Psych Exam 1: Mental Status Exam

Whats the difference between MSE and aa psychosocial assessment?

MSE looks at the pts current mental status and cognition—what theyre thinking and feeling at the moment

Psychosocial assessment focuses on pts background and history—where they come from and how they came to be basically

How would therapeutic relationship impact ability to perform an accurate MSE?

The main elements of therapeutic relationships include: trust, professionalism, mutual respect, caring/partnership.

• its important to develop these during pt care to perform accurate MSE

What is the decision tree approach?

helps make decisions by mapping out different choices and the possible outcome for each choice

List what to do during assessment phase of MSE: (8)

1. Tree approach

2. Age/Language/ Cultural considerations

3. Mileu/ Environment

   • physical env.—quiet…etc

   • responsibilities of healthcare team

   • emotional climate

4. Review of Systems

5. Lab data

   • underlying cause of depression d/t hormones

6. Psychosocial assessment

   • how they came to be who they are

7. Self-awareness

8. Validating the assessment

What kind of data would a nurse rely on to collect evidence?

Objective data!!

• eyes darting

• shaky

• anxious

• VS!

What is the difference between the content and process of patient communication?

1. Content: overly communicated information

2. Process: how communication occurs

   • feelings

   • intuition

   • behaviors that come with speech and thought

Does content and process always appear congruent? (related)

What would be an important finding then??

NO

• Pt may deny feeling depressed but will appear sad and tearful

**Incongruence can be important finding!!*

Physical Appearance categories: (7)

1. Apparent age

2. Clothes

3. Cleanliness

4. Posture/Gait

5. Facial expressions

6. Eye contact

7. Pupil dilation/Constriction

—observe manic vs depressive state (very kept vs unkept)

3 types of motor activity to look for:

1. Level of activity:

   a. lethargic

   b. tense

   c. restless/ loud = manic

   d. agitated

2. Type of activity:

   a. tics

   b. grimaces

   c. tremors

3. Unusual gestures/ mannerisms

The acronym for MSE: (8)

BESTPICK

1. Behavior/ Attitude

2. Emotions

3. Speech

4. Thought process

5. Perception

6. Insight and Judgement

7. Cognitive exam

8. Knowledge

Behavior/ Attitude: (6)

attitude and affect are kind of the same but attitude describes relationship towards someone:

1. Normal:

   • calm, pleasant, relaxed, friendly, comfortable

2. Happy:

   • cheerful, bright, peppy, content, self-satisfied, silly, giggly, grandiose, euphoric, elated, exalted

3. Sad:

   • gloomy, sullen, depressed, pessimistic, morose, hopeless, discouraged

4. Agitated:

   • worried, tense, nervous, apprehensive, frightened, terrified, bewildered, paranoid

5. Angry:

   • irritable, disdainful, bitter, arrogant, defensive, sarcastic, annoyed, furious, enraged, hostile

6. Indifferent:

   • shallow, superficial, cool, distant, apathetic, aloof, dull, vacant, affectless, uninterested

Emotions: (2)

1. Affect: worker’s impression of the pt’s emotional state aka objective data

2. Mood: the patients self report of how they feel

   • “How’s your mood today?”

What are qualities of affect? (3)

1. Stability: continuum from stable affect (normal) to labile affect (abnormal)

2. Appropriateness related to situation

3. Range:

   • most people have full range of affect (happy, sad, annoyed, angry)

   • constricted affect is seen in depression and flat affect is seen in schizophrenia

What are some examples of affect a practitioner can observe? (7)

1. flat

   • schizophrenia

2. blunted

3. constricted

   • depression

4. euthymic/full

5. elated

6. inappropriate/ incongruent

7. labile (abnormal)