MPA 531 Patient History and Physical Diagnosis - Mental Status Examination (MSE)

What is somatoform?

Symptoms w/o adequate medical or physical explanation often related to psychological conditions

What is the mnemonic for diagnosing bipolar mania symptoms?

DIGFAST

D - Distractability

I - Insomnia

G - Grandiosity

F - Flight of Ideas

A - Activities

S - Speech

T - Thoughtlessness

What is the mnemonic for diagnosing bipolar depression symptoms?

SIGECAPS

S - Sleep

I - Interest

G - Guilt

E - Energy

C - Concentration

A - Appetite

P - Psychomotor

S - Suicide

What are the 3 clusters of personality disorders?

A: odd, eccentric

B: dramatic, emotional, erratic

C: anxious, fearful

What are the personality disorders that fall within cluster A (eccentric)?

- Paranoid

- Schizoid

- Schizotypal

What are the personality disorders that fall within cluster B (emotional, erratic)?

- Antisocial

- Borderline

- Histrionic

- Narcissistic

What are the personality disorders that fall within cluster C (Anxious)?

- Avoidant

- Dependent

- Obsessive Compulsive

Paranoid Personality Disorder (Cluster A)

distrust and suspiciousness

Schizoid Personality Disorder (Cluster A)

detachment from social relationships

Schizotypal Personality Disorder (Cluster A)

Eccentric behaviors and cognitive distortions

antisocial personality disorder (cluster B)

Disregard for the law and rights of others

borderline personality disorder (Cluster B)

instability in interpersonal relationships and self-image

Histrionic Personality Disorder (Cluster B)

emotional, attention-seeking behavior

narcissistic personality disorder (Cluster B)

Persistent grandiosity, need for admiration and lack empathy for others

Avoidant Personality Disorder (Cluster C)

social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation

Dependent Personality Disorder (Cluster C)

Submissive and clinging behavior

obsessive-complusive personality disorder (Cluster C)

Rigid, detail oriented behavior often associated with compulsions

What is attention?

the ability to focus or concentrate over time on one task or activity

What is memory?

Process of registering or recording information

What is orientation?

Awareness of personal identity, place and time

What are perceptions?

sensory awareness of objects in the environment and their interrelationships

What is thought process?

The way a patient thinkgs

What is thought content?

What a patient thinks about

What is Insight?

Awareness the symptoms or disturbed behaviors are normal or abnormal

What is Judgment?

process of comparing and evaluating alternatives when deciding on a course of action

What is Affect?

Observable, episodic feeling or tone expressed through voice, facial expression and demeanor

What is Mood?

a more sustained emotion that may color a person's view of the world

What is language?

Complex symbolic system for expressing, receiving and comprehending words

What is high cognitive function?

Assessed by vocabulary, abstract thinking, calculations, etc.

What is transference?

Unconscious tendency to assign others in one's present environment the feeling and attitude associated with significance in one's early life.

If patient presents with suicidal ideals, what must you ask as a provider?

- Plan

- Means

- Intent

what is alert (Level of consciousness)?

awake and attentive to normal stimuli

What technique is used for alert patients?

Speak to patient in a normal tone of voice

What is a lethargic level of consciousness?

- Appears drowsy but opens eyes and looks at you; may fall asleep

What technique is used for lethargic patients?

Speak to pt in a loud voice and call the patient by name

What is obtunded level of consciousness?

- Open eyes and looks at you but responds slowly and is somewhat confused

What technique is used for obtunded patients?

- Shake the patient gently

What is stupor LOC?

Patient arouses from sleep only after painful stimuli

What technique is used for stupor patients?

Apply painful stimulus

What is coma LOC?

patient is unresponsive and generally cannot be aroused

What technique is used for coma patients?

Apply repeated painful stimuli

What is circumlocutions?

Substitutes a word for a phrase

What is semantic paraphasia?

Substituting entire word for a word with a similar meaning

What is phonemic paraphasia?

Malformed word that is close to the original word

What is neologistic paraphasia?

Invented Word

What is an example of circumlocution?

Saying "that think you write with" instead of the word "pen"

Example of semantic paraphasia?

"Marker" instead of pen

Example of phonemic paraphasia

"den" instead of pen

Example of Neologistic Paraphasia

"Thar" instead of pen

What are the different components of a speech and language assessment?

Word Comprehension

Repetition

Naming

Reading comprehension

Writing

What is mood vs. affect?

Mood - What patients report

Affect - What we see/observe

incoherence

speech that is incomprehensible because it is illogical

What is confabulation?

fabrication of facts or events in response to questions, to fill in the gaps from impaired memory

What is echolalia?

Repeats other's words or phrases

What is blocking?

Sudden interruption of speech

What is perservation?

persistent repetition of words or ideas

What is clanging?

Speech in which a person chooses a word based on its sound

What is compulsions?

Repetitive behaviors or mental acts

What are phobias?

persistent, irrational fears

What are feelings of unreality?

a sense that things in the environment are strange, unreal, or remote

What are delusions?

False fixed personal beliefs that are not shared by others

What are obsessions?

recurrent, uncontrollable thoughts, images, or impulses that a patient considers unacceptable

What are anxieties?

Apprehensions, fears, tension or uneasiness that may e focused or free floating

What are methods used to assess attention?

- Serial 7's

- Spelling backwards (World is commonly used)

- Digit Span (normal response: repeating 5 digits forward and four backwards)

What is remote memory?

long term memory that may be impaired in late stages of dementia

What is recent memory?

Events of that day

What are ways to assess higher cognitive functions?

- Information and Vocabulary - Inquirng about specific facts

- Calculating ability - addition and/or multiplication

- Abstract Thinking - assessed by 1) asking pt what a specific proverb mean or 2) comparing two objects and having the pt tell how they are alike

Who is more likely to attempt suicide?

women

Who is more likely to die by suicide?

Men

Who has the highest suicide rate incidence?

Older Males (75 y.o. Or older)

What is the purpose of the CAGE questionnaire?

To Assess Hx of substance abuse

What questions are asked on the CAGE questionnaire?

1) Have you ever felt you should cut down on your drinking?

2) Have people annoyed you by criticizing your drinking?

3) Have you ever felt bad or guilty about your drinking?

4) Have you ever had a drink first thing in the morning to steady nerve or get rid of a hangover?

What is circumstantiality?

Speech characterized by indirection and delay in reaching the point because of unnecessary details

What is flight of ideas?

Continuous flow of accelerated speech in which person changes abruptly from topic to topic

labile affect

rapid & abrupt changes in affect

blunted affect

reduced or minimal emotional response

flat affect

a lack of emotional responsiveness

congruent affect

matches stated mood

inappropriate affect

emotional displays that are improper for the situation

What rating is suggestive of cognitive impairment on the MMSE?

<24

What is the Mini-Mental State Examination (MMSE)?

A test used to screen for cognitive dysfunction or dementia