1 The Mental Status Exam & Screening for Neurological Injuries University of South Dakota...
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Transcript of 1 The Mental Status Exam & Screening for Neurological Injuries University of South Dakota...
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The Mental Status Exam & The Mental Status Exam & Screening for Neurological Screening for Neurological
InjuriesInjuries
The Mental Status Exam & The Mental Status Exam & Screening for Neurological Screening for Neurological
InjuriesInjuries
University of South Dakota
Vermillion, South Dakota
University of South Dakota
Vermillion, South Dakota
Dale Pietrzak, Ed.D., LPC-MH, CCMHCDale Pietrzak, Ed.D., LPC-MH, CCMHC
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Mental Status Exam: GeneralMental Status Exam: General
The MSE is analogous to the physical exam. The focus is the current signs, symptoms, affect, behavior and cognition.
Outline is the standard way of collecting the information
A good interviewer is not just listening to content. He or she is also observing affect, motor, speech, and thought processes.
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Mental Status Exam: OutlineMental Status Exam: Outline
Appearance Motor Behaviors &
Skills Speech Affect Thought Content
Thought Processes Perception Intellect Insight Mini-Mental Status
Exam (pg 123)
Zimmerman (1994) page 120-125
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MSE: AppearanceMSE: Appearance
Age Sex, Race Build Position & Posture Eye Contact Dress Grooming Interaction Style
Attentiveness Distinguishing
features Physical
Abnormalities Facial expression Alertness
Don’t I look good?
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MSE: MotorMSE: Motor
Retardation-Acceleration Agitation Abnormal Movements Gait & Stance Catatonia
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MSE: SpeechMSE: Speech
Rate Rhythm Volume Articulation Spontaneity Amount & Style
And ... Yabidy yabidy yabidy yabity yab ...
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MSE: AffectMSE: Affect
Stability range Appropriateness Intensity Affect (in session) Mood (patient’s report)
I’m just so sadall the time. Whatshould I do?
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MSE: Thought ContentMSE: Thought Content
Suicide-Homicide Obsessiveness,
ruminations Depressive Phobias Ideas of reference
Paranoia Magical Ideation delusions Overvalued Ideas Major themes
I do not have aproblem. My wife
just does not understandI am a fish.
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MSE: Thought ProcessesMSE: Thought Processes
Associations Coherence Logic Stream of thought Clang Associations
Perseveration Neologisms Blocking Attention & Vigilance
I am a special typeof fish. I can be outof the water for ...
I see
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MSE: PerceptionMSE: Perception
Hallucinations Illusions Depersonalization Derealization Deja vu-Jamais vu
I am telling youGod spoke tome about it!
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MSE: IntellectMSE: Intellect
Global evaluation (Below Average, Average, above Average)
I am so bright...
If he wereany slowerhe could beoutsmartedby his fish!
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MSE: InsightMSE: Insight
Current Awareness of Illness Current Understanding of Causes Current Acceptance of Treatment
*$(%#
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MSE: MMSEMSE: MMSE
2nd Major aspect of MSE is to RULE OUT Neurological Difficulties
Screener for Gross Neurological Injury or Impairment
Late Adolescents, Adults and the Elderly
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WhyWhy should the Mental should the Mental Health Professional Health Professional carecare??
Hartlage (1990)
It is almost inevitable that any practicing clinical, school, or counseling psychologist will encounter, in the course of professional practice, individuals who have sustained head injury.
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Incidence StatisticsIncidence StatisticsIncidence StatisticsIncidence Statistics
9 million new cases a year By age 60 the average American will have
suffered 2 significant head injuries Head injury is perhaps more common than
any other single mental health etiology. Typical head injury victim usually does not
seek help (<1 in 20 hospitalized)
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Brain Injury Fast FactsBrain Injury Fast Facts
No linear relationship between severity of injury and severity of problems
Mild injuries may not have lost consciousness, few overt signs of injury
Often misdiagnosed depressed or PTSD IQ tests and related measures may mask
some of the symptoms of head injury No single test type can screen for injuries Children often diagnosed ADHD
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Some Symptoms of InjurySome Symptoms of Injury Depersonalization Anxiety Hostility Irritability Restlessness Overactivity or
underactivity Balance Impairment Nausea
Dizziness Fatigue Headaches Malaise Decreased Libido Insomnia Depression Labile affect Inappropriate
Social Behavior
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Fundamental AnatomyFundamental AnatomyFundamental AnatomyFundamental Anatomy
Cerebrum Cerebellum Brain Stem Cranial Nerves Spinal Cord Connective Nerves
Central Nervous SystemCentral Nervous System
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Assessment ComponentsAssessment ComponentsAssessment ComponentsAssessment Components
History Orientation Screen Gross Motor Systems Screen Fine Motor Systems Screen Sensory Systems Screen Mental Processes Screen Verbal Processes
History Orientation Screen Gross Motor Systems Screen Fine Motor Systems Screen Sensory Systems Screen Mental Processes Screen Verbal Processes
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OrientationOrientationOrientationOrientation
Time/Date Place Person (body
position /situation)
Who am I?Where am I?What year is it?
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Concentration & AttentionConcentration & AttentionConcentration & AttentionConcentration & Attention
Vigilance (simple) Vigilance (complex) Concentration
Are you on task?
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Visual ProcessesVisual ProcessesVisual ProcessesVisual Processes
Tracking Neglect Suppression
/Extinction
Tracking Neglect Suppression
/Extinction
Visual QuadrantsVisual Quadrants
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Auditory ProcessesAuditory ProcessesAuditory ProcessesAuditory Processes
Hearing and Neglect Suppression or Extinction
What’d you say?
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Tactile SensationTactile SensationTactile SensationTactile Sensation
Neglect Suppression
Reach out and touch someone .
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Motor and BalanceMotor and BalanceMotor and BalanceMotor and Balance
Balance Purposeful
Movements
Come on and move with me!
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Language ProcessesLanguage ProcessesLanguage ProcessesLanguage Processes
Auditory Comprehension Written Comprehension Confrontational Naming Oral Expression Written Expression
What we have hereis a failure to communicate.
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Short-Term Memory Learning Curve Recent Memory Remote Memory Retention
Short-Term Memory Learning Curve Recent Memory Remote Memory Retention
Memory and LearningMemory and LearningMemory and LearningMemory and LearningNow, what
was I supposedto remember?
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Construction/Spatial/Fine MotorConstruction/Spatial/Fine Motor
Bender Clock Drawing Complex Figure Test (Rey or Taylor) Fine Motor Sequencing
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Nonverbal & Tactile ProcessingNonverbal & Tactile Processing
Rhythm Tactile Comprehension
Rhythm Tactile Comprehension
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Reasoning & JudgmentReasoning & JudgmentReasoning & JudgmentReasoning & Judgment
Verbal Reasoning Judgment & Problem Solving
Verbal Reasoning Judgment & Problem Solving
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The EndRun for
it!