Presentations text content in By Salina Chan, R3
Slide1
By Salina Chan, R3
2013
Slide2Psychiatric Diagnosis
Components of an accurate psychiatric diagnosis
History – HPI and
especially
past psychiatric history
Collateral
Psychiatric interview
Mental Status Exam
Biological workup
Slide3What is the Mental Status Exam (MSE)?
The MSE is a set of standardized observations and questions designed to evaluate 5 basic elements:
Sensorium
Perception
Thinking
Feeling
Behaviour
Slide4What is the Mental Status Exam (MSE)?
Integral part of
any
clinical interview, not just in the psychiatric context
Records only observed behaviour, cognitive abilities and inner experience during the interview
Partly integrated into the history
To help provide info re: diagnosis, help formulate
txn
plan, and follow a patient’s clinical course
Essential to a complete psych assessment
Slide5Helpful Determinants of Diagnosis
Reasons for referralPrevious personality/level of functioningThought disorder on the MSEPrevious psych d/oTesting for organic conditions
Personality testing
Insight & judgment on MSE
Appearance & behaviour on MSE
Affect & mood on MSE
Physical Exam
Slide6MSE Menomic
A = Appearance
S = Speech
E = Emotion
P = Perception
T = Thought form and thought content
I = Insight and judgment
C = Cognition
Slide750% of the MSE is FREE
Free Parameters
Level of ConsciousnessAppearanceBehaviorCooperationReliabilityAffectThought form
Parameters to ask about
Orientation
Cognitive functions
Suicidal/homicidal thoughts
Knowledge base
Perception
Mood
Thought content
Slide8A
Slide9Appearance
General appearance
Behaviour
Motor disturbances
Internal state
Cooperation, reliability, accessibility
For your exam: describe from outside then go inward
Slide10Slide11Appearance
Gender & Cultural background
Actual and apparent age
Attire
Grooming and hygiene
Body
habitus
Physical abnormalities & assistive devices
Jewelry & cosmetics
Other notable Features
Slide12Appearance
77
yo
white Caucasian M who looked his stated age, thin and tall, with neatly groomed beard, dressed casually and, walked with a cane and an
antalgic
gait
34
yo
Asian female who looked younger than her stated age, average body size, dressed provocatively, wearing
colourful
makeup applied in excess, with a number of rings adorned on her fingers, with tattoo along the right side of her neck
Slide13Slide14Behaviour
General ObservationsActivity levelHabits & mannerismsPsychomotor agitation, restlessness or retardation
Specific Movement
Abnormalties
Akathisia
Automatisms
Catatonia
Choreoathetoid
mvmts
Compulsions
Dystonia
& EPS
Tardive
Dyskinesia
Tremors
Negative Symptoms
Slide15Behaviour
Pt sat comfortably in the room with his arms folded across his chest and absent-mindedly
figeted
with the zipper of his jacket.
Slide16Slide17Cooperation & Reliability
Eye Contact
Attitude/Demeanor
Attentiveness to the I/V
LOC
Affect
Secondary Gain
Malingering
Factitious
d/o
Slide18S
Slide19Slide20Speech
Primary language d/oE.g. aphasia, dystarhria, anomia, apraxiaQuality of speechAccent, dialect, amount (), articulation, modulation Quantity of speech
Prosody
Pitch/intonation/musicality
Spontaneity/latency
Rhythm/cadence
Stress/inflection
Volume
Slide21E
Slide22Mood & Affect
Slide23Affect & Mood
Mood
The person’s internal feeling state, subjective
“emotional background”
Affect
Visible, external, or objective manifestation of emotional state
“emotional foreground”
Slide24Affect & Mood
Affect
Type/QualityRange/VariabilityDegree/IntensityStability/MobilityAppropriatenessCongruence
Mood
TypeQuality
Reactivty
Intensity
Stability/Duration
Pattern
Slide25P
Slide26Slide27Perception
HallucinationsIllusionsDisturbances of self & environmentDepersonalizationDerealizationDisturbances of experiencesDeja vuJamais vu
Disturbances of Quality of size
Micropsia
Macropsia
Dysmegalopsia
Disturbances in intensity of perception
Hyperacusis
Visual
hyperaesthesia
Slide28T
Slide29Thought Form/Process
Describes the way in which ideas are produced and organized
An assessment of how patients are communicating
Degree of connection
b/t
ideas
Flow of thought
Assessed via speech, writing and behaviour
Slide30Thought Form
Logical and goal-oriented?
Tangential or Circumstantial?
Flight of Ideas?
Loosening of Associations?
Slide31Designed to show thoughts of persecution
Slide32Thought Content
What the patient talks about
Delusions = fixed, false belief
Lots of different ones!
Overvalued Idea = preoccupy patient’s thinking and alter behaviour
Less firmly held – pt can admit not true
Content less absurd & Not systematized
Obsessions = Thoughts/impulses/images that are recurrent, unwanted, not controllable, recognized as
irrationa
Slide33Thought Content
Phobias = marked, persistent fears that are excessive, with anxiety
Thoughts of suicide and homicide.
Be direct and specific when asking
Suicide assessment lecture
Slide34I
Slide35Insight & Judgment
Insight
Awareness of having illnessUnderstanding of factors contributing to illnessAppreciation that various signs and symptoms part of diseaseAwareness of illness impacts on other ppl and society Acknowledgment of need for txn
Judgment
Appraising the situation
Surveying the alternatives
Weighing the alternatives
Deliberating about selection
Making a commitment to a choice
Slide36C
Slide37Sensirium & Cognitive
LOC and attentiveness
Orientation
x
3
Attention
Concentration
Memory
Knowledge
Intelligence
Capacity for abstract thinking
Slide38Examples
Catatonia:
http://www.youtube.com/watch?v=_s1lzxHRO4U&list=PLB917B13752F820BE&index=24
Pressured Speech:
http://www.youtube.com/watch?v=F_YPZt7CuNY&list=PLB917B13752F820BE&index=16
Thought Block
http://www.youtube.com/watch?v=0u9d96b-Tyc&list=PLB917B13752F820BE&index=6
Delusion
http://
www.youtube.com/watch?v
=Gc2Nox6PMnc&list=PLB917B13752F820BE&index=7&ytsession=v_3GrpGVjj4SZQikefVmIwQM3XDixgmygOKTnNMFPF8U3b9mP0Rhpm8KNWmuRRAIEmGzO3q7MnFfwhhwSzSaCdwdRAh8Q6SOLbrnLYz55bdDdSrGVc_jA7k1q4MZ2MR2Z7YN4hYQII4EeeMYhFa99GHdynP62Qai9rNUAVjYpEXKIq83rtLJEFIjtc58SYPmJ0D9kHZEun5FZalQsGSw5woaoPvtU8FmcZnny-S3jfw_R_oVmcfHXY3Mmo7l0hTnPdBhubWfENumayfjnzJbX3LLF2OMVMUnfgbBSfsAy_PraWyJMcW-8t-fN_PVGCrHWdB8scm4ETqkDr1KgCg4gaP7czlWq_zh4tEX-IoFuIPYt06Szua9SxEC8-of_f0I97iQ9IOcU4Crv7tM5S7eNLSy4Xw2gBqn299ZtKhgv5DwWnay2eANL3fNxr5L3aaZS_VGX-3NyFA6PHZ-itMqjQLhgEYfMc4iwYRixaPjUrQRJoCtObxUCPxjv-s1oUtn2
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By Salina Chan, R3
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