2. The Mental Status Examination (MSE).ppt

8/21/2019 2. The Mental Status Examination (MSE).ppt

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The Mental StatusExamination (MSE)


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Mental Status

Mental status is the total expression ofa person’s emotional responses, mood,cognitive function, and personality

It is closely linked to the individual’sexecutive functioning, i.e. motivation,

initiative, goal formation, planning andperforming, self-monitoring, andintegration of feedback


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Quick Neurology Review

Frontal lobeSpeech formation (roca area!

"motions#affect$rive %&areness of self Short-term memory'oal-oriented behavior


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arietal lobeSensory perception

Spatial sense and navigation


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)emporal lobe erception and interpretation of sounds

*ernicke’s area Integration of behavior, emotion, and

personality

+ong-term memory


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+imbic system Survival behaviors (mating, aggression,

fear, affection!eactions to emotions, and expression of

affect is mediated by connections of thelimbic system and the frontal lobe


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Dementia

$ementia is a clinical syndrome,characteried by deteriorating cognition,

behavior, and functional independence It is usually related to obvious structural

disease of the brain (most commonly

atrophy!Dementia affects !""# of a$ults

ol$er than %&


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Mnemonic for causes of

$ementia

$ drugs and toxins" endocrine

/ metabolic and mechanical" epilepsy0 nutritional and nervous system

) tumor and trauma I infection % arterial


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Delirium

$elirium is different than dementia

It is an acute confusional state

accompanied by a disorder ofperceptionSymptoms include alterations in mental

status (disorientation!, attention span,sleep patterns, and affect

Sudden and fluctuating

1sually reversible


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Mental Status Examination

)he /S" is one component of an examand may be vie&ed as the

psychological e2uivalent of the physicalexam

It is an important component to aneurological evaluation


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'actors affecting the MSE

3ulture and educational background of thepatient *hat is abnormal for a person &ith high

intellectual ability may be normal for a person ofless education

atients &ith "S+ may have difficulty &ith some

components of the exam


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Maor om*onents of the MSE

4. %ppearance

5. /otor

6. Speech

7. %ffect 8 mood

9. )hought 3ontent

:. )hought rocess

;. erception


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+**earance

%ge

'ender

ace

ody build

osture

"ye contact

$ress

'rooming

/anner

%ttentiveness toexaminer

"motional facialexpression

%lertness


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Motor

ehavior leasant> 3ooperative> %ppropriate for the particular situation>

?esitancy %gitation

%bnormal movements'ait3atatonia


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S*eech

ate

hythm

@olume %mount

%rticulation

Spontaneity


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+ffect an$ Moo$

%ffect ?o& do they appear to you>

Stability

ange %ppropriateness

Intensity

/ood $r. asks the patient directly ho&

he#she feels


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Thought ontent

Suicidal ideation$eath &ishes

?omicidal ideation

$epressivecognition

Absessions

uminations

hobiasaranoid ideation

/agical ideation

$elusionsAvervalued ideas

$escription of &hat the patient is thinkingabout


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Thought ,rocess

%ssociations3oherence

+ogic

Stream3lang associations

erseveration0eologism

)hought blocking

%ttention

$escription of the &ay in &hich the patientthinks


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,erce*tion

?allucinations

Illusions

$epersonaliation$erealiation

dBCD vu

Camais vu


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-ntellect

'lobal impression average, aboveaverage, belo& average


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-nsight

%&areness of illness


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MSE

)he full /S" is a lengthy exam Eou assess many components of the /S"

in your normal &ork up of a patient*hen you need to do a shorter

neurological screening exam, you mayshorten the /S" to the /ini /ental Status"xam (//S"!


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MMSE

)akes approximately 4 minutes

)he //S" tests

Arientation Immediate and short-term memory

3oncentration

%rithmetic ability +anguage

raxis (learning!


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MMSE

Arientation *hat is the (year! (season!

(date! (day! (month!> *here are &e>(state! (country!

(to&n! (office! (floor! 9 points

egistration 0ame 6 obCects, taking 4

second to name each. )henask the patient to repeat them.4 point for each correct.

%ttention and 3alculation %sk the patient to countback&ards from 4 in ;s.Stop after 9 ans&ers.

%lternatively, ask the patient tospell G&orldH back&ards.

4 point for each correctans&er (9!

4 point for each correct

ans&er (9!




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MMSE ecall

%sk the patient for the 6 obCectsnamed under GegistrationH.

+anguage oint to t&o obCects and ask the

patient to name them (pen and&atch!. %sk the patient to repeat G0o ifs,

ands, or buts.H %sk the pt. to follo& a 6-step

command G)ake this paper in yourright hand, fold it in half, and put it

on the table.H %sk the pt. to read and obey the

follo&ing G3lose your eyes.H *rite a sentence. 3opy a dra&ing of intersecting

pentagons.

4 point for each correct ans&er(6!

4 point for each correct ans&er

(5!

4 point for correct ans&er (4!

4 point for each correct task(6!

4 point for correct task (4! 4 point for correct task (4! 4 point for correct task (4!

)otal (6!


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-nter*retation of the MMSE

)he traditional threshold for the //S" is a score of56 or greater

Scores of -56 argue strongly for the diagnosis of

dementia ut, false-positive results are a concern &hen

applied to large populations &ith lo& incidence ofdementia, so some experts prefer the follo&ing

scoring system -5 dementia highly probable 5:-6 dementia highly unlikely 54-59 results not conclusive


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)he //S" is a copyrighted psychologicaltest published by sychological %ssessmentesources (%!, Inc.


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So. why $o Ds nee$ to $o MSEs/

Emotional an$ 0ehavioral changes areoften the first signs of organic 0rain$isease

$oes the patient see his or her /.$. asfre2uently as he or she sees you, thechiropractor>

rain tumors, subdural hematomas, small

infarcts, and cerebral atrophy may beundetected on routine neurologicalexamination, &hereas the cognitive effects ofthese lesions may be apparent on an /S"


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Draw0acks

$oes a normal /S" or //S" indicatecompetence>

0o

3ompetence relates to a pt.’s ability toprovide food 8 shelter, to manage , and toparticipate in activities and decisions

ts. &ho score &ell may have difficulty &ithbasic activities of daily living


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Draw0acks

$oes an abnormal /S" or //S" indicateincompetence>

0ot necessarily

/any pts. &ith cognitive limitations developalternative means of coping &ith deficits,allo&ing them to live fairly independent

lives


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Draw0acks

)he /S" and //S" screenings havelimitations )hey are subCect to interpretive bias and

experience of the intervie&er

)hey have a fairly significant false-negative rate,esp. in pts. &ith right hemisphere lesions

$emographics and culture %ge (J:!, education

(K=th

grade!, limited cultural experiences, and lo&socioeconomic status limit usefulness

Screening 2uestionnaires are less sensitive tocognitive impairments


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Do you have to 0e a D 1 a

,sychiatrist2,sychologist/

0o. It is not realistic to expect that youevaluate a patient to the same level of apsychiatrist or a psychologist

ut, a large part of a person’s overall healthis his or her mental health

%s subluxations may be caused by

GthoughtsH, a person’s mental status shouldbe important to you


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Documentation of Mental

Status

$ocumentation of the patient’s mental statusis not remarkably different than thedocumentation for the history exam or

physical exam

Include it in the 0eurology section of your

narrative history


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Exam*le of normal3

G)he patient is alert and oriented x 6.3orrect registration of 6 obCects &as noted. %ttention and calculation are appropriate&ith serial ; counting. Short term memory isintact. +anguage skills are demonstrated&ithout evidence of agnosia, aphasia or

apraxia.H


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Exam*le of a0normal3

G)he patient is alert and oriented to person andtime, but is unable to identify the location,believing she is in her childhood home in

Amaha. 3orrect registration of 6 obCects isnoted. )he patient’s attention and calculation aredeficient, &ith the patient correctly countingback&ards from 4 by ;s to


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The MMSE an$ ,T

)he //S" is considered a componentof the neurological portion of the "8/L

therefore, no separate 3) code isentered

2. The Mental Status Examination (MSE).ppt

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