heMentalStatusExaminationMSEPalmerCollegeof精神状态检查MSE帕大学.ppt

TheMentalStatusExamination MSE MentalStatus Mentalstatusisthetotalexpressionofaperson semotionalresponses mood cognitivefunction andpersonalityItiscloselylinkedtotheindividual sexecutivefunctioning i e motivation initiative goalformation planningandperforming self monitoring andintegrationoffeedback QuickNeurologyReview FrontallobeSpeechformation Brocaarea Emotions affectDriveAwarenessofselfShort termmemoryGoal orientedbehavior QuickNeurologyReview ParietallobeSensoryperceptionSpatialsenseandnavigation QuickNeurologyReview TemporallobePerceptionandinterpretationofsoundsWernicke sareaIntegrationofbehavior emotion andpersonalityLong termmemory QuickNeurologyReview LimbicsystemSurvivalbehaviors mating aggression fear affection Reactionstoemotions andexpressionofaffectismediatedbyconnectionsofthelimbicsystemandthefrontallobe Dementia Dementiaisaclinicalsyndrome characterizedbydeterioratingcognition behavior andfunctionalindependenceItisusuallyrelatedtoobviousstructuraldiseaseofthebrain mostcommonlyatrophy Dementiaaffects3 11 ofadultsolderthan65 Mnemonicforcausesofdementia D drugsandtoxinsE endocrineM metabolicandmechanicalE epilepsyN nutritionalandnervoussystemT tumorandtraumaI infectionA arterial Delirium DeliriumisdifferentthandementiaItisanacuteconfusionalstateaccompaniedbyadisorderofperceptionSymptomsincludealterationsinmentalstatus disorientation attentionspan sleeppatterns andaffectSuddenandfluctuatingUsuallyreversible MentalStatusExamination TheMSEisonecomponentofanexamandmaybeviewedasthepsychologicalequivalentofthephysicalexamItisanimportantcomponenttoaneurologicalevaluation FactorsaffectingtheMSE CultureandeducationalbackgroundofthepatientWhatisabnormalforapersonwithhighintellectualabilitymaybenormalforapersonoflesseducationPatientswithESLmayhavedifficultywithsomecomponentsoftheexam MajorComponentsoftheMSE AppearanceMotorSpeechAffect moodThoughtContentThoughtProcessPerceptionIntellectInsight Appearance AgeGenderRaceBodybuildPostureEyecontact DressGroomingMannerAttentivenesstoexaminerEmotionalfacialexpressionAlertness Motor Behavior Pleasant Cooperative Appropriatefortheparticularsituation HesitancyAgitationAbnormalmovementsGaitCatatonia Speech RateRhythmVolumeAmountArticulationSpontaneity AffectandMood Affect Howdotheyappeartoyou StabilityRangeAppropriatenessIntensityMood Dr asksthepatientdirectlyhowhe shefeels ThoughtContent SuicidalideationDeathwishesHomicidalideationDepressivecognitionObsessionsRuminations PhobiasParanoidideationMagicalideationDelusionsOvervaluedideas Descriptionofwhatthepatientisthinkingabout ThoughtProcess AssociationsCoherenceLogicStreamClangassociations PerseverationNeologismThoughtblockingAttention Descriptionofthewayinwhichthepatientthinks Perception HallucinationsIllusionsDepersonalizationDerealizationd j vujamaisvu Intellect Globalimpression average aboveaverage belowaverage Insight Awarenessofillness MSE ThefullMSEisalengthyexamYouassessmanycomponentsoftheMSEinyournormalworkupofapatientWhenyouneedtodoashorterneurologicalscreeningexam youmayshortentheMSEtotheMiniMentalStatusExam MMSE MMSE Takesapproximately10minutesTheMMSEtests OrientationImmediateandshort termmemoryConcentrationArithmeticabilityLanguagePraxis learning MMSE Orientation Whatisthe year season date day month Wherearewe state country town office floor 5pointsRegistration Name3objects taking1secondtonameeach Thenaskthepatienttorepeatthem 1pointforeachcorrect AttentionandCalculation Askthepatienttocountbackwardsfrom100in7s Stopafter5answers Alternatively askthepatienttospell world backwards 1pointforeachcorrectanswer 5 1pointforeachcorrectanswer 5 1pointforeachcorrectanswer 3 1pointforeachcorrectanswer 5 MMSE Recall Askthepatientforthe3objectsnamedunder Registration Language Pointtotwoobjectsandaskthepatienttonamethem penandwatch Askthepatienttorepeat Noifs ands orbuts Askthept tofollowa3 stepcommand Takethispaperinyourrighthand folditinhalf andputitonthetable Askthept toreadandobeythefollowing Closeyoureyes Writeasentence Copyadrawingofintersectingpentagons 1pointforeachcorrectanswer 3 1pointforeachcorrectanswer 2 1pointforcorrectanswer 1 1pointforeachcorrecttask 3 1pointforcorrecttask 1 1pointforcorrecttask 1 1pointforcorrecttask 1 Total 30 InterpretationoftheMMSE ThetraditionalthresholdfortheMMSEisascoreof23orgreaterScoresof0 23arguestronglyforthediagnosisofdementiaBut false positiveresultsareaconcernwhenappliedtolargepopulationswithlowincidenceofdementia sosomeexpertspreferthefollowingscoringsystem 0 20 dementiahighlyprobable26 30 dementiahighlyunlikely21 25 resultsnotconclusive TheMMSEisacopyrightedpsychologicaltestpublishedbyPsychologicalAssessmentResources PAR Inc So whydoDCsneedtodoMSEs EmotionalandbehavioralchangesareoftenthefirstsignsoforganicbraindiseaseDoesthepatientseehisorherM D asfrequentlyasheorsheseesyou thechiropractor Braintumors subduralhematomas smallinfarcts andcerebralatrophymaybeundetectedonroutineneurologicalexamination whereasthecognitiveeffectsoftheselesionsmaybeapparentonanMSE Drawbacks DoesanormalMSEorMMSEindicatecompetence NoCompetencerelatestoapt sabilitytoprovidefood shelter tomanage andtoparticipateinactivitiesanddecisionsPts whoscorewellmayhavedifficultywithbasicactivitiesofdailyliving Drawbacks DoesanabnormalMSEorMMSEindicateincompetence NotnecessarilyManypts withcognitivelimitationsdevelopalternativemeansofcopingwithdeficits allowingthemtolivefairlyindependentlives Drawbacks TheMSEandMMSEscreeningshavelimitationsTheyaresubjecttointerpretivebiasandexperienceoftheinterviewerTheyhaveafairlysignificantfalse negativerate esp inpts withrighthemispherelesionsDemographicsandculture Age 60 education 9thgrade limitedculturalexperiences andlowsocioeconomicstatuslimitusefulnessScreeningquestionnairesarelesssensitivetocognitiveimpairments DoyouhavetobeaDC aPsychiatrist Psychologist No ItisnotrealistictoexpectthatyouevaluateapatienttothesamelevelofapsychiatristorapsychologistBut alargepartofaperson soverallhealthishisorhermentalhealthAssubluxationsmaybecausedby thoughts aperson smentalstatusshouldbeimportanttoyou DocumentationofMentalStatus Documentationofthepatient smentalstatusisnotremarkablydifferentthanthedocumentationforthehistoryexamorphysicalexamIncludeitintheNeurologysectionofyournarrativehistory Exampleofnormal Thepatientisalertandorientedx3 Correctregistrationof3objectswasnoted Attentionandcalculationareappropriatewithserial7co