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Higher mental function examination

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  • 1. Mental Status Examination
  • 2. Mental Status Examination
    Consciousness
    Level of consciousness
    Arousal (Eye opening closing)
    Attention
    Concentration
    Orientation
    Kinetic melody
    Affect
    Mood
    Behavior
    Cognition
    Language
    Memory
    Thinking: Content, Speed
    Reasoning
    Judgment
    Abstract thinking
    Insight
    Construction
    Praxis
    Gnosis
  • 3. Consciousness
    Consciousness is Awareness of self and environment or knowledge of one's own mental process (subjective)
    Arousal and Level of consciousness
    Content of consciousness or Cognition
    Test for responsiveness (objective)
    Verbal,  motor , and vegetative response to visual, verbal, tactile and noxious stimuli, one step or two step command
    Level of response: Meaningful -> not meaningful -> reflex -> none
                       Verbal word, phrase or sentence
  • 4. Level of Consciousness
    Alert: awake, aware, interesting, responsive to stimuli
    Lethargic (drowsy): Can be roused but cannot maintain arousal.
    Stuporous: Can be roused with intense stimulation
    Comatose: Cannot be roused with any stimuli
    Confusion: Unable to think in customary speed and clarity. Altered awareness and responsiveness with inattention and distractibility.
    Delirium: confused, agitated and hallucinating.
  • 5. B. Attention and Concentration (RAS)
    Alertness is aroused and attend to all extraneous stimuli.
    Attention is the capacity to focus on single stimuli and screen out irrelevant stimuli.
    Clinical: noting the distractibility while history taking.
    Digit span: (forward and backward)
    Letter span
    Alphabet repetition read randon alphabets and asks to tap when particular alphabet repeated.
    Word repetition
    Sentence repetition
  • 6. Concentration is the ability to focus attention over a more extended period of time.
    Seven subtraction
    Random letter repetition
  • 7. C. Behavior (limbic system, prefrontal area, caudate area)
    Clinical assessment:  Observation of a patient’s mood, facial expression, clothing, and ability to relate to the examiner.
    Appearance. Clothing and grooming. Bizarre, seductive, soiled, stained.
    Motor activity:
    Increased activity
    Decreased activity
    Tics
    Repetitive acts
    Facial expression: Normal, blunted, abnormal twitching
    Mood and affect: Affect is immediate overt expression of an emotional state. Mood is more sustained or underlying emotion.
    Behavior: Irritability, demanding, anger and euphoria, helplessness
  • 8. D. Language
    Comprehension
    Expression
    Repetition
    Reading
    Writing
    Naming
  • 9. Comprehension:
    Identification of color, object, action, letter, number and forms.
    Body part identification
    One, two and three step command
    Complex ideation material
    Two ideas (boat/stone sink in water)
    Story comprehension
  • 10. Expression:
    Word output
    Fluency
    Prosody: loss of melodic aspect of speech (emotional speech – right hemisphere corresponding to Broca’s area)
    Grammar
    Paraphasias:
    Verbal - Green -> Red
    literal - Green -> Gret
    Neologism: Green -> Grump
    Word finding difficulty
    Automatic speech: number, alphabet, month, days, poem, song.
  • 11. Reading:
    Oral reading, word phrase and sentence
    Reading comprehension
    Symbol
     Word
     Oral spelling,
     Word, picture matching,
     Reading sentence
  • 12. Writing
    Mechanical: name, address
    Primer level dictation, letter, number, word, sentence, paragraph
    Written confrontation naming
    Narrative writing
  • 13. Repetition
    Word
    Phrase
    Sentence
  • 14. Naming:
    Responsive naming (what do we tell time with)
    Visual confrontation naming: object, color, action, letter, number, form
    Body part naming
    Object naming: Animal, vegetable and fruit
  • 15. Thought (Speed, content, coherence and logic)
    Form
    Reduced content: poverty of ideas, associated with vague repetition, overtly abstracts speech, which contains little information.
    Circustantiality: delay in reaching the point, because of unnecessary detail and parenthetical speech
    Derailment: shift in thinking from one topic to another. Loss of association.
    Tangentiality:  Loosing of association or derailment in response to the examiners questions. Shift in topic at first may be related but progressively move further away from the starting topic.
    Blocking: sudden cessation of speech because of thought was lost or mind became blank
    Flights of idea: accelerated speech and rapid shift in topic. Speech may become disorganized and incoherent. Syntax and vocabulary are usually intact.
    Clang association: a form of derailment in which shift in topic are based on the sound of words rather than the meaning.
    Confabulation: apparent fabrication of facts or events to fill gaps in memory.
    Neologism: are new words or distortion of standard words.
    Echolalia: the echoing of words or phrases of others. Often associated with perseveration repetition of the same words
    Perseveration: persistent repetition of words and phrases.
    Word salad: syntax is lost, vocabulary is idiosyncratic.
  • 16. Content  of Thought
    An illusion:is a misperception of real external stimuli.
    A delusion: is a false personal belief based on an incorrect interpretation of reality
    Hallucination:
        i.      Auditory:
                                                                  ii.      Visual
                                                                iii.      Olfactory
                                                                iv.      Gustatory
                                                                 v.      Tactile
    Assaultive thought: wishes or intensions to harm an individual or less commonly an institution or organization.
    Homicidal thoughts: wishes or intension to kill another person, these may be vague or poorly formulated or may be impulsive.
    Homicidal plans: the intensions or wishes to kill have been crystallized into a potentially real threat.
    Feeling of hopelessness:
    Feeling of guilt:
    i.         Suicidal thoughts:
    j.         Suicidal plans
    Obsessions: recurrent, persistent ideas, images, or impulses that are not experienced as being produced voluntarily but as being invaded thoughts.
     
    Phobias: irrational, persistent, fear of an object, activity or situation that produces a wish to avoid the stimulus. Closeness to the stimulus causes increased feeling of anxiety and over activity of autonomic nervous system.
    Sexual concerns:
    Somatic preoccupation:
    Religiosity.
  • 17. Memory
    Short term memory:  testing require a patient to be attentive, cooperative and good comprehension
    Recall of recent event, confirm with relative
    Four semantically unrelated words, sentence, Objects, design, Short story
    Remote memory:
    Personal Historical events
  • 18. Constructional ability (graphomotor)
    A complex task involving visual, perceptual and analytical function of the occipital and parietal lobes and the motor planning and action of the prefrontal and frontal lobes. Both hemisphere are involved but, right parietal lobe produces more severe impairment in performance.
    Copy two and three-dimensional objects and shapes.
  • 19. Calculation
    Measure the ability of a person to perform mental arithmetic. Performance is highly correlated to intelligence and education.
     Normal attention concentration and language memory are prerequisite.
    Simple calculation
    Serial 7 subtraction
  • 20. Abstract thinking
    Similarities: to abstract the essential relationship between word pairs consisting of objects and ideas.
    Ask the patient how word pairs are alike (e.g. turnip and cauliflower; chair and table, painting and symphony)
    Proverb interpretation:  depends on the patient’s cultural, intellectual and educational background.
    Prefrontal and frontal cortex involved.e.g. Rome wasn’t built in a day.
  • 21. Conceptual ability
    Prefrontal cortex. Ask to complete following sentence.
     A  C  E  G  ---
    1  4   7  10  ---
    AZ  BY  CX  D—
    Hydrangea            789876332
    Jewel                      46883
    Hat                          ----- (any three letter number)
  • 22. Judgment
    Refer to the patient’s understanding of what he has done or will do in various situations. To see the patient’s ability to cope with difficult situation.
    Insight
    Refers to the patient’s awareness of the significance of his symptoms and illness. Which may range from partial to full understanding of the origin, nature and prognosis.
  • 23. Frontal Lobe
    Observe: Behaviour, Attention, Memory, Motor, Speech, Planning, Bladder
    MotorBilateral/ Left
    Kinetic melody
    Frontal release sign
    Gagenhaltan
    Gait apraxia
    Eye movement
    Akinetic, abulic,  (mesial)
    Right
    Motor neglect
    Motor impersistence
    Dysprosody
    Euphoria
    Emotional liability, euphoria, dysphoria
    Jocularity (Orbital)
    Lack of social judgment (orbital)
    Behavioural
    Utilization and imitation behavior
    Intelligence, attention, concentration and learning
  • 24. Temporal lobe
    Auditory comprehension
    Verbal memory dominant
    Visual memory non dominant
    Vegetative
    Emotion
    Quadrinopias
  • 25. Parietal Lobe
    Any hemisphere
    Cortical sensation
    Optico kinetic nystagmus
    Quadrinopia
    Dominant
    Right left orientation
    Finger agnosia
    Acalculia
    Agraphia
    logicogramatical and syntactical language
    Optic alexia
    Non dominant
    Neglect (bisect line, dazy, clock drawing)
    Spatial disorientation (map drawing, object in a room)
    Constructional apraxia ( two and three dimentional)
    Dressing apraxia
    Bilateral
    Ideomotorapraxia
  • 26. Occipital lobe
    Hmianopias
    Naming color, shape, object, face, picture
    Reading
  • 27. Callosal function
    Anterior
    Left hand praxis
    Left hand agraphia
    Middle
    Matching left finger, left hand
    Naming object in left hand
    Posterior
    Naming object left field
    Right hand constructional apraxia