齐鲁医学heMentalStatusExamination(MSE)-PalmerCollegeof精神状态检查(MSE)-帕大学.pptx

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1、The Mental Status Examination(MSE)12021/10/23 星期六Mental StatuslMental status is the total expression of a persons emotional responses,mood,cognitive function,and personalitylIt is closely linked to the individuals executive functioning,i.e.motivation,initiative,goal formation,planning and performing

2、,self-monitoring,and integration of feedback22021/10/23 星期六Quick Neurology ReviewlFrontal lobe lSpeech formation(Broca area)lEmotions/affectlDrive lAwareness of selflShort-term memory lGoal-oriented behavior32021/10/23 星期六Quick Neurology ReviewlParietal lobe lSensory perceptionlSpatial sense and nav

3、igation42021/10/23 星期六Quick Neurology ReviewlTemporal lobe lPerception and interpretation of sounds lWernickes area lIntegration of behavior,emotion,and personalitylLong-term memory52021/10/23 星期六Quick Neurology ReviewlLimbic system lSurvival behaviors(mating,aggression,fear,affection)lReactions to

4、emotions,and expression of affect is mediated by connections of the limbic system and the frontal lobe62021/10/23 星期六DementialDementia is a clinical syndrome,characterized by deteriorating cognition,behavior,and functional independencelIt is usually related to obvious structural disease of the brain

5、(most commonly atrophy)lDementia affects 3-11%of adults older than 6572021/10/23 星期六Mnemonic for causes of dementialD:drugs and toxinslE:endocrinelM:metabolic and mechanicallE:epilepsy lN:nutritional and nervous systemlT:tumor and traumal I:infectionlA:arterial 82021/10/23 星期六DeliriumlDelirium is di

6、fferent than dementia lIt is an acute confusional state accompanied by a disorder of perceptionlSymptoms include alterations in mental status(disorientation),attention span,sleep patterns,and affectlSudden and fluctuatinglUsually reversible92021/10/23 星期六Mental Status Examination lThe MSE is one com

7、ponent of an exam and may be viewed as the psychological equivalent of the physical examlIt is an important component to a neurological evaluation102021/10/23 星期六Factors affecting the MSElCulture and educational background of the patient lWhat is abnormal for a person with high intellectual ability

8、may be normal for a person of less educationlPatients with ESL may have difficulty with some components of the exam112021/10/23 星期六Major Components of the MSE1.Appearance 2.Motor3.Speech4.Affect&mood5.Thought Content6.Thought Process7.Perception8.Intellect9.Insight122021/10/23 星期六AppearancelAgelGend

9、erlRacelBody buildlPosturelEye contact lDresslGroominglMannerlAttentiveness to examinerlEmotional facial expressionlAlertness132021/10/23 星期六MotorlBehavior:Pleasant?Cooperative?Appropriate for the particular situation?lHesitancylAgitationlAbnormal movementslGaitlCatatonia142021/10/23 星期六SpeechlRate

10、lRhythm lVolumelAmount lArticulation lSpontaneity152021/10/23 星期六Affect and MoodlAffect:How do they appear to you?lStabilitylRangelAppropriatenesslIntensitylMood:Dr.asks the patient directly how he/she feels162021/10/23 星期六Thought ContentlSuicidal ideationlDeath wisheslHomicidal ideationlDepressive

11、cognitionlObsessionslRuminationslPhobiaslParanoid ideationlMagical ideationlDelusionslOvervalued ideasDescription of what the patient is thinking about172021/10/23 星期六Thought ProcesslAssociationslCoherencelLogiclStreamlClang associations lPerseverationlNeologism lThought blockinglAttentionDescriptio

12、n of the way in which the patient thinks182021/10/23 星期六PerceptionlHallucinationslIllusionslDepersonalizationlDerealizationldj vuljamais vu192021/10/23 星期六IntellectlGlobal impression:average,above average,below average202021/10/23 星期六InsightlAwareness of illness212021/10/23 星期六MSElThe full MSE is a

13、lengthy examlYou assess many components of the MSE in your normal work up of a patientlWhen you need to do a shorter neurological screening exam,you may shorten the MSE to the Mini Mental Status Exam(MMSE)222021/10/23 星期六MMSElTakes approximately 10 minuteslThe MMSE tests:lOrientationlImmediate and s

14、hort-term memorylConcentration lArithmetic ability lLanguagelPraxis(learning)232021/10/23 星期六MMSElOrientation:lWhat is the(year)(season)(date)(day)(month)?lWhere are we?(state)(country)(town)(office)(floor)5 pointslRegistration:lName 3 objects,taking 1 second to name each.Then ask the patient to rep

15、eat them.1 point for each correct.lAttention and Calculation:lAsk the patient to count backwards from 100 in 7s.Stop after 5 answers.lAlternatively,ask the patient to spell“world”backwards.l1 point for each correct answer (5)l1 point for each correct answer (5)l1 point for each correct answer (3)l1

16、point for each correct answer (5)242021/10/23 星期六MMSElRecall:lAsk the patient for the 3 objects named under“Registration”.lLanguage:lPoint to two objects and ask the patient to name them(pen and watch).lAsk the patient to repeat“No ifs,ands,or buts.”lAsk the pt.to follow a 3-step command:“Take this

17、paper in your right hand,fold it in half,and put it on the table.”lAsk the pt.to read and obey the following:“Close your eyes.”lWrite a sentence.lCopy a drawing of intersecting pentagons.l1 point for each correct answer (3)l1 point for each correct answer (2)l1 point for correct answer (1)l1 point f

18、or each correct task (3)l1 point for correct task (1)l1 point for correct task (1)l1 point for correct task (1)lTotal (30)252021/10/23 星期六Interpretation of the MMSElThe traditional threshold for the MMSE is a score of 23 or greaterlScores of 0-23 argue strongly for the diagnosis of dementiaBut,false

19、-positive results are a concern when applied to large populations with low incidence of dementia,so some experts prefer the following scoring system:l0-20:dementia highly probablel26-30:dementia highly unlikelyl21-25:results not conclusive262021/10/23 星期六lThe MMSE is a copyrighted psychological test

20、 published by Psychological Assessment Resources(PAR),Inc.272021/10/23 星期六So,why do DCs need to do MSEs?lEmotional and behavioral changes are often the first signs of organic brain diseaselDoes the patient see his or her M.D.as frequently as he or she sees you,the chiropractor?lBrain tumors,subdural

21、 hematomas,small infarcts,and cerebral atrophy may be undetected on routine neurological examination,whereas the cognitive effects of these lesions may be apparent on an MSE282021/10/23 星期六DrawbackslDoes a normal MSE or MMSE indicate competence?lNolCompetence relates to a pt.s ability to provide foo

22、d&shelter,to manage$,and to participate in activities and decisionslPts.who score well may have difficulty with basic activities of daily living 292021/10/23 星期六DrawbackslDoes an abnormal MSE or MMSE indicate incompetence?lNot necessarilylMany pts.with cognitive limitations develop alternative means

23、 of coping with deficits,allowing them to live fairly independent lives302021/10/23 星期六DrawbackslThe MSE and MMSE screenings have limitations lThey are subject to interpretive bias and experience of the interviewer lThey have a fairly significant false-negative rate,esp.in pts.with right hemisphere

24、lesionslDemographics and culture:Age(60),education(9th grade),limited cultural experiences,and low socioeconomic status limit usefulness lScreening questionnaires are less sensitive to cognitive impairments312021/10/23 星期六Do you have to be a DC&a Psychiatrist/Psychologist?lNo.It is not realistic to

25、expect that you evaluate a patient to the same level of a psychiatrist or a psychologist lBut,a large part of a persons overall health is his or her mental health lAs subluxations may be caused by“thoughts”,a persons mental status should be important to you322021/10/23 星期六Documentation of Mental Sta

26、tuslDocumentation of the patients mental status is not remarkably different than the documentation for the history exam or physical examlInclude it in the Neurology section of your narrative history332021/10/23 星期六Example of normal:“The patient is alert and oriented x 3.Correct registration of 3 obj

27、ects was noted.Attention and calculation are appropriate with serial 7 counting.Short term memory is intact.Language skills are demonstrated without evidence of agnosia,aphasia or apraxia.”342021/10/23 星期六Example of abnormal:l“The patient is alert and oriented to person and time,but is unable to ide

28、ntify the location,believing she is in her childhood home in Omaha.Correct registration of 3 objects is noted.The patients attention and calculation are deficient,with the patient correctly counting backwards from 100 by 7s to 86.The patient correctly repeats the names of objects,without evidence of

29、 agnosia or aphasia.The patient is unable,however,to complete commands or purposeful actions and demonstrates difficulty completing written or verbal commands.Apraxia is suspected.352021/10/23 星期六The MMSE and CPTlThe MMSE is considered a component of the neurological portion of the E&M;therefore,no separate CPT code is entered362021/10/23 星期六