Difficult
What does the DSM-5 tell us? What does it not include?
Describes mental disorder syndromes and what they are usually associated with
Does not include treatment recommendations
Observed or inquired?
What should be noted?
gait, posture, clothes, grooming
Do they appear their stated age?
Are they dressed appropriately?
How is their hygiene/grooming?
Speech and language:
observed or inquired?
What is noted?
Observed
Quantity (talkative, spontaneous, rambling, to the point), rate, volume, fluency and rhythm
Attention:
Observed or inquired?
What is noted?
Both
attention, concentration, distractibility
can use calculations, forward and reverse counting, reverse spelling
What is the mini-mental state exam? (in general)
form of cognitive assessment
X. Select thought terminology. Define:
Flow of ideas, spontaneous, goal directed, racing thoughts, perseverative, flight of ideas
Flow: quality of associations the person makes between ideas or between points in the person's discussion
Spontaneous: readily volunteers info
Goal: answers main questions and does not stray
Racing: thinks rapidly, speech appears pressured
Perseverative: goes over the same point or idea
Flight: from one thought to another in logical sequence but far from original topic
Behavior:
observed or inquired?
What is noted?
Observed
Mannerisms, gestures, eye contact, ability to follow commands, engagement while communicating, hypersexuality?
Insight and judgement:
Observed or inquired?
What is noted?
Both
Insight: ability to recognize impact of the mental illness on their life
Judgement: the ability to make appropriate decisions
Memory:
Observed or inquired?
What is noted?
Inquired
Recent (what meds did you take today?), remote (when did you get married?), immediate and new (Remember 3 words and repeat in 5 min)
What are the targets of the MMSE?
orientation (person, place, time)
Attention (instructions, concentration)
Memory (recall)
Language (grammar)
VII Speech and language: define these terms
Pressured, aphasia, perseveration, stereotypy, echolalia
Pressured: rapid but constantly talking, cannot be interrupted
Aphasia: loss of ability to understand and produce language
Perseveration: repeating verbal or motor response to a prior stimulus even when confronted with a new stimulus
Stereotypy: constant repetition of speech or actions
Echolalia: repetition of everything heard or mimicking others
Attitude/demeanor:
Observed or inquired?
What should be noted?
observed
cooperative, demanding, hostile, open, secretive, playful, seductive, manipulative, demanding, withdrawn
Thought process/form:
Inquired or observed?
What is noted?
Both
Logical/linear, relevant, flow and coherence of thought in response to general questioning
flight of ideas, blocking, perseveration, incoherent, loose associations, circumstancial
Intellectual:
Observed or inquired?
What is noted?
both
vocab (what grade level), abstraction (similarities (apples vs oranges) or provers (What does "two heads are better than one" mean to you?)
How can the MMSE be used?
Performance corresponds to degree of impairment
variable methods of interpretation
For VI Affect, what do these terms refer to?
Broad, appropriate, constricted, flat, mobile, labile, blunted affect
Broad: normal range of moods
Appropriate: appropriate to the situation
Constricted: restricted range of emotional expression
Flat: no change in mood or face
Mobile: rapid changes in face and mood
Labile: rapid change in mood (laughing then crying)
blunted: no change in mood or face
Level of consciousness:
Observed or inquired?
What is noted?
observed
vigilant, alert, drowsy, lethargic, asleep, confused, fluctuating
Thought content:
Observed or inquired?
What is noted?
Both
Hallucinations (voices, smells, feeling?), illusions, depersonalization (feeling detached from ones body or mental), derealization (feeling detached from ones surroundings)
Suicidality and homocidality:
Observed or inquired?
What is noted?
inquired
Have you thought of harming yourself?
Have you thought of hurting others?
Define these motor activity terms:
mannerisms, posturing, motor retardation
Mannerisms:unconscious repetitive actions
Posturing: assumes certain postures and holds them inappropriately
Motor retardation: moves slowly in a constricted manner with minimal motor response
For the mental health status exam, what are the 15 components? Group them into the 7 groups (A,M,S,I,T, Cognition, Risk)
A:appearance, behavior, attitude, level of consciousness
M: mood, affect
S: speech and language
I: insight and judgement
T: thought process/form, thought content
Cognition: orientation, attention/concentration, memory, intellectual functioning
risk: suicidality and homicidality
Mood: inquired or observed?
Affect: inquired or observed?
What is noted and what is the difference between the 2?
Mood: inquired, how the patient says they feel (subjective)
Affect: observed, the outward expression of inner feeling and emotion (objective)
Orientation:
Observed or inquired?
What is noted?
Inquired
Full name, where are you, what is today's date?
What are some other considerations to note during a mental exam?
Mood changes, sleep changes, appetite changes, motor activity (fidgeting, abnormal movements, involuntary movements)
Define these motor activity terms:
Severe akathisia, tardive dyskinesia, catatonic behavior
Akathisia: severe restlessness
Dyskinesia: "late appearing abnormal movements", tongue protrusion
Catatonic: posture rigidity, resists attempts to reposition