal side effect of antipsychotic drug. These commonly cause immobility or a thick feeling of mouth or tongue. Laryngospasm is potentially dangerous, as it threatens the airway
MSE 33 |
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Extrapyramidal symptoms
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subsumes tremor, bradykinesia, cogwheeling, paratonia (diffuse muscle stiffness), dystonia, and akathisia. It is preferred to list individually the specific symptoms or signs
MSE 34 |
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Lead pipe rigidity; caused by?
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markedly increased muscle tone and resistance to passive movement independent of direction of movement. Patient is almost as stiff as a board. During movement of an extremity, the muscle tone is smooth and consistent during all degrees of motion (vs. cogwheel). May indicate brain damage, NMS, or acute withdrawal from dopaminergic medications in a parkinsonian patient
MSE 35 |
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Paratonia
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Momentary reduction in muscle tone if direction is suddenly reversed
MSE 35 |
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Parkinsonian movements - causes
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occur in parkinsonism and other extrapyramidal disorders such as progressive supranuclear palsy; as side effects of antipsychotic medications; following brain anoxia or carbon monoxide poisoning; in encephalitis and neurosyphilis; or after exposue to carbon disulfide, manganese, or MPTP (an opiate drug - chemical intermediate in meperidine production)
MSE 36 |
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Viscosity
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the "gluey" interictal behavior of some patients with temporal lobe epilepsy, including interpersonal clinginess, difficulty breaking conversations, and excessive talking. Viscosity is possibly more likely to be associated with left-sided seizure focus
MSE 37 |
