the mental status exam - indian health service | indian ... mental status exam jonathan bolton md...
TRANSCRIPT
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The Mental Status Exam
Jonathan Bolton MD Center for Rural and Community
Behavioral Health University of New Mexico
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Thought
• Process – How thoughts are linked together
• Content – What the person thinks about
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Thought Process
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Thought Process4
Circumstantial
Tangential
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Flight of Ideas
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‘Word Salad’
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Thought Content
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Delusions
• Persecutory • Greatness (Grandiose) • Nothingness (Nihilistic) • Paranoid • Love (Erotomanic) • Jealousy • Guilt • Illness (Hypochondriacal) • Poverty
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Other Thought Content Problems
• Preoccupations • Over-valued ideas • Obsessions • Fears/Phobias
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Homicidality/Suicidality
• Gather historical information (e.g., attempts, methods, circumstances, substance abuse, family history)
• Not binary; dimensional • Assess for ‘motivation’
– To die – To get out of/end an intolerable situation – To hurt someone else – To hurt self, atone
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Perception
• Hallucination vs Illusion • Which senses?
– Auditory: sounds, voices (identifiable/not) – Visual: geometric/mandala, identifiable, vague – Olfactory – Sensory – Gustatory
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Schneiderian First Rank Symptoms (modified)
• Voices – Speaking his thoughts
out loud – Pt is subject of
discussion – Command
• Delusional percept (ideas of reference)
• Somatic passivity
• Thought – Insertion – Withdrawal – Broadcasting
• “Made” – Feelings – Impluses – Voluntary acts
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Other experiences
• Depersonalization • Derealization • Déjà vu • Jamais vu
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Insight
• The ability to be self-aware • To acknowledge illness/problems • Ask ‘Are you ill?’ • Lack of insight associated with psychosis,
conversion disorders, addictions • Anosognosia: extreme lack of insight due to
damage to the parietal lobe (right)
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Judgment
• Affected by level of insight (and cognitive abilities, intelligence, mood, personality, life circumstances, intoxication, delirium…)
• The process of consideration and formulation regarding a particular issue or situation that can lead to a decision/action.