MENTALSTATUSEXAMINATION：精神状态检查

• Examiner uses paper and pencil • Total of 30 points orientation (10) recent memory (3) attention (3) calculation, spell backward (5) name, read, repeat (4) write (1) constructional ability (1) ideomotor praxis (3) • Not timed
EMOTION Affect Mood Suicide Homicide
EMOTION
AFFECT “Affect is to weather as mood is to climate” • predominate sad, euphoric, angry, anxious • intensity unmodulated • range narrow, broad • congruence incongruent with content MOOD euthymic, dysthymic, elated SUICIDE Do you ever wish you won’t wake up? Does it ever seem that life isn’t worth it? HOMICIDE Is there someone who deserves to be hurt?
TO ORIENT
To understand one’s relationship to the environment
Person Place Time
Situation
“Oriented X 3” “O X3”
Person Place Time
Situation
“Oriented X 3” “Oriented X 4” “O X3” “OX4”
PURPOSES
• • • • Detect Describe Neuroanatomical localization Assess functional implications of Abnormalities/deficits in:
• Behavior • Emotion • Cognition
Person Place Time
Situation
“Oriented X 3” “Oriented X 4” “O X3” “OX4”
ORIENTATION ASSESSES:
• • • • •
language perception reasoning remote memory recent memory
AROUSAL
COGNITIVE EXAM (“Mental status”)
Must know education
REASONING
LANGUAGE
MEMORY
ATTENTION
AROUSAL
Can the patient hear?
MEMORY
Immediate memory = attention Recent memory (episodic) Recall of three words at 5 minutes Ensure that pt has registered the items “Repeat these words after me, I want you to remember them.” Remote memory (semantic & episodic) Tends to overlap with knowledge, most of what we ask is overlearned Presidents, date of W.W.II, etc..
MEDICAL ENCOUNTER
Comprehensive global assessment
Focused selected assessment
IN PRACTICE, MOST ENCOUNTERS ARE FOCUSED
• Accordingly the formal mental status exam is often limited to an assessment of COGNITION • Further cognition is often assessed solely using: • ORIENTATION
MENTAL STATUS EXAMINATION
Outline
• Operational definition • Purposes • Components
– Behavior – Cognition – Emotion
• Cognitive examination • Mini Mental Status
Less precise Less comprehensive Shorter Examiner norms
More precise More comprehensive Longer Statistical norms
Mini Mental Status
Orientation Full mental status Neuropsychological Testing
Operations Arousal Attention Memory Emotion Language Reasoning
BEHAVIOR Appearance Attitude Activity Speech Dress Grooming Hygiene
COGNITION Thought content Coherence Goal directedness Insight/judgment
COGNITION Thought content Thought progression Insight/judgment
BEHAVIOR Appearance Attitude Activity Speech Dress Grooming Hygiene
COGNITION Thought content Coherence Goal directedneWhat is the (year) (season) (date) (day) (month)? Where are we? (state) (county) (city) (hospital) (floor)(10) Ask pt to repeat three objects - give one per second. Number repeated first trial = score (3). Present till all repeated or 6 presentations. Serial 7’s - 5 subtractions (93, 86, 79, 72, 65) (5). Score number of correct answers or spell “world” backward, score is number of letters in correct order. “dlorw” is 3 points.
MEDICAL ENCOUNTER
Comprehensive global assessment
BEHAVIOR Appearance Attitude Activity Speech Dress Grooming Hygiene
BEHAVIOR Appearance Attitude Activity Speech Dress Grooming Hygiene
Dress
Grooming Hygiene
casual, provocative, dirty
disheveled, meticulous clean, malodorous
COGNITIVE EXAM (“Mental status”)
REASONING
LANGUAGE
MEMORY
ATTENTION
MENTAL STATUS EXAMINATION:
What is it?
ASSESSMENT of the: • Behavior (see it all) • Emotion (see some of it) • Cognition (see none of it) Exhibited by the patient during the entire medical encounter
ABNORMALITIES & DEFICITS Require diagnostic explanation May compromise capacity • to coherently and reliably describe medical state • to give informed consent • to adhere to a therapeutic plan
BEHAVIOR Appearance Attitude Activity Speech Dress Grooming Hygiene
COGNITION Thought content Thought progression Insight/judgment Arousal Attention Memory Language Reasoning
REASONING (Higher cognitive fx)
Tests problem solving, abstract thinking Fund of knowledge - overlaps with remote memory How many weeks in a year? Name four presidents since 1940? What causes rust? Calculations Add, subtract, multiple, divide Sequences 1, 2, 3, ... 1, 4, 9, 16, .... 2, 3, 5, 7, 11, ...
REASONING (continued)
Similarities Apple - orange Car - airplane Poem - novel Proverbs Don’t cry over spilt milk A stitch in time saves nine People who live in glass houses shouldn’t throw stones
MINI MENTAL STATE EXAM
ADVANTAGES • brief (10 min), systematic bedside instrument • wide recognition among physicians • since it is standardized, the score it yields is meaningful to physicians familiar with it DISADVANTAGES • specific deficits may be ignored if the overall score is not low (less than 25 out of 30) • the global score has no localizing valve • repeated use with intact patients produces a mechanical transaction
Operations Arousal Attention Memory Emotion Language Reasoning
EMOTION Affect Mood Suicide Homicide
BEHAVIOR
Appearance Attitude Activity Speech appears stated age, uses a cane to walk cooperative, hostile, detached normal, increased, agitated, subdued normal rate/rhythm, dysarthric