Neuropsych Lec 5 Mental Status Exam

Psychiatry II Lecture 2 – Mental Status Examination Department of Neurology and Psychiatry USTFMS ‘08

c.

-notes from Jo-Anne Ponce; last year’s lecture

INTERVIEW OF PSYCHIATRIC PATIENT PURPOSE 1. diagnostic 2. therapeutic

d.

V. -

Interview – verbal and non-verbal (of two participants) whose behaviors affect each other’s style of communication resutin gin specific patterns of interaction Basic Elements 1. A – Attention 2. R – Rapport 3. F – Freedom from interruption 4. P – Psychological privacy 5. E – Emotional objectivity

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Depersonalization & Derealization- extreme feelings of detachment from the self or environment formication

Thought Content and Mental Trends thought process- way in which a person puts together ideas & associations thought content- what a person is actually thinking about: ideas, beliefs, obsessions

Thought __________

A.

Process or form of thought

1.

loosening of association: do the ideas expressed seem unrelated & idiosyncratically connected

2.

neologism: invention of new words or phrases or the use of conventional words in idiosyncratic ways

3.

Empathy – Carl Rogers – ability to recognize immediate emotional perspective of another person while maintaining own perspectives

flight of ideas: succession of multiple associations so that thoughts seem to move abruptly from idea to idea; often expressed thorugh rapid, pressured speech

4.

Sympathy – over identification with the patient and does nothing

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thought blocking: sudden interruption of thought or a break in the flow of ideas racing thoughts

Engagement – refers to the ongoing development of a sense of safety and respect from which the patient feels increasingly at ease Rapport – establish positive relation

Ideal Interview Techniques 1. open-ended questions – minimally structured 2. facilitation 3. clarification 4. confrontation 5. direct questions Psychiatric history (45 mins to 1 hr) I. Identifying Data II. Chief Complaint III. Pre-morbid • Personal History (Anamnesis) o Prenatal/perinatal o Early childhood o Middle childhood and late childhood o Adolescence o Adulthood

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Sexual history = after 6th or 7th session

II.

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Appearance: posture, poise, clothing, grooming o Signs of anxiety: moist hands, perspiring forehead, tense posture, wide eyes behavior and psychomotor activity: o mannerisms, tics, gestures, twitches, stereotyped behavior, echopraxia attitude toward the examiner: o cooperative, friendly, defensive, hostile, guarded

Circumstantiality: overinclusion of trivial or irrelevant details that impede the sense of getting to the point

6.

Tangentiality: in response to a question, patient gives a reply that is appropriate to the general topic w/out actually answering the question Word Salad

7.

B.

8.

Clang Association: thoughts are associated by the sound of words rather than by their meaning (rhyming or assonance)

9.

Punning: association of double meaning

Content of Thought • • • • •

VI.

Mental Status Examination I. General Description

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5.

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Affect: patients present emotional responsiveness, inferred from facial expressive behavior; normal, constricted, blunted, flat Appropriateness of affect

Affect – external expression of one’s feeling during interview Mood – internal sustained emotional state of the patient overall expression of emotions III.

Speech Characteristics a. Quantity, rate of production, quality b. Dysprosody- unusual rhythm or accent

IV.

Perception – illusions, hallucinations

a.

Hypnagogic hallucination- occurs as one falls asleep

b.

Hypnopompic hallucination- as one wakes up

Sensorium and Cognition – conscious or abstract thought, orientation, insight, judgement MMSE- orientation, memory, calculations, reading & writing, visuospatial ability, language

VII.

Consciousness: clouding, somnolence, stupor, coma, lethargy, alert

VIII. Remote Memory

Orientation & Memory Childhood data, important events known to have occurred when the patient was younger or free of illness, personal matters, neutral material The past few months The past few days, what the patient did yesterday, the day before, what the patient had for breakfast, lunch, dinner Digit-span measures; ability to repeat six figures after examiner dictates them- first forward, then backwar; ability to repeat 3 words immediately & 3-5 minutes later

Recent Past Recent

Mood and Affectivity Mood: pervasive & sustained emotion that colors the person’s perception of the world; includes depth, intensity, duration, fluctuations

delusions and false beliefs phobias preoccupations suicidal ideas paranoia

Immediate Retention & Recall

IX. X. XI. XII. XIII. XIV. XV. XVI.

Reliability Concentration & Attention Reading & Writing Visuospatial Ability Abstract Thought Information & Intelligence Impulsivity Judgement & Insight

Further Diagnostic Studies 1. Physical Exam 2. Neurological Exam 3. additional psych tests Diagnosis DSMIV – Multiaxial (?)

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