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Mental Status Exam

From ANCC Review

QuestionAnswer
Appearance includes overall appearance related to age and culture, hygiene and grooming, style, appropriateness of clothing for age, weather and occasion, posture and mannerisms, psychomotor excitation and slowness
Behavior Includes General behavior - impulsivity, passive, hostile, fearful. Motor behavior - pacing, lethargy, catatonic. Attitude toward clinician and willingness to cooperate.
Emotion includes mood and affect
Mood is internal feelings that influence behavior
Examples of mood provided depressed, suspicious, elated, irritable, angry, euthymic
Affect is the emotional expression variation - found in face, voice, use of body movements
Examples of affect provided flat, guarded, inappropriate, blunted, restricted, labile
Thought Processes and Content include ability to use words to communicate, stream of thought, continuity of logical progression of thought, content of thought.
Thought processes include continuity/org. of ideas - problems w word finding, processing abstract ideas, blocking, unexpected thought stoppage. Consider flow & rhythm - slowed or racing thoughts. Logical coherency, amount - excessive/poverty of speech, language/meaning deficits
Evaluation of thought content includes Suicide, Homocide, Delusions, Phobias, Obsessions, Insight, Judgement
Evaluation of thought content - suicide plan, intent, opportunity means
Evaluation of thought content - Homicide victim, realistic plan
Evaluation of thought content - delusions fixed, false beliefs - control : can control others thoughts or someone has control over their thoughts
Evaluation of thought content - phobias intense, unreasonable fear
Evaluation of thought content - obsessions intrusive, repetitious
Evaluation of thought content - insight realization of the problem. The extent of the individuals awareness, willingness to look at role in maintaining the symptoms, awareness of behavioral consequences - lifestyle changes needed for coping
Evaluation of thought content - judgement decision making, realistic foresight. realistic decision making based on current level of knowledge and realistic understanding of options - resources, strengths and limitations.
Definition of delusion as provided by ANCC False beliefs that cannot be dislodged by logic or contradictory evidence, not congruent with normative culture or religious beliefs.
Delusions - of reference other people's thoughts words or actions refer to self
Delusions - of persecution other people have malevolent intentions towards self or are conspiring against the person
Religious Delusions unrealistic special relationship with God
Nihilistic Delusions destruction of self, world, body part
Grandiose Delusions special or gifted, powerful or important without factual support
Language & Thought Processing - Clanging* choice of words based on similar sound, not associated ideas
Language & Thought Processing - Echolalia* repetition of other peoples words or phrases
Language & Thought Processing - Neologisms* creation of new words that don't make sense
Language & Thought Processing - Word Salad* disorganized, senseless progression of words
Language & Thought Processing - Perseveration tedious repetition of the same words or ideas regardless of stimuli
Language & Thought Processing - flight of ideas/loose association ideas are not logically connected, abrupt changes in topic
Language & Thought Processing - thought blocking interruption or delay in thought processing, not related to lack of concentration, distraction or anxiety
Language & Thought Processing - tangential pt goes of on a tangent not related to subject
Language & Thought Processing - circumstantial pt answers questions about everything related to question and finally gets to the point
Language & Thought Processing - confabulation pt recalls false memories - could be part of disease processes - dementia
Disurbances of Perception - depersonalization A sense of alienation from normal identity, as though one has become an outside observer with no control of one’s own mental or physical processes.
Disurbances of Perception - derealization The false sensation that one’s surroundings have become unfamiliar or unreal.
Disurbances of Perception - illusions A distorted perception of reality; unlike delusions, illusions are generally shared by most people, as in a 3D “hidden picture” puzzle. - breeze blows curtain - think someone is behind it
Disurbances of Perception - deja vu, jamais vu A false sense of visual familiarity in a situation. The term means “already seen” in French. The strange feeling that one does not recognize a familiar situation. Literally means “never seen” in French.
Disurbances of Perception - flashbacks involuntary recurrent memory
Disurbances of Perception - hallucinations can be auditory/visual/olfactory/tactile command, pervasive, episodic with stress
Auditory hallucinations are found in psychiatric disorders
visual hallucinations are more common in cognitive and organic disorders
olfactory and tactile hallucinations are more common with drug use, medical conditions
Mood congruent tends to occur in depression*
Mood incongruent tends to occur in schizophrenia*
Disturbances in sensorium and cognition are related to organic dysfunction due to meds, substance abuse, cognitive disorder
Assess memory recall for immediate, recent and remote
Assess orientation to person, time and place
Assess concentration through serial 7s - keep in mind educational level
Assess abstract thinking through proverb interpretation
Two short tests to check cognitive impairment MMSE (Folstein) and SLUMS (St. Louis University MSE)
Scoring on the MMSE is 25-30 Normal 21-24 Mild cognitive d/o 16-20 Moderate cognitive d/o <15 severe cognitive disorder or mild and severe cut offs of 24 and 18
Anything below __ on the MMSE is an indicator of dementia.* 24
This test has greater sensitivity than the MMSE SLUMS
The Clock Drawing Task is incorporated into which test SLUMS
Scoring on the SLUMS w HS education 27-30 Normal 21-26 Mild Neurocog Impairment 1-20 Dementia <HS education 25 20 <20
This can be used as a rapid screening for dementia the clock drawing test (11:10 or 8:20) 4 points total
Created by: jonquil