Psychiatry II Lecture 2 – Mental Status Examination c.

Depersonalization & Derealization- extreme

Department of Neurology and Psychiatry USTFMS ‘08
feelings of detachment from the self or
-notes from Jo-Anne Ponce; last year’s lecture
environment
d. formication
INTERVIEW OF PSYCHIATRIC PATIENT PURPOSE
1. diagnostic
2. therapeutic
V. Thought Content and Mental Trends
Interview – verbal and non-verbal (of two participants) whose - thought process- way in which a person puts
behaviors affect each other’s style of communication resutin gin together ideas & associations
specific patterns of interaction - thought content- what a person is actually thinking
about: ideas, beliefs, obsessions
Basic Elements
1. A – Attention Thought __________
2. R – Rapport
3. F – Freedom from interruption A. Process or form of thought
4. P – Psychological privacy 1. loosening of association: do the ideas expressed
5. E – Emotional objectivity seem unrelated & idiosyncratically connected
Engagement – refers to the ongoing development of a sense of 2. neologism: invention of new words or phrases or the
safety and respect from which the patient feels increasingly at use of conventional words in idiosyncratic ways
ease 3. flight of ideas: succession of multiple associations
so that thoughts seem to move abruptly from idea to
Rapport – establish positive relation idea; often expressed thorugh rapid, pressured
speech
Empathy – Carl Rogers – ability to recognize immediate emotional
perspective of another person while maintaining own perspectives 4. thought blocking: sudden interruption of thought or
a break in the flow of ideas
Sympathy – over identification with the patient and does nothing • racing thoughts
5. Circumstantiality: overinclusion of trivial or
Ideal Interview Techniques irrelevant details that impede the sense of getting
1. open-ended questions – minimally structured to the point
2. facilitation
3. clarification 6. Tangentiality: in response to a question, patient
4. confrontation gives a reply that is appropriate to the general topic
5. direct questions w/out actually answering the question
7. Word Salad
Psychiatric history (45 mins to 1 hr) 8. Clang Association: thoughts are associated by the
I. Identifying Data sound of words rather than by their meaning
II. Chief Complaint (rhyming or assonance)
III. Pre-morbid
• Personal History (Anamnesis) 9. Punning: association of double meaning
o Prenatal/perinatal B. Content of Thought
o Early childhood • delusions and false beliefs
o Middle childhood and late childhood • phobias
o Adolescence • preoccupations
o Adulthood • suicidal ideas
• paranoia
 Sexual history = after 6th or 7th
session
VI. Sensorium and Cognition – conscious or abstract
thought, orientation, insight, judgement
Mental Status Examination
I. General Description • MMSE- orientation, memory, calculations, reading &
writing, visuospatial ability, language
- Appearance: posture, poise, clothing, grooming
o Signs of anxiety: moist hands, perspiring VII. Consciousness: clouding, somnolence, stupor, coma,
forehead, tense posture, wide eyes lethargy, alert
- behavior and psychomotor activity:
o mannerisms, tics, gestures, twitches, VIII. Orientation & Memory
stereotyped behavior, echopraxia Remote Childhood data, important events known to have
Memory occurred when the patient was younger or free
- attitude toward the examiner: of illness, personal matters, neutral material
o cooperative, friendly, defensive, hostile, Recent Past The past few months
guarded Recent The past few days, what the patient did
yesterday, the day before, what the patient had
II. Mood and Affectivity for breakfast, lunch, dinner
- Mood: pervasive & sustained emotion that colors the Immediate Digit-span measures; ability to repeat six figures
person’s perception of the world; includes depth, Retention & after examiner dictates them- first forward,
intensity, duration, fluctuations Recall then backwar; ability to repeat 3 words
immediately & 3-5 minutes later
- Affect: patients present emotional responsiveness,
inferred from facial expressive behavior; normal,
constricted, blunted, flat IX. Reliability
- Appropriateness of affect X. Concentration & Attention
XI. Reading & Writing
Affect – external expression of one’s feeling during interview XII. Visuospatial Ability
Mood – internal sustained emotional state of the patient XIII. Abstract Thought
- overall expression of emotions XIV. Information & Intelligence
XV. Impulsivity
III. Speech Characteristics XVI. Judgement & Insight
a. Quantity, rate of production, quality
b. Dysprosody- unusual rhythm or accent
Further Diagnostic Studies
IV. Perception – illusions, hallucinations 1. Physical Exam
2. Neurological Exam
a. Hypnagogic hallucination- occurs as one falls 3. additional psych tests
asleep
b. Hypnopompic hallucination- as one wakes up Diagnosis
DSMIV – Multiaxial (?)
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