Hill - Mental Status Exam

Front 1

When is the mental status exam used?

Back 1

- 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

Front 2

Name the components of the mental status exam (10)

Back 2

Affect & Mood
Appearance
Attitude
Behavior
Insight
Judgment
Perceptions
Sensorium: alertness, orientation, concentration, memory, knowledge
Speech
Thought Processes: form and content

Front 3

What are the components of a psychiatric exam?

Back 3

Identifying data, CC, HPI, PMH, Past psychiatric history, SH, Personal history, FH, MSE (mental status exam), diagnostic impression, recommendations

Front 4

Whatis teh psychiatric diagnostic impression based on?

Back 4

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

Front 5

T/F

The MSE if objective and can vary depending on day or time of day

Back 5

true

Front 6

Name some of the things you take into account with evaluation of appearance

Back 6

- Body type: obese, skinny
- Clothes: casual, flamboyant, bizzare
- Grooming and Hygiene: disheveled
- Posture: rigid, slumped
- Young/Old
- Appearance of Health: sickly, frail

Front 7

What to take into account when commenting on behavior ...

Back 7

- Gait
- Level of Activity/Body Movements:hyperactivity, restlessness, pacing
- Abnormal Movements: tics, twitches
Agitation

Front 8

With you can see this with patients with anxiety or schizophrenia

Back 8

psychomotor agitation

Front 9

You will see psychomotor retardation in patients with ...

Back 9

depression

Front 10

this is a common side effect of antipsychotic drugs ...

Back 10

Akathisia

Front 11

Some descriptors you will see with attitude ...

Back 11

Pleasant
Cooperative
Guarded
Withdrawn
Apathetic – think depression

Front 12

If abnormally guarded you want to think of

Back 12

psychotic disorders
personality disorders

Front 13

Some descriptors you will see with speech ...

Back 13

- Rate: rapid, slow (depression), hesitant/halting (anxiety), pressured
- Quality: monotone, dysarthria, loud, whisper, mumbled
- Quantity: excessive, hyperverbal

Front 14

If speech is abnormally pressured think ..

Back 14

Bipolar mania

Front 15

Some descriptors you will see with mood & affect ...

Back 15

Depressed, Anxious, Irritable, Anxious, Euphoric, Labile (erratic), Confused, Frightened

Front 16

Mood is described by the _______ while affect is described by the ______

Back 16

mood- patient
affect- examiner

Front 17

if mood and affect are not together this is labeled as

Back 17

incongruent

Front 18

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?

Back 18

Circumstantial

Think of:
Anxiety disorders
Delirium (if severe)

Front 19

This form of thought is common with psychotic disorders such as schizophrenia. What does it mean?

Back 19

Loose associations

Shifting of ideas with no logical connection -- patient unaware of this

Front 20

Name this form of thought disorder: - Inappropriate responses to questions
- Patient loses track of questions
- Interviewer usually able to follow
Common in which disorders?

Back 20

Tangential

Mania & Schizophrenia

Front 21

Describe flight of ideas. What disorder is this common with?

Back 21

Thoughts move quickly from one idea to the next. Ideas usually associated in some way
- Usually seen with pressured speech in bipolar mania

Front 22

Perseveration or repetition of words is common with what psychiatric disorders?

Back 22

Traumatic brain injury
Stroke
Delirium
- also autism

Front 23

You will see the following with what form of thought dysfunction?

Thoughts stop abruptly or responses are delayed - acute anxiety or schizophrenic patients

Back 23

Blocking

Front 24

You will see the following with what form of thought dysfunction?

direct repetition of examiner’s words
Who will you see this in?

Back 24

delirium, schizophrenia

Front 25

Name it: Fixed, false belief, out of context with patient’s cultural beliefs. What types are there?

Back 25

Delusions

Paranoid/persecutory
Grandiose
Nihilistic (me)
Somatic
Bizarre (you)
Reference

Front 26

This must be a part of every MSE if depression is suspected ...

Back 26

Suicidal thoughts

Front 27

Difference b/t suicidal ideation, attempt, gesture?

Back 27

- 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)

Front 28

Over 50% of suicides are committed with ...

Back 28

firearms

Front 29

T/F

Medical conditions can be considered a suicide risk?

Back 29

True

especially if they are prolonged and painful/progressive

Front 30

Name some suicide risk factors

Back 30

- 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

Front 31

Name some protective factors against suicide

Back 31

- good clinical care
- easy access to clinical interventions
- family/community support (pets too!)
- problem solving/conflict resolution skills
- cultural/religious beliefs against suicide

Front 32

What to do in suicide assessment ...

Back 32

document
list risk & protective factors
hospitalize if you feel they are at risk
level of risk - high, moderate, low, acute, chronic

Front 33

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

Back 33

False - Tarasoff vs Regents of U of Ca - duty to warn & protect

Front 34

What are formications?

Back 34

the feeling that insects are crawling on your skin - seen with cocaine or amphetamine intoxication

Front 35

Contrast hallucinations & illusions

Back 35

hallucinations - the shit is not really there

illusions are a misinterpretation of actual stimulus

Front 36

What is confabulation?

Back 36

Unconsciously making up answers to cover up memory impairment
Seen in: Chronic alcoholism & Dementia

Front 37

With psychotic patients you should try to correct their delusions.

Back 37

false- do not argue against or agree with

Front 38

What is the Mini-mental status exam? When do you use it?

Back 38

More comprehensive screening
– Usually done separate from MSE if cognitive disorder (dementia) is suspected

Front 39

What categories are checked with the MMSE?

Back 39

consciousness
orientation
memory (recent, remote, recent past, immediate retention & recall, attention, concentration, abstract thought, insight & judgement, fund of knowledge, impulse control (from hx)