Psychopathology Test #1

MENTAL STATUS EXAMINATION (MSE) areas of examination

Speech

Behavior

Motor Activity

Appearance

Mood

Affect

Orientation

Thought Content

Thought Process

Perceptual Disturbance

Memory

Intelligence

Judgment

Insight

Sleep

Appetite

Additional Comments

Speech: This part of the Mental Status Exam describes the _______ characteristics of speech.

physical

MSE - Speech can be described in terms of its _________, rate of _________, and ________.

quantity

production

quality

MSE - Speech is appropriate when the individual’s speech is ________, _________, and appropriate to the _________.

fluent

understandable

situation

MSE - Speech is delayed when it takes the individual ________ than _________ to respond

longer

normal

MSE - Speech is excessive when the individual talks a _______ _______ more than _________ to answer the question.

great deal

necessary

MSE - Speech is slowed when the rate of speech is _______ than _______.

slower

normal

MSE - Speech is slurred when words are ______ ______ or _______ ________ enunciated.

strung together

not fully

MSE - Speech is mechanical when the individual speaks with no _______, changes in pitch or tone.

inflection

MSE - Speech is incoherent when the individual’s words are _____.

unintelligible

MSE - Speech is rapid/pressured when the rate of speech is ______ than normal; the individual may be difficult to ______ or have difficulty ___ ___ ___ ____.

faster

interrupt

stopping themselves from speaking

MSE - Speech is stutters when the individual has a ____.

stutter

MSE - Speech is loud when the volume is ____ ____ _____ to be heard by the interviewer.

louder than necessary

MSE - Speech is soft when the volume is ____ ____ ____ to be heard by the interviewer.

softer than necessary

MSE - As an interviewer, you may also want to note whether speech is “spontaneous,” meaning the individual answers or provides information without ____ ____.

undue prompting

Behavior: This part of the Mental Status Exam refers to how the individual’s observable _______ communicate attitude toward the ______/assessor.

actions

interviewer

MSE - Behavior may be appropriate: when no marked abnormalities of behavior are noted and the person behaves in a way that is _____ with the situation.

consistent

MSE - Behavior may be withdrawn: when the person’s behavior demonstrates a ___, ___, or ____ to interact with others as appropriate to the situation. This person may not ___ questions, make ___ or ___ eye contact, and ___ participation in social activities.

decrease

refusal

inability

answer

minimal

no

refuse

MSE - Behavior may be cooperative: when the person maintains an ___ stance and appears to provide ___ information in an ____ and open manner.

open

requested

honest

MSE - Behavior may be bizarre: when the person displays marked abnormalities such as holding an ___ posture for long periods of time, echopraxia (imitating the posture of the ____), or other mannerisms, and is usually associated with an individual who has a __ disorder.

uncomfortable

clinician

odd

psychotic

MSE - Behavior may be belligerent: when the individual is openly and verbally ____ towards the ___. This may include such behavior as ___, making accusations, or ____ the clinician.

hostile

examiner/interviewer

shouting

insulting

MSE - Behavior may be volatile: when the individual acts in an ___ manner and expresses ____ and aggression (verbal or physical) even in situations of minor annoyance.

unpredictable

hostility

MSE - Behavior may be drowsy: when the individual appears to have ___ paying attention and ____ ____ during the interview.

difficulty

staying awake

MSE - Behavior may be guarded: when the individual is vague in their answers due to a ____ of the intentions of the examiner. This person may not want to provide anything they perceive as personal ___ and may question ___ the examiner wants to know the information.

suspiciousness

information

why

MSE - Behavior may be apprehensive: when the individual appears anxious and expresses ____ about the use of requested information or ___ ___ he/she is doing in the interview.

worry

how well

MSE - Behavior may be suspicious: when the individual ___ questions the ____ of the examiner and ___ else involved in their life.

directly

intentions

anyone

MSE - Behavior may be hypervigilant: may be related to being ___, paranoid, or apprehensive; when the individual maintains a ___ ___ of awareness of noise and movement in the immediate ___. This person may refuse to sit with his/her ___ , will repeatedly the environment, and may be easily ____.

suspicious

high level

surroundings

back to

the door

scan

startled

MSE - Motor Activity or (Psychomotor Behavior) may be both the quantitative and the qualitative aspects of the communicate attitude toward the interview/assessor.

MSE - Included Motor Activities are mannerisms, tics, gestures, twitches, stereotyped behavior,

hyperactivity, agitation, restlessness, wringing of hands, pacing, and other

physical manifestations.

MSE - Motor Activities can include Psychomotor retardation or generalized slowing down of body movements

should be noted. Any aimless, purposeless activity should be described.

MSE - Motor Activities May be noted as appropriate, restless/fidgety, hyperactive, tremors, hypoactive,

calm, tic/spasms, handwringing, agitated, belligerent

MSE - Mood refers to the emotion experienced by the individual over a period of time and therefore is based on self-report. Mood should be evaluated directly through a simple open-ended question such as, “How have you been feeling lately?” or “How would you

describe your mood?” rather than a closed and leading question that suggests an answer: “Are you depressed?”

MSE - Mood Include your client's response to the mood question verbatim (and in quotes) in your MSE report.

This makes it easier to compare a client's self-reported mood on one occasion with self-reported

mood on another occasion.

Cyclothymic D/O (F34.0)– Diagnostic Criteria

Cyclothymic D/O (F34.0)– Diagnostic Criteria

Cyclothymic D/O (F34.0)– Diagnostic Criteria

A. For at least 2 years (at least 1 in children and adolescents) there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode.

A. For at least 2 years (at least 1 in children and adolescents) there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode.

Cyclothymic D/O (F34.0)– Diagnostic Criteria

B. During the above 2-year period (1 year in children and adolescents), Criterion A symptoms have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time.

B. During the above 2-year period (1 year in children and adolescents), Criterion A symptoms have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time.

Cyclothymic D/O (F34.0)– Diagnostic Criteria •       C. Criteria for a major depressive, manic, or hypomanic episode have never been met.

C. Criteria for a major depressive, manic, or hypomanic episode have never been met.

Cyclothymic D/O (F34.0)– Diagnostic Criteria •       D. The symptoms in Criterion A are not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.

•       D. The symptoms in Criterion A are not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.

Cyclothymic D/O (F34.0)– Diagnostic Criteria •       E. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

•       E. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

Cyclothymic D/O (F34.0)– Diagnostic Criteria F. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning,

F. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning,

Cyclothymic D/O (F34.0)– Diagnostic Criteria •       Specify if: with anxious distress (p. 169 in DSM)

•       Specify if: with anxious distress (p. 169 in DSM)

Cyclothymic D/O – Differential Dx: Bipolar and related disorder due to another medical condition and depressive disorder due to another medical condition

Bipolar and related disorder due to another medical condition and depressive disorder due to another medical condition

Cyclothymic D/O – Differential Dx: Substance/medication-induced bipolar and related disorder and substance/medication-induced depressive disorder

Substance/medication-induced bipolar and related disorder and substance/medication-induced depressive disorder

Cyclothymic D/O – Differential Dx: Bipolar I disorder, with rapid cycling, and bipolar II disorder, with rapid cycling

Bipolar I disorder, with rapid cycling, and bipolar II disorder, with rapid cycling

Cyclothymic D/O – Differential Dx: __ personality disorder

Borderline

Cyclothymic D/O Comorbidity - •       those with cyclothymic d/o at higher risk for:

substance-related disorders

•       those with cyclothymic d/o at higher risk for:

substance-related disorders

Cyclothymic D/O Comorbidity - •       those with cyclothymic d/o at higher risk for: •       sleep disorders

sleep disorders

Cyclothymic D/O Prevalence – lifetime prevalence approximately 0.4% - 2.5%

Prevalence – lifetime prevalence approximately 0.4% - 2.5%

Cyclothymic D/O Prevalence - appears equally common in males and females in the general population

appears equally common in males and females in the general population

Cyclothymic D/O Onset/Course – insidious (slow) with persistent course

•       Onset/Course – insidious (slow) with persistent course

Cyclothymic D/O Onset/Course •       usually begins in adolescence or early adulthood

•       usually begins in adolescence or early adulthood

Cyclothymic D/O Onset/Course 15-50% risk that an individual with cyclothymic d/o will then develop bipolar I or bipolar II disorder; more common in youth than adult onset

15-50% risk that an individual with cyclothymic d/o will then develop bipolar I or bipolar II disorder; more common in youth than adult onset

Cyclothymic D/O Onset/Course - development of bipolar I or bipolar II d/o more common in youth than adult onset

bipolar I

bipolar II

common

youth

Risk factors of developing cyclothymic d/o: individuals with Major depressive disorder, bipolar I disorder, and bipolar II disorder are more common

Risk factors of developing cyclothymic d/o: individuals with Major depressive disorder, bipolar I disorder, and bipolar II disorder are more common

Risk factors of developing cyclothymic d/o: more common among first-degree relatives with cyclothymic disorder than the general population

more common among first-degree relatives with cyclothymic disorder than the general population