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Flashcards in Mental Status Exam Deck (33)
1

What are the 8 points of a mental status exam?

A Snake Moves Toward Prey Silently In Jungles

  • Appearance, Attitude & Behavior
  • Speech
  • Mood & Affect
  • Thought Form/Process & Content
  • Perception
  • Sensorium/Cognition
  • Insight
  • Judgment 

2

Appearance, Attitude & Behavior 

  • Describe overall appearance, emphasizing abnormalities
  • Describe attitude toward examiner
  • Describe physical behavior

3

Speech 

  • Describe speech (not content of speech, but distinctive qualities of speech: rate, tone, rhythm, volume), emphasizing abnormalities
  • Normal: “fluent, w/ normal rate, rhythm & volume” 

4

Mood vs. Affect

  • Mood – describes patient’s subjective, internal state of feeling
  • Affect – describes patient’s objective, external appearance of feeling
  • Normally, affect is an accurate reflection of mood 

5

Describing the mood & affect of patients

  • Mood & affect are normally congruent, but may be incongruent in some psychiatric syndromes
  • Many terms can be used to describe mood & affect
    • Euphoric, elated, depressed, hopeless, irritable, anxious, frightened, etc.
  • Affect is appropriate when it “fits” w/ the patient’s situation & feelings
  • Patients w/ psychotic disorders often have inappropriate affect
  • Comment on range, intensity & appropriateness
  • A normal state of mood & affect: “euthymic, appropriate, congruent” 

6

Thought Form/Process

  • Thought form (process) describes how the patient is thinking
  • Normal thought form: “logical, linear, goal-oriented”

7

What are the abnormalities of thought form? (9)

  • Thought blocking 
  • Poverty of thought 
  • Circumstantiality 
  • Tangentiality 
  • Loose associations (derailment) 
  • Clang associations 
  • Neologisms 
  • Perseveration 
  • Flight of ideas 

8

mind frequently goes blank 

Thought blocking 

9

very little thought occuring 

Poverty of thought 

10

takes a long time to get to the point 

Circumstantiality 

11

logical, but never gets to the point 

Tangentiality 

12

logical connections btwn thoughts break down 

Loose associations (derailment)

13

thoughts are expressed through sounds rather than meaning 

Clang associations

14

new words/phrases invented 

Neologisms

15

being stuck on a single thought 

Perseveration

16

rapid jumping from thought to thought (mania) 

Flight of ideas

17

Thought content 

Definition

Abnormalities (9)

  • Thought content refers to what the patient is thinking
  • Abnormal thought content needs to be explored & documented
    • Delusions 
    • Ideas of reference 
    • Ideas of influence 
    • Obsessions 
    • Compulsions 
    • Phobias 
    • Hypochondriacal symptoms 
    • Thoughts of suicide 
    • Thoughts of violence 

18

fixed, false beliefs impervious to disproof or argument; many types

(grandeur, persecution, somatic, paranoid, etc)

Delusions

19

belief that TV, radio, etc. are talking to or about patient 

Ideas of reference

20

belief that another person or force is controlling some aspect of patients thoughts or behavior 

Ideas of influence

21

upsetting, unstoppable thoughts 

Obsessions

22

irresistible urge to act on obsessional thoughts 

Compulsions

23

irrational, troublesome fears 

Phobias

24

consuming bodily concerns w/o medical cause, but not delusional 

Hypochondriacal Symptoms

25

always inquire & document in careful detail, intervene if necessary 

Thoughts of suicide

Thoughts of violence

26

What are the two most common perceptual disturbances?

Hallucinations

Illusions

27

What is a hallucination?

  • Most common type of perceptual disturbance (Schizophrenia)
  • Sensory perceptions in any modality (auditory, visual, tactile, olfactory, gustatory) that are internally generated
  • To patients, they are as real as the externally generated perceptions everyone experiences 

28

What is an illusion?

Misinterpretations of externally generated perceptions
Often vague 

29

What is sensorium?

patient’s state of awareness & cognitive abilities

30

What are some examples of sensorium? (11)

  • Alertness – somnolent, obtunded, clouded, fluctuating
  • Orientation – to person, place, time, situation
  • Concentration – serial 7s or 3s, reverse spellings
  • Memory – immediate (retention & recall), recent, long-term
  • Calculation – everyday money questions work well
  • Fund of knowledge – geography, current events
  • Abstract reasoning – interpretation of proverbs, similarities
  • Reading – doctor writes “close your eyes”, then patient reads & does it
  • Writing – patient is asked to write a complete sentence
  • Visuospatial ability – patient is asked to draw a clock face, interlocking pentagons, or a cube
  • Estimated intelligence – “above/below/about average”

31

Insight

Definition

When is it lacking

  • Broad term that can describe a patient’s capacity for self-reflection, awareness of illness, understanding of his/her present situation
  • Often lacking in patients w/ chronic psychotic disorders (schizophrenia), delirium or severe personality disorders
  • Lack of insight makes treatment more difficult & prognosis worse in chronic disorders
  • Deficits in insight often become obvious during a psychiatric interview, but may be less so in chronic patients 

32

Judgment

Definition

Impairment

  • Refers to a patient’s capacity to make reasonable decisions
  • Judgment can be temporarily impaired (intoxication) or chronically impaired (dementia)
  • Questions to assess judgment can be asked in the MSE
  • But judgment or lack thereof is often evident in the patient’s recent behavior 

33

What is the Folstein Mini-Mental Status Exam?

  • 1-page, structured instrument that covers most of the “Sensorium” items
  • Numeric score generated (30 pts = no gross cognitive defects)
  • ~10 minutes
  • Emphasis on cognition
  • Delirious patient will score low
  • Psychotic patient may or may not do well
  • Relatively objective way of monitoring cognitive changes