2022年医学专题—heMentalStatusExamination(MSE)-PalmerCollegeof精神状态检查(MSE)-帕大学(1).ppt

The Mental Status Examination(MSE),第一页，共三十七页。,Mental Status,Mental status is the total expression of a persons emotional responses,mood,cognitive function,and personalityIt is closely linked to the individuals executive functioning,i.e.motivation,initiative,goal formation,planning and performing,self-monitoring,and integration of feedback,第二页，共三十七页。,Quick Neurology Review,Frontal lobe Speech formation(Broca area)Emotions/affectDrive Awareness of selfShort-term memory Goal-oriented behavior,第三页，共三十七页。,Quick Neurology Review,Parietal lobe Sensory perceptionSpatial sense and navigation,第四页，共三十七页。,Quick Neurology Review,Temporal lobe Perception and interpretation of sounds Wernickes area Integration of behavior,emotion,and personalityLong-term memory,第五页，共三十七页。,Quick Neurology Review,Limbic system Survival behaviors(mating,aggression,fear,affection)Reactions to emotions,and expression of affect is mediated by connections of the limbic system and the frontal lobe,第六页，共三十七页。,Dementia,Dementia is a clinical syndrome,characterized by deteriorating cognition,behavior,and functional independenceIt is usually related to obvious structural disease of the brain(most commonly atrophy)Dementia affects 3-11%of adults older than 65,第七页，共三十七页。,Mnemonic for causes of dementia,D:drugs and toxinsE:endocrineM:metabolic and mechanicalE:epilepsy N:nutritional and nervous systemT:tumor and trauma I:infectionA:arterial,第八页，共三十七页。,Delirium,Delirium is different than dementia It is an acute confusional state accompanied by a disorder of perceptionSymptoms include alterations in mental status(disorientation),attention span,sleep patterns,and affectSudden and fluctuatingUsually reversible,第九页，共三十七页。,Mental Status Examination,The MSE is one component of an exam and may be viewed as the psychological equivalent of the physical examIt is an important component to a neurological evaluation,第十页，共三十七页。,Factors affecting the MSE,Culture and educational background of the patient What is abnormal for a person with high intellectual ability may be normal for a person of less educationPatients with ESL may have difficulty with some components of the exam,第十一页，共三十七页。,Major Components of the MSE,Appearance MotorSpeechAffect&moodThought ContentThought ProcessPerceptionIntellectInsight,第十二页，共三十七页。,Appearance,AgeGenderRaceBody buildPostureEye contact,DressGroomingMannerAttentiveness to examinerEmotional facial expressionAlertness,第十三页，共三十七页。,Motor,Behavior:Pleasant?Cooperative?Appropriate for the particular situation?HesitancyAgitationAbnormal movementsGaitCatatonia,第十四页，共三十七页。,Speech,Rate Rhythm VolumeAmount Articulation Spontaneity,第十五页，共三十七页。,Affect and Mood,Affect:How do they appear to you?StabilityRangeAppropriatenessIntensityMood:Dr.asks the patient directly how he/she feels,第十六页，共三十七页。,Thought Content,Suicidal ideationDeath wishesHomicidal ideationDepressive cognitionObsessionsRuminations,PhobiasParanoid ideationMagical ideationDelusionsOvervalued ideas,Description of what the patient is thinking about,第十七页，共三十七页。,Thought Process,AssociationsCoherenceLogicStreamClang associations,PerseverationNeologism Thought blockingAttention,Description of the way in which the patient thinks,第十八页，共三十七页。,Perception,HallucinationsIllusionsDepersonalizationDerealizationdj vujamais vu,第十九页，共三十七页。,Intellect,Global impression:average,above average,below average,第二十页，共三十七页。,Insight,Awareness of illness,第二十一页，共三十七页。,MSE,The full MSE is a lengthy examYou assess many components of the MSE in your normal work up of a patientWhen you need to do a shorter neurological screening exam,you may shorten the MSE to the Mini Mental Status Exam(MMSE),第二十二页，共三十七页。,MMSE,Takes approximately 10 minutesThe MMSE tests:OrientationImmediate and short-term memoryConcentration Arithmetic ability LanguagePraxis(learning),第二十三页，共三十七页。,MMSE,Orientation:What is the(year)(season)(date)(day)(month)?Where are we?(state)(country)(town)(office)(floor)5 pointsRegistration:Name 3 objects,taking 1 second to name each.Then ask the patient to repeat them.1 point for each correct.Attention and Calculation:Ask the patient to count backwards from 100 in 7s.Stop after 5 answers.Alternatively,ask the patient to spell“world”backwards.,1 point for each correct answer(5)1 point for each correct answer(5)1 point for each correct answer(3)1 point for each correct answer(5),第二十四页，共三十七页。,MMSE,Recall:Ask the patient for the 3 objects named under“Registration”.Language:Point to two objects and ask the patient to name them(pen and watch).Ask the patient to repeat“No ifs,ands,or buts.”Ask the pt.to follow a 3-step command:“Take this paper in your right hand,fold it in half,and put it on the table.”Ask the pt.to read and obey the following:“Close your eyes.”Write a sentence.Copy a drawing of intersecting pentagons.,1 point for each correct answer(3)1 point for each correct answer(2)1 point for correct answer(1)1 point for each correct task(3)1 point for correct task(1)1 point for correct task(1)1 point for correct task(