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Definition
| air of confidence and enjoyment; a mood more cheerful than usual. |
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Definition
| feelings of joy, triumph, intense self-satisfaction, or optimism |
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Definition
| expression of feelings without restraint with an overestimation of their importance |
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Definition
| feeling of intense rapture |
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Definition
| intense elation with feelings of grandeur. |
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Definition
| easily annoyed and provoked to anger |
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Definition
| psychopathological feeling of sadness. |
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Definition
| loss of interest in and withdrawal from all pleasurable activities, often associated with depression. |
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Definition
| sadness appropriate to a real loss. |
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Definition
| thoughts of taking one's own life. |
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Term
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Definition
a person's difficulty in describing or being aware of emotions.
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Term
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Definition
•“Normal” appropriate= a broad range of affect
–i.e. when discussing something unhappy the individual appears sad and laughs when things are funny
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Term
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Definition
| disharmony between emotional feeling tone, idea, thought, or speech accompanying it |
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Definition
| severe reduction in the intensity of external tone of feeling |
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Definition
| rapid and abrupt changes in emotional tone that is unrelated to external stimuli |
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Term
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Definition
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Term
| Look for “appropriateness” of emotions based on the subject matter being discussed. |
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Definition
•Discussing the recent death of a child with cheerfulness or smiles
•Discussing a recent promotion with sadness and anger
•Discussing a children’s movie they recently saw with intense fear and apprehension
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Term
| Biological Indicators that can alter expressed affect |
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Definition
•Ask about psychophysiological changes
–Diurnal variation of mood
–Changes in sleep
–Changes in appetite and weight
–Changes in libido
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Term
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Definition
•Continuity of Thought
– The extent to which a person’s thoughts are goal directed.
–Disturbances are thought to be caused by:
•Pathological disorders (e.g. Schizophrenia, head injury)
•If not pathological in nature examine if they are due to limited intelligence, culture factors or a severe reaction to overwhelming negative emotional states
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Term
•Continuity of Thought (measured by speech)
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Definition
Clang associations – connected illogically by rhyming or puns
Echolalia – person repeats what you say (copy cat)
Neologisms – invented or condensed words that have meaning only to the the patient (quantrum)
Perseverations – involuntarily responding to all questions in the same way
Word salad – nonsense words and phrases
Looseness of associations – jumps from one topic to another, the connection between the topics is lost
Blocking – sudden lapse of thought mid sentence without recovery of train of thought
Circumstanitiality – absence of direction toward a goal of thought. Very detail oriented, they get stuck but do come to a conclusion
Tangentiality – severe circumstantiality where the individual strays completely from the topic and includes thoughts seem to be totally unrelated or irrelevant (Seen in Schizophrenia most commonly)
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Term
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Definition
Reveals how connected, coherent, and logical the patient's thoughts are.
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Term
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Definition
| deep seated false belief despite objective contradictory evidence |
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Term
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Definition
| (false belief that the person has a special link with God) |
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Term
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Definition
•Don’t Challenge the Delusions but evaluate them.
•Evaluate:
–Severity
–Fixedness
–Elaborateness
–Power to influence the patient
–Deviation from normal (Bizarre vs. Non-Bizarre)
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Term
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Definition
•Suicidal and/or Homicidal Ideation
•Preoccupations (e.g., with illness or symptoms).
•Obsessions (repetitive, and intrusive thoughts, images, or impulses)
•Compulsions (repetitive and intrusive actions)
•Phobias (excessive and irrational fears)
•Paranoia
•Ideas of reference and influence
•Poverty of Content (lack of words)
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Term
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Definition
Always ask about suicidal thoughts especially if there is any sign of depression
In a Mental Status Exam: Always ask about any history of suicidal thoughts and record the response in your write-up:
“Pt denied current suicidal ideation.”
“Pt. stated no history of suicidal ideation”
“Have you ever thought of hurting yourself or other people? Why are you no longer suicidal and what has changed?”
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Term
Follow-up on all potential suicidal thoughts.
Create a “contract” with the patient
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Definition
-Hospitalize if the patient is unable or unwilling to follow-up or create a “contract”.
Keep following up.
-Attempt to help the patient change the hopeless/helpless ideation about their life.
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Term
| Format for write-up of Thought |
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Definition
| evaluation of suicidal and/or homicidal thoughts, gestures or actions. |
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Term
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Definition
•Abnormal sensory functioning
•Hallucinations - sensory impression with no external stimulus
•**Auditory (most common in psychosis)**
•**Visual (most common in medical disorders)**
•Tactile (haptic) - touch
•Gustatory – taste
•Olfactory - smell
•Vestibular sense – feels like flying
•Hallucinosis – associated with chronic alcohol abuse and that occur within a clear sensorium, as opposed to delirium tremens (DTs), hallucinations that occur in the context of a clouded sensorium.
•Hallucinations can also occur when falling asleep (hypnogogic) or when awaking (hypnopompic). (these are generally nonpathological).
Hypnogogic: feel like you’re falling when you’re falling asleep.
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Term
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Definition
–Illusions – misrepresentation of real stimuli (thinking a stranger is someone you know until they get closer).
–Depersonalization – loss of reality of the self (the persons feels they are different). See yourself outside your body.
–Derealization – the person feels their environment has changed and that external reality is no longer familiar. Take off your glasses, your world is a little fuzzier. Usually temporary.
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Term
Format for write-up
of Perception
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Definition
Perceptual Alterations: Record hallucinations in any of the six sensory spheres (auditory, visual, olfactory, gustatory, tactile and somatosensory) being aware of possible neurologic and physical etiologies. Document any illusions, depersonalization or dissociation currently or recently.
Perceptional disturbance.
-”Do you see or hear things that other people don’t see or hear”.
-”I’m glad you don’t hear and see things other people don’t".
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Term
Format for write-up
of Judgment
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Definition
Judgment: Evaluate and document the level of judgment (i.e. poor to excellent or critical, automatic, impaired).
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Term
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Definition
the capacity to understand that there is a problem, to think about how it came about.
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Term
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Definition
1. Complete denial of illness
2. Slight awareness of being sick and needing help but denying it at the same time.
• Awareness of being sick but blaming it on others, on external factors, or on organic factors.
• Awareness that illness is due to something unknown in the patient.
• Intellectual insight: admission that the patient is ill and that symptoms or failures in social adjustment are due to the patient's own particular irrational feelings or disturbances without applying this knowledge to future experiences.
• True emotional insight: emotional awareness of the motives and feelings within the patient and the important people in his or her life, which can lead to basic changes in behavior.
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Term
| Format for write-up of Insight |
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Definition
Insight: Document the individuals understanding of their illness, it’s severity and seriousness, it’s treatment and their need for therapeutic interventions, and any other special circumstances such as criminal charges, conservatorships, etc. Use the appropriate label for the person’s level of insight.
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Term
Physical Examination:
Appearance and Behavior |
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Definition
•Describe the individual so that anyone who is reading your report will understand what they looked like during the interview:
–Record overall physical appearance
–How old does the patient look? Older or younger their stated age
–Grooming – are they appropriately dressed, clean?
–Note eye contact or lack of eye contact
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Term
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Definition
•Level of consciousness – How alert is the patient during the interview
–This is especially important in psychiatric and hospital settings and will dictate the presentation of their mental functioning
–Described on a continuum from comatose to alert.
•Comatose, Stupor, Lethargy, Drowsy, Alert
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Term
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Definition
How alert is the patient during the interview
–Described on a continuum from comatose to alert.
•Comatose, Stupor, Lethargy, Drowsy, Alert
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Term
| Consciousness (5 broad levels) |
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Definition
•1. Coma – no verbal or motor responses in response to noxious stimuli
•2. Stupor – individuals required repeated stimulation to be roused
•3. Lethargy – individuals are sleepy, and indifferent. They respond in a manner which is incomplete and delayed
•4. Drowsy – individuals who are sleepy but can be roused by aversive stimuli
•5. Alert – wakefulness. Individuals respond promptly and appropriately.
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Term
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Definition
•1. Disorientation – disturbance of orientation in time, place or person
•2. Clouding of consciousness – incomplete clear-mindedness with disturbances in perception and attitudes
•3. Delirium – restless, confused, disoriented associated with fear and hallucinations
•4. Coma vigil – patient appears to be asleep but ready to be aroused (AKA akinetic mutism)
•5. Twilight state – disturbed consciousness with hallucinations
•6. Dreamlike state - often used as a synonym for complex partial seizure or psychomotor epilepsy
•7. Somnolence – abnormal drowsiness
•8. Confusion – involves in appropriate reactions to environmental stimuli; manifested by disordered orientation
•9. Sundowning – syndrome in older persons that usually occurs at night and may consist of confusion, drowsiness, ataxia and falling (usually associated with overly sedative medications)
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Term
•If consciousness is impaired what does it tell us?
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Definition
–Mild impairment observed in individuals with unilateral cortical or thalamic lesions
–Severe impairment in individuals with damage to the brainstem or bilateral lesions of the thalami or cerebral hemispheres
–Toxic or metabolic factors also common causes of impairment
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Term
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Definition
Record a description of the person’s appearance including but not limited to their general height, weight, body type, neatness, cleanliness, manner of dress and whether they appear their stated age. Also note the person’s level of consciousness.
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Term
Assessment Areas of Cognition
Mini Mental State (Status) Examination
Mini Mental State (Status) Examination
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Definition
1. Level of Consciousness
2. Orientation
3. Attention and Concentration
4. Registration of information
5. Memory
6. Language
7. Visuo-spatial abilities
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Term
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Definition
Assessment of certain functions is critically dependent on the integrity of other functions.
Critical Skills
•1. Level of consciousness and attention
•2. Memory: immediate, short and long term
•3. Language: naming, fluency, repetition
•4. Visuospatial Skills: construction abilities
•5. Executive Skills: abstraction
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Term
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Definition
| the areas of the brain that process and register incoming sensory information and make possible the conscious awareness of the world. |
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Term
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Definition
•The “normal” patient is alert, oriented, aware, and able to cooperate and sustain attention through out the interview.
Clear and Cloudy.
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Term
| Mini Mental State Examination (MMSE) |
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Definition
•Empirically validated screening tool (widely used)
•Score of 0-30 possible
–Normal
–Mild impairment
–Moderate impairment
–Severe impairment
•This measure does not DIAGNOSE !! (distinguish the nature of an illness through medical analysis).
•Good test-retest reliability
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