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Mental status examination PowerPoint.pptx
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- 2. Mental status examination Definition It is a systematic appraisal of behaviours, emotions and cognitive functions of an individual.
- 3. Objectives Aids inmaking accurate diagnosis of patient Helps to assess the response to treatment Methods used: Observation Interaction – questioning and listening
- 4. Mental status examination-components General appearance State of consciousness Attitude towards examiner Motor activity Speech Thought process Perception Orientation Memory Attention and concentration Abstract thinking Intelligence Insight Judgement
- 5. Mental status examination-components General appearance Body built and nourishment Height and weight Personal presentation Dressing : well dressed/ unkempt Hair : grooming, healthy Hygiene and self care
- 6. Facial expression:happy/ sad/ anxious/ dull/ angry Eye contact: yes/ no, intermittent, sustained State of consciousness Alert/ drowsy/ hyper vigilant/ clouding of consciousness/ confusion/ fluctuation in consciousness/ ability to carryout simple and complex orders. Rapport : ease of rapport establishment
- 7. Attitude towardsexaminer Co-operative/ uncooperative Friendly/ hostile/ defensive Uninterested / apathetic Attentive/ interested Guarded/ suspicious/ seductive / evasive Playful/ frank Ingratiating- pleasing/ capable of winning favor
- 8. Motor activity Posture Erect Recumbent Relaxed Tense Stooped Waxy flexibility Odd postures; changing postures
- 9. Level ofactivity: hypo (level of retardation)/ hyper(excitement, agitation) Fluctuation in the level of activity Gait: normal/ ataxia/ shuffling/ limping Adaptive movements: goal directed/aimless, appropriate/ inappropriate, smoothly co-ordinated/ awkward Non-adaptive movements Tremors, tics, rigidity, mannerisms, echopraxia, waxy flexibility
- 10. Speech and language Content relevancy Spontaneous/ hesitant Mutism Productivity: increased/ decreased Pressure of speech/ poverty of speech Intensity: loud/soft/normal Pitch: monotonous/ fluctuations Fluency Reaction time: slow/ rapid/ normal Speed And any abnormalities of speech: word salad, neologism, clang association, echolalia
- 11. Mood Subjective: howare you feeling now? I am feeling sad Objective: He looks dull Appropriateness of both : Fluctuations /Stability over time Variation in mood with stimuli (reactivity)
- 12. Thought process Formof thought: assess for symptoms using Open ended question Stream of thought: As the interview goes based on the speech productivity assess the symptoms
- 13. Content ofthought Delusions: Do you think people are against you? Do you believe that you have extraordinary power? Do you belief that you are being controlled by some one? Do you think your spouse is not faithful to you Do you think people are trying to kill/ harm you? Do you think people are talking bad about you? Obsession: Do you get any repeated irrational thoughts that disturbs you?. Phobia :Do you have any irrational fear of object or situation? Suicidal ideations : Have you ever thought of ending your life?
- 14. Possession ofthought Do you think your thoughts are known to others? Do you think your thoughts are taken away by someone? Do you think some one inserts some thoughts in to your mind?
- 15. Perception Doyou hear voices when you are sitting alone? Dou you see something or people in their absence? Or do you see things that others are not able to see? Do you have sense of taste in your mouth without anything in your mouth.
- 16. Hallucination andits type 2nd / 3rd person Commanding Commenting How many voices Which part of the day Male/ female Known/ unknown voices illusion Depersonalization Derealization Dejavu
- 17. Orientation Time Withoutlooking at your watch, by looking outside can you tell me the approximate time now? Place Which place is this? Person Who is staying with you? identify with name and relationship and then countercheck Disorientation in time precedes disorientation in place and person
- 18. Memory Immediate(give 3 objects/ 5 digit number and ask after 5 minutes) Recent (breakfast/ lunch, date of admission), counter check with the relative Remote (date of birth/ anything important in past), counter check with the relative Confabulation
- 19. Attention andconcentration Weekdays forward and backward Months of the year forward and backward 1 to 10 forward and backward Serial subtraction, 5 times - 100 – 7 (120 sec), 40-3 (60 sec) Digit span test Spell the word WORLD forward and backward
- 20. Abstract thinking Proverb testing similarities & difference: table and chair, light and fan, Banana and orange Compulsions
- 21. Intelligence Questionsabout general information Vocabulary Arithmetic calculations Level of Abstarction Overall level of functioning
- 22. Insight Areyou mentally ill? Do you know your symptoms? Are you willing for treatment? Consequences of not taking the treatment
- 23. Clinical rating ofinsight 1- denial 2- awareness and denying 3-attrbute to physical factors 4- something unknown in self 5 – intellectual insight 6- true emotional insight
- 24. Judgment Personal: Plan after discharge Strengths and weakness Social Observe-How the person behaves in social situation When called for a wedding how would you go Test House on fire Addressed, stamped envelope on the road
- 25. Precaution inattentivepatient Coma, unconscious, fluency in language Summary Include only main findings
- 26. MMSE- Mini MentalStatus Examination Folstein test 30 point questionnaire A tool to assess Mental status systematically
- 27. Indications Impaired cognitivefunctions- delirium, dementia Pre and post ECT to assess cognitive impairment
- 28. 11 questions 5 areas of cognitive functions Orientation Registration Attention and concentration Recall Language Max score 30
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- 30. Orientation 10 secfor each reply Year Season Month Date Day Score 5/5 Country State City Address/ building name Floor/ room Score 5/5
- 31. Registration Name 3objects - unrelated 1 sec to say each. Ask to repeat Allow 20 seconds for reply Score 3/3
- 32. Attention and concentration Serial subtraction 100-7 upto 5 times / Spell WORLD backward Score 5/5
- 33. Recall Ask torepeat 3 objects name Score 3/3
- 34. Language Repeat thephrase “no ifs, ands, or buts” 1 Give blank paper and say: take the paper, fold it in half and put in on the floor 3 Show pencil and watch and name it 2 Read and obey the following 1 Close your eyes Write a sentence 1 Copy the design shown 1
- 35. Total score30 24-30 – no cognitive impairment 18-23 – mild cognitive impairment 0-17 – severe cognitive impairment Limitation Depends on verbal response, reading and writing.
- 36. Neurological examination Components History - accuracy Level of consciousness- GCS MSE Cranial nerve functions: motor and sensory functions of the nerve Motor power: muscle strength sensory function: touch, pain, temp, kinesthetic sense Cerebellar functions: tandom walk, romberg test, finger to nose test
- 37. Investigations Blood tests Electrolytes : Hypo / hypernatremia Hypo / hyperkalemia Hypo / hypercalcemia Hb Wbc- patients on clozapine and carbamazepine Mcv increased in ADS Uninalysis- drug screening Renal function - lithium
- 38. LFT- carbamazepine,valproate, benzodiazepine, ADS RBS- >35 routine screening, olanzapine TSH- refractory depression, on lithium HIV testing- IV drug users, sexual abuse Toxicology screening- when substance use is suspected Drug levels – indicate compliance and toxic / therapeutic levels Litium, carbamazepine valproate
- 39. EEG Seizures,neoplasms, degenerative diseases MRI Malignancies, degenerative diseases CT Lesions, IC Hge
- 40. Serum prolactinlevel TSH Dexamethasone suppresssion test
- 41. Psychological tests Specializedprocedures for determining such characteristics of an individual as intellectual capacity, motive pattern, self concept, perception of environment, coping pattern and general personality integration.
- 42. Intelligence tests Neuropsychological tests Personality test Aptitude Tests Achievement Test
- 43. Objective tests Paper pencil tests Personality and intelligence Personality tests- 16 persnality factor, Minnesota Multiphasic Personality Inventory (MMPI) Intelligence tests- Wechsler Adult Intelligence Scale(WAIS), Standford Binet Kamat Test, Bhatias performance battery of intelligence
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- 45. 16 PF 167questions
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- 47. WAIS Consists ofsix verbal and five performance subtests. The verbal tests were: Information, Comprehension, Arithmetic, Digit Span, Similarities, and Vocabulary. The Performance subtests were: Picture Arrangement, Picture Completion, Block Design, Object Assembly, and Digit Symbol
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- 49. Projective tests Use of ambiguous stimuli Rorschach Ink Blot test (10) Thematic apperception test 30 pictures cards Draw a person test Sentence completion test
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- 55. Rating scales forpsychiatric illnesses Becks depression inventory Positive and negative symptoms of schizophrenia Young mania rating scale Ybocs- obsessive compulsive disorder Brief psychiatric rating scale
- 56. Role of nurse Aware of all the tests Explain the safety and confidentiality of all tests Include the data obtained from tests in the application of nursing process