[01.30] Mental Status Examination V2.pdf

Mental Status Examination (MSE)

What is a systematic format for recording findings about thinking, feeling, and behavior?

Thinking (thoughts), Feeling (emotions), Behavior (physical aspect of our actions or the physical manifestation of our emotions and thoughts)

The Mental Status Examination (MSE) is a systematic format for recording findings about these three aspects.

Assesses the mental and psychological function at a particular time

What does the MSE assess regarding a patient's function?

Can vary from moment to moment, day to day, and minute to minute

Why is the MSE considered very dynamic?

Examiner’s observation

Upon what is the MSE based?

The moment they walk into your clinic

When does a doctor's job to examine a patient for the MSE begin?

Placed in the context of the patient’s history

How are MSE findings contextualized?

Assists in diagnosis

What is a primary purpose of conducting a thorough MSE, helping to determine if a problem is medical, neurological, or psychiatric?

Assesses organicity

What purpose of the MSE helps determine if a medical problem is due to something organic?

Assesses threat to self or others

What purpose of the MSE is critical for patients with suicidal or self-harm thoughts, or homicidal plans?

Assists in decision-making with regards to the management of patients

What purpose of the MSE helps guide patient care?

Helps in the evaluation of patient’s progress through therapy

What purpose of the MSE allows for tracking a patient's improvement over time?

Determines prognosis

What purpose of the MSE helps predict the likely course of a patient's illness?

Necessary skill to become competent evaluators of patients

What is the MSE considered for healthcare professionals regarding patient evaluation?

General Description, Mood and Affect, Speech, Perception, Thought Content/Process, Cognition, Impulsivity, Judgment and Insight

List the eight main components of the MSE.

Objective descriptions and avoid judgmental terms

What type of descriptions should be used when performing the MSE, and what should be avoided?

Appearance, Behavior, Attitude toward examiner

What are the three sub-components of the General Description in MSE?

As soon as the patient enters the clinic

When is a patient's appearance assessed during MSE?

Grooming, posture, poise, clothing, body odors

What specific aspects are assessed under a patient's general appearance?

Healthy, ill at ease, unkempt

What are examples of descriptions for a patient's general appearance?

Behavior

This component of MSE involves observing a patient's psychomotor activity.

Mannerisms, tics, gestures, twitches, agitation, combativeness, rigidity, gait, purposeless activity, slowing of body movements

Name specific observations made regarding a patient's behavior during MSE.

Attitude toward examiner

What component of MSE checks how the patient interacts with the clinician?

Cooperative, friendly, attentive, interested, frank, seductive, playful

What are some positive or engaging attitudes a patient might display towards the examiner?

Hostile, guarded, or evasive

What are some challenging or withdrawn attitudes a patient might display towards the examiner?

Mood

What is defined as the pervasive and sustained emotion that colors the person's perception of the world?

Ask the patient: “Ano po ang nararamdaman niyo today?”

How do examiners typically assess a patient's mood?

Depressed, Anxious, Euphoric, Empty, Guilty, Frightened

Name some examples of moods a patient might report.

Labile or fluctuating

How might a patient's mood be described if it changes rapidly or unpredictably?

Affect

This is inferred from the patient’s facial expression.

Congruent or incongruent with the mood

How can affect be classified in relation to the patient's reported mood?

Incongruent affect

What term describes when a patient says they are happy but their facial expression is blunted or flat?

Normal, Constricted, Blunted, Flat

Name the different classifications of facial expressions or affect.

Controlled facial expression

What is meant by a "constricted" affect?

More severe, monotonous voice, immobile face, no sign of expression

What characteristics describe a "flat" affect?

Mood is something that we ask the patient, and affect is how we observe the patient

What is the key differentiation between mood and affect in MSE?

Appropriateness

What quality should always be looked for when assessing mood and affect?

Quantity, Quality, Impairments in speech, Spontaneity

What four aspects are used to assess and describe a patient's speech?

Quantity

What aspect of speech assessment determines if the patient is talkative, has poverty of speech, or is silent?

Talkative, poverty of speech, silent, one-worded or one-phrase responses, not able to talk in complete sentences

Name specific observations made under "Quantity" of speech.

Quality

What aspect of speech assessment covers characteristics like being pressured, monotonous, loud, mumbling, or comprehensible?

Pressured to talk, monotonous, loud, mumbling, comprehensible

Name specific observations made under "Quality" of speech.

Stuttering

What is an example of an impairment in speech mentioned?

Spontaneity

What aspect of speech assessment determines if the patient talks freely or needs encouragement?

Perception

How the patient perceives or understands their environment using their 5 senses.

Perceptual Disturbances

What category of disturbances is assessed under Perception?

Hallucinations, Illusions, Depersonalization, Derealization

Name the four types of perceptual disturbances discussed.

Hallucinations

What is a false sensory perception with no external stimuli?

Illusions

What is a misperception or misinterpretation of real external stimuli?

Depersonalization

What term describes a patient feeling unreal, strange, unfamiliar, or "not there"?

Derealization

What term describes a patient feeling the environment is unreal?

“Is this really me?”, “Am I really here?”, “Am I really talking to you?”

What are examples of questions a patient might ask when experiencing derealization, which may also apply to depersonalization?

Do not automatically mean that they are pathognomonic

Experiencing perceptual disturbances does not automatically imply what for a psychiatric disorder?

Sensory modality, circumstances of the occurrence, hallucinatory content

What three aspects are important to assess and describe for hallucinations?

Auditory, Visual, Tactile, Olfactory

Name the different sensory modalities of hallucinations.

“May naririnig po ba kayo na kayo lang ang nakakarinig?”

What is an example question to assess auditory hallucinations?

Hypnagogic or hypnopompic

These types of hallucinations occur as one is falling asleep or waking up, respectively, and are considered normal.

Postictal (after a seizure)

When do postictal hallucinations occur?

Stress or anxiety-related

Hallucinations can be related to these emotional states.

Auditory

What sensory modality of hallucination can be a sign of a psychotic disorder?

Voices talking despite being alone in a room

What is an example of an auditory hallucination?

Visual

What sensory modality of hallucination is usually due to drug use or substance abuse?

Seeing bizarre things

What is an example of a visual hallucination?

Tactile

What sensory modality of hallucination can be caused by cocaine intoxication or alcohol detoxification?

Formication

What is the feeling of bugs crawling under the skin, often associated with tactile hallucinations?

Olfactory

What sensory modality of hallucination involves smelling something that is not there?

Complex partial seizures (temporal), Seizure disorders

What neurological conditions can cause olfactory hallucinations?

Thought Content

What answers the question, "Ano ang nilalaman ng mga iniisip?" (What are you thinking about?)

Thought Process

How we are able to process our thoughts, if there are any derailments, etc.

Delusions, Preoccupations, Obsessions and compulsions, Phobias, Suicidal or homicidal thoughts and ideas, Ideas of reference, Poverty of content

What aspects should be looked for when assessing thought content?

Delusions

What is a false belief based on incorrect inference about external reality, fixed and difficult to challenge?

Objective and obvious contradictory proof or evidence, The fact that other members of the culture or religion do not share the belief

Delusions are firmly held despite these contradicting factors.

Delusion of Control

What type of delusion involves a false belief that a person’s will, thoughts, or feelings are being controlled by external forces?

Belief that an alien is controlling their thoughts or is controlling them

What is an example of a delusion of control?

Delusion of Grandeur

What type of delusion involves an exaggerated conception of one’s importance, power, or identity?

“I am powerful,” “I am the president,” “I am someone important,” “I am married to someone important”

What are examples of statements indicating a delusion of grandeur?

Delusion of Infidelity (pathological jealousy)

What type of delusion involves a false belief that one’s lover is unfaithful, often eliciting symptoms of jealousy?

Delusion of Persecution

What is the most common delusion, characterized by a false belief of being harassed or persecuted?

Belief that they are being followed, or someone intends to harm them, paranoia

What are examples of beliefs or feelings associated with delusion of persecution?

“How is the patient processing thoughts?”

What question does the assessment of thought process answer?

Normal

What type of thought process involves the patient giving a coherent answer?

Tangential

What type of thought process involves the patient giving an answer that is really far off and does not answer the question?

Circumstantial

What type of thought process involves the patient answering the question but only after going through irrelevant data first?

Looseness of Association (Derailment)

What type of thought process involves the patient being unable to go back to the central idea of the question, with a loss of logical flow and coherence?

Neologism

What is the term for coming up with non-existent words or those not in the dictionary?

Clang association

What is the tendency to use words that rhyme or have a similar sound?

Thought blocking

What term describes suddenly freezing and not being able to respond or give an answer?

Cognition

What MSE component helps identify possible organic brain problems, differentiating them from primary psychiatric conditions?

Intelligence, Memory, Abstract thinking, Judgment, Insight

What five areas does cognitive assessment test?

Consciousness, Orientation, Memory, Concentration and Attention Span, Reading and Writing

What are the specific components of cognition that are tested in MSE?

Awake, Somnolence, Stuporous, Coma

What states of consciousness should be noted during MSE?

Time, Place, and Person

What three areas are checked for orientation?

Immediate Memory, Recent Memory, Recent Past Memory, Remote Memory

Name the four types of memory assessed during MSE.

Immediate Memory

What type of memory includes immediate recall and retention, often tested by repeating words or numbers?

Saying “bola, mangga, puno” and repeating them after 3-5 minutes

What is an example of a test for immediate memory?

Recent Memory

What type of memory refers to events of the past few days?

“Ano ang kinain mo kanina?” or “Ano ang kinain mo kahapon?”

What are example questions to assess recent memory?

Recent Past Memory

What type of memory refers to events in the past few months?

Remote Memory

What type of memory includes childhood data, growing up years, earliest memories, and important events from the patient's younger life?

Serial 7’s

What test involves instructing a patient to count backwards from 100 deducting 7 each time, used to assess concentration and attention span?