This document describes the components of a mental status examination used to evaluate psychiatric patients. It involves assessing a patient's appearance, speech, behavior, mood, thought processes, memory, orientation, judgment, insight and other cognitive functions. The exam is used to describe the patient's condition at the time of interview and obtain an overall impression of their mental health status.
Mental status examination Maja (1) (1).pptxAmitSherawat2
The Mental Status Examination [MSE], also referred to as Mental State Examination, is an integral and essential skill to develop in a psychiatric evaluation. Conducting an accurate MSE helps elicit signs and symptoms of apparent mental illness and associated risk factors.
Mental status examination Maja (1) (1).pptxAmitSherawat2
The Mental Status Examination [MSE], also referred to as Mental State Examination, is an integral and essential skill to develop in a psychiatric evaluation. Conducting an accurate MSE helps elicit signs and symptoms of apparent mental illness and associated risk factors.
The Mental Status Examination Uniformed Service University o.docxcherry686017
The Mental Status Examination
Uniformed Service University of the Health Sciences
Department of Psychiatry
Objectives: At the completion of the class, students should be able to:
1. Describe the main components of the mental status examination
2. Compose a mental status examination based on a patient observation and
interview
3. Recognize the difference between thought process and thought content
4. Estimate degree of psychopathology based on the mental status examination
5. Document adequate safety (suicidal and homicidal) assessment of each
patient
The Mental Status Examination is an integral portion of the psychiatric interview.
It serves as a “snapshot” of the person you are evaluating. It should include all of the
pertinent observations and findings you accomplish during your encounter with the patient.
Not only is it important for describing the “state” of the patient, it is an important tool that
can help substantiate a diagnosis, convey information to another provider, and assist in
determining most appropriate step in treatment.
Based on the following sections, the mental status examination may appear quite
involved and complicated. This is not the case. As you will see, much of the information
for the mental status examination is obtained from the natural course of the interview.
It is important to state that the goal is not pinpoint the absolute correct term to
describe an observation. The beauty of the mental status examination is, even if you do
not know the specific term, you can use your own words and observations.
APPEARANCE
Yes, this is as straightforward as it sounds – this section describes how the patient
looks, smells, behaves, speaks, establishes eye contact, etc. If this section is thorough
enough, a reader of your mental status exam should be able to pick out the person out of a
room. The mental status exam starts when you first set eyes on the patient. The following
is a sample of items that should be included in the APPEARANCE section:
Ethnicity
Apparent age (younger, older, or appeared stated age)
Sex
Coordination/gait/notable movements
Adherence to social conventions (i.e., shakes hands, military bearing)
Build (Average, underweight, emaciated, petite, thin, obese, muscular)
Grooming (Good, poor, adequate, immaculate, neglected)
Dress (Casual, stylish, mismatched items, formal, tattered, appropriate
for particular setting)
Psychomotor activity (Described as increased in the case of agitation;
decreased in cases of depression or catatonia)
Page 1 of 9
A description of how the patient relates to the interviewer is a necessary
component of the APPEARANCE section. This is sometimes also described as the
“interpersonal style.”
Congenial
Guarded
Open/candid
Cooperative
Withdrawn
Distant
Annoyed/Irritable
Engaging
Hostile
Shy
Relaxed
Cautious
Defensive
Resistant
Speech is something you can also comm ...
the presentation describes in detail about the mental illness, i.e. schizophrenia along with its diagnostic criteria, symptoms, prognosis, course as well as its causes.
Archer USMLE step 3 Psychiatry lecture notes. These lecture notes are samples and are intended for use with Archer video lectures. For video lectures, please log in at http://www.ccsworkshop.com/Pay_Per_View.html
The Mental Status Examination Uniformed Service University o.docxcherry686017
The Mental Status Examination
Uniformed Service University of the Health Sciences
Department of Psychiatry
Objectives: At the completion of the class, students should be able to:
1. Describe the main components of the mental status examination
2. Compose a mental status examination based on a patient observation and
interview
3. Recognize the difference between thought process and thought content
4. Estimate degree of psychopathology based on the mental status examination
5. Document adequate safety (suicidal and homicidal) assessment of each
patient
The Mental Status Examination is an integral portion of the psychiatric interview.
It serves as a “snapshot” of the person you are evaluating. It should include all of the
pertinent observations and findings you accomplish during your encounter with the patient.
Not only is it important for describing the “state” of the patient, it is an important tool that
can help substantiate a diagnosis, convey information to another provider, and assist in
determining most appropriate step in treatment.
Based on the following sections, the mental status examination may appear quite
involved and complicated. This is not the case. As you will see, much of the information
for the mental status examination is obtained from the natural course of the interview.
It is important to state that the goal is not pinpoint the absolute correct term to
describe an observation. The beauty of the mental status examination is, even if you do
not know the specific term, you can use your own words and observations.
APPEARANCE
Yes, this is as straightforward as it sounds – this section describes how the patient
looks, smells, behaves, speaks, establishes eye contact, etc. If this section is thorough
enough, a reader of your mental status exam should be able to pick out the person out of a
room. The mental status exam starts when you first set eyes on the patient. The following
is a sample of items that should be included in the APPEARANCE section:
Ethnicity
Apparent age (younger, older, or appeared stated age)
Sex
Coordination/gait/notable movements
Adherence to social conventions (i.e., shakes hands, military bearing)
Build (Average, underweight, emaciated, petite, thin, obese, muscular)
Grooming (Good, poor, adequate, immaculate, neglected)
Dress (Casual, stylish, mismatched items, formal, tattered, appropriate
for particular setting)
Psychomotor activity (Described as increased in the case of agitation;
decreased in cases of depression or catatonia)
Page 1 of 9
A description of how the patient relates to the interviewer is a necessary
component of the APPEARANCE section. This is sometimes also described as the
“interpersonal style.”
Congenial
Guarded
Open/candid
Cooperative
Withdrawn
Distant
Annoyed/Irritable
Engaging
Hostile
Shy
Relaxed
Cautious
Defensive
Resistant
Speech is something you can also comm ...
the presentation describes in detail about the mental illness, i.e. schizophrenia along with its diagnostic criteria, symptoms, prognosis, course as well as its causes.
Archer USMLE step 3 Psychiatry lecture notes. These lecture notes are samples and are intended for use with Archer video lectures. For video lectures, please log in at http://www.ccsworkshop.com/Pay_Per_View.html
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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2. MENTAL STATUS EXAMINATION
describes the sum total of the examiner’s
observations and impressions of the
psychiatric patient at the time of the interview
the description of the patient’s appearance,
speech, actions, and thoughts during the
interview
3.
4. Appearance
Bizarre??
Has anyone ever commented
on your look?
How would you describe how
you look?
Can you help me understand
some of the choices you
make in how you look?
overall physical impression
posture, poise, clothing, and grooming
6. Speech characteristics
physical characteristics of speech in terms of
its quantity, rate of production, and quality
talkative, garrulous, voluble, taciturn,
unspontaneous, or normally responsive to
cues from the interviewer
can be rapid or slow, pressured, hesitant,
emotional, dramatic, monotonous, loud,
whispered, slurred, staccato, or mumbled
8. Overt behavior and psychomotor
activity
describes both the quantitative and qualitative
aspects of the patient's motor behavior
mannerisms, tics, gestures, twitches, stereotyped
behavior, echopraxia, hyperactivity, agitation,
combativeness, flexibility, rigidity, gait, and agility
restlessness, wringing of hands, pacing, and other
physical manifestations
9. Overt behavior and psychomotor
activity
psychomotor retardation or generalized
slowing of body movements
aimless, purposeless activity
10. Mood
defined as a pervasive and sustained emotion
that colors the person's perception of the
world
depth, intensity, duration, and fluctuations
depressed, despairing, irritable, anxious,
angry, expansive, euphoric, empty, guilty,
hopeless, futile, self-contemptuous,
frightened, and perplexed
can be labile, fluctuating or alternating rapidly
between extremes
11. Affect
Defined as the patient's present emotional responsiveness,
inferred from the patient's facial expression, including the
amount and the range of expressive behaviour
NORMAL - variation in facial expression, tone of voice,
use of hands, and body movements
CONSTRICTED - range and intensity of expression are
reduced
BLUNTED - emotional expression is further reduced
FLAT - no signs of affective expression should be
present; the patient's voice should be monotonous and
the face should be immobile
difficulty in initiating, sustaining, or terminating an
emotional response
12. Appropriateness of Affect
delusion of persecution - angry or frightened
about the experiences they believe are
happening to them
inappropriate affect for a quality of response
found in some schizophrenia patients, in
which the patient's affect is incongruent with
what the patient is saying
13. Perception
Hallucinations and illusions
Hypnagogic hallucinations - occurring as a
person falls asleep
Hypnopompic hallucinations - occurring as a
person awakens
Feelings of depersonalization and derealization
Formication - seen in cocainism
14. Thought content and mental
trends
Thought can be
divided into process
(or form) and content
PROCESS refers
to the way in
which a person
puts together
ideas and
associations, the
form in which a
person thinks.
15. Thought content and mental
trends
Thought can be
divided into process
(or form) and content
CONTENT refers
to what a person
is actually
thinking about:
ideas, beliefs,
preoccupations,
obsessions.
16. FORMAL THOUGHT DISORDERS
Circumstantiality Overinclusion of trivial or irrelevant details that impede
the sense of getting to the point.
Clang associations Thoughts are associated by the sound of words rather
than by their meaning (e.g., through rhyming or
assonance).
Derailment (Synonymous with loose
associations)
A breakdown in both the logical connection between
ideas and the overall sense of goal-directedness. The
words make sentences, but the sentences do not make
sense.
Flight of ideas succession of multiple associations so that thoughts
seem to move abruptly from idea to idea; often (but
not invariably) expressed through rapid, pressured
speech.
Neologism The invention of new words or phrases or the use of
conventional words in idiosyncratic ways.
Perseveration Repetition of out of context of words, phrases, or
ideas.
Tangentiality In response to a question, the patient gives a reply that
is appropriate to the general topic without actually
answering the question.
Thought blocking A sudden disruption of thought or a break in the flow
of ideas.
17. Sensorium and Cognition
The sensorium and
cognition portion
of the mental
status examination
seeks to assess
brain function,
including
intelligence,
capacity for
abstract thought,
and level of insight
and judgment.
18.
19.
20. Consciousness
Disturbances of consciousness usually indicate organic brain impairment
Clouding of consciousness is an overall reduced awareness of the
environment
patient who has an altered state of consciousness often shows some
impairment of orientation as well, although the reverse is not necessarily
true
clouding, somnolence, stupor, coma, lethargy, or alert
21. Orientation and memory
Any impairment usually appears in this order
(i.e., sense of time is impaired before sense of
place); similarly, as the patient improves, the
impairment clears in the reverse order
determine whether a patient can give the
approximate date and time of day
patients should be able to state the name and
the location of the hospital correctly and to
behave as though they know where they are
whether they know the names of the people
around them and whether they understand their
roles in relationship to them
22. MEMORY TESTS
Remote memory: Childhood data, important events
known to have occurred when the patient was younger or
free of illness, personal matters, neutral material
Recent past memory: The past few months
Recent memory: The past few days, what the patient did
yesterday, the day before, what the patient had for
breakfast, lunch, dinner
Immediate retention and recall: Digit-span measures;
ability to repeat six figures after examiner dictates theM
”first forward, then backward (patients with unimpaired
memory can usually repeat six digits backward); ability to
repeat three words immediately and 3 to 5 minutes later
23. Concentration and attention
A cognitive disorder, anxiety, depression, and internal
stimuli, such as auditory hallucinations, can all
contribute to impaired concentration
Subtracting serial 7s from 100 is a simple task that
requires intact concentration and cognitive capacities
Could the patient subtract 7 from 100 and keep
subtracting 7s? If the patient could not subtract
7s, could 3s be subtracted?
always assess whether anxiety, some disturbance of
mood or consciousness, or a learning deficit
(dyscalculia) is responsible for the difficulty
24. Concentration and attention
Attention is assessed by calculations or by asking the
patient to spell the word world (or others) backward.
The patient can also be asked to name five things
that start with a particular letter.
25. Reading and writing
ask the patient to read a sentence
patient should also be asked to write a simple but
complete sentence
27. Abstract thought
ability to deal with concepts
Can the patient explain similarities, such as those
between an apple and a pear or between truth
and beauty?
Are the meanings of simple proverbs, such as A
rolling stone gathers no moss, understood?
Answers can be concrete (giving specific examples to
illustrate the meaning) or overly abstract (giving too
generalized an explanation).
In a catastrophic reaction, brain-damaged patients
become extremely emotional and cannot think
abstractly.
28. Information and intelligence
Does the patient have trouble with mental tasks
patient's intelligence is related to vocabulary and
general fund of knowledge
patient's educational level (both formal and self-
education) and socioeconomic status must be taken
into account
psychiatrist estimates the patient's intellectual
capability and capacity to function at the level of
basic endowment
29. Impulsivity
Capability of controlling sexual,
aggressive, and other impulses
critical in ascertaining the
patient's awareness of socially
appropriate behavior and is a
measure of the patient's
potential danger to self and
others
Impulse control can be
estimated from information in
the patient's recent history and
from behavior observed during
the interview
30. Judgment
Does the patient understand the likely outcome of
his or her behavior, and is he or she influenced by
this understanding?
Can the patient predict what he or she would do in
imaginary situations (e.g., smelling smoke in a
crowded movie theater)?
31. Insight
Degree of awareness and understanding about being ill
A summary of six levels of insight follows:
1.Complete denial of illness
2.Slight awareness of being sick and needing
help, but denying it at the same time
3.Awareness of being sick but blaming it on
others, on external factors, or on organic factors
4.Awareness that illness is caused by something
unknown in the patient
32. Insight
5. Intellectual insight: admission that the patient is ill
and that symptoms or failures in social adjustment
are caused by the patient's own particular irrational
feelings or disturbances without applying this
knowledge to future experiences
6. True emotional insight: emotional awareness of the
motives and feelings within the patient and the
important persons in his or her life, which can lead to
basic changes in behavior.
33. Reliability
with the psychiatrist's impressions of the patient's
reliability and capacity to report his or her situation
accurately
includes an estimate of the psychiatrist's impression
of the patient's truthfulness or veracity
Editor's Notes
Do you ever find yourself suddenly doing something before you have really had a chance to think about it? Do you ever do things you had decided not to do, and don't know why? Does money "burn a hole in your pocket"?