mse1
TRANSCRIPT
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MENTAL STATUS EXAMINATION
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Mental status examination2
Structured way of observing and describing a patient’s current state of mind
Purpose is to obtain a comprehensive cross-sectional description of the patient's mental state
When combined with the biographical and information of the history, allows for an accurate diagnosis, and hence, for treatment
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The data is collected through a combination of direct and indirect means:
• unstructured observation while obtaining the biographical and social information,
• focused questions about current symptoms, and
• formalized psychological tests
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Integration of History and MSE
History MSE
Identifying data
Chief complaint
Appearance, behaviour, orientation, level of consciousness
HOPI Co-operation, speech, thought form, content
Exploration of symptoms from HOPI
Affect, Mood, suicidal ideations
Direct testing Knowledge base, cognitive functions, insight, judgment
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Overview
General appearance and behaviour Attitude towards examiner Language functions Memory Orientation Abstraction Judgment General Knowledge
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Mood and affect Speech Thought form, thought content, thought
stream Perception Insight
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Consciousness-7
State of awareness of self and environment
Intensity of stimulation needed to arouse the patient and duration of time patient can maintain attention
5 levels of consciousness on a continuum-alert, clouding, obtundation, stupor, coma
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Alertness: awake, fully aware of normal stimuli, capable of meaningful interaction with examiner.
Clouding/Lethargy: not fully alert, drifts off to sleep when not stimulated, cannot pay close attention to examiner, loses train of thought, valid MSE difficult
Obtundation: transitional state, difficult to arouse and when aroused is confusional (quiet delirium), constant stimulation for marginal co-operation, meaningful MSE not possible.
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Stupor: respond to vigorous and persistent stimulation, does not rouse but when aroused groans/mumbles/moves restlessly. Indicative of extensive brain dysfunction; no MSE.
Coma: un-arousable, no evidence of behavioural response to stimulation. Deep coma/light coma (reflex actions).
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Glasgow coma scale – eye opening, verbal and motor response (Teasedale and Jennett,1974)
–Numeric score for actual level.
–Three response categories: eye opening, verbal, motor.
–Does not take into account level of stimulation.
Score from 3 to 15, with 3 being the most severe head injury and 15 being the least severe head injury.
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Rapport12
Spontaneous feeling of harmonious responsiveness that promotes development of a constructive therapeutic alliance.
Implies an understanding and trust between the doctor and the patient
How do you establish rapport???
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1. General appearance13
Appearance and appropriateness to situation
AttireHygiene and groomingBody typePhysical abnormalitiesJewelry and cosmetic use
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Handedness
Eye contact (fleeting, unwavering)
Facial expression and posture
Manner of relating (relaxed, tense, guarded)
Attitude towards examiner (co-operative, seductive, over-familiar, suspicious, guarded)
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2. Motor behavior15
Rate or speed (over-activity, fidgety, restless, retardation)
Purposive and goal directedness (mannerisms, stereotypies)
Response to external stimuli
Involuntary movements (tics) and catatonic features
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Attention-16
Patients ability to attend to a specific stimulus without being distracted by internal or external stimuli
Evaluation- Digit span test- digit forward and
backward 5-7 digits is normal
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Concentration-17
Is the ability to maintain attention to a specific stimulus over an extended period
Evaluation- Serial subtraction tests- 100-7, 40-3,
20-1 Month and days of the week
backwards
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Language functions-18
Phonation
Articulation (slurring, mumbling, unclear)
Fluency- ability to produce spontaneous speech - animal naming test, words beginning with a letter
Comprehension- pointing commands, yes or no questions
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Repetition- sentences with 19 syllables
Naming- body parts, objects, colors
Reading- reading comprehension and reading aloud; education
Writing
Prosody- tonal intonations
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Orientation-20
Time (time of the day, day of the week, date, month, year, season)
Place (hospital/clinic, town, state, country) Person (identity of the person, family members,
friends, hospital staff) Sense of passage of time
Sequence of loss of orientation: Time > place>person
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Memory-
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Recent- Address test
Object test
Recall of events
Remote- personal and impersonal events
Topographic memory
Memory of skills
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Abstract ability-22
Abstract thinking is the ability to grasp the essentials of a whole, to break it into parts, and to discern common properties
Tests- Proverb interpretation
Test of similarity and dissimilarity
Concrete, semi-abstract, abstract
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Judgment-23
Ability to assess situation correctly and act appropriately with in that situation
Test judgment- response in test situation
Social- history and observation
Personal- about present and future
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General Information and Calculation
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General information- Based on educational, social background
Calculation- Verbal and written- 1 or 2 step problem
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Intelligence25
Capacity to solve problems, cope with new situations, acquire skills through learning and experiences, establish logical deductions, and to form abstract concepts
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Next Class…
Thought o Streamo Formo Possessiono Content
Mood and Affect
Perception
Other psychotic phenomena
Insight