Eval of Psychiatric D & Mental Status Exam

Component of MSE are part of every clinical rating scale

DSM-5:
-Provides a common lang.
-contains comp that provide a comprehensive understanding of the illness + assist clinicians in making an accurate diagnosis
-Incl. 5 axes

Axis I:
-clinical disorders
-ex: schizophrenia, anxiety, delirium, dementia, sleep disorders

Axis II:
-Personality disorders & mental retardations
-ex: paranoid, schizoid, schizotypal, antisocial, narcissistic disorders

Axis III:
-General medical conditions
-ex: diabetes, HTN, I.D.

Axis IV:
-Psychosocial and environmental problems
-ex: educational, occupational, housing, economic

Axis V:
-Global assessment of functioning (GAF)
-ex: clinician's assessment of the person's overall functioning lvl (100 p scale w/ 100 representing highest lvl of functioning)

Mental Status Exam

-desc. of current pt. behavior, thoughts, perceptions and functioning and provides an objective eval used for diagnosis, assessment of course of illness and response to treatment

Outline of Mental Status Exam:

A) General Description:
-appearance
-behavior and psychomotor activity (posturing, stereotypic movement, motor tics, etc)
-attitude toward the examiner

B) Mood & Affect
-Mood
-Affect (flat, labile)
-Appropriateness

C) Speech
-language, quantity, rate of production
-quality (confabulating, perseveration, circumstantial, echolalia)

D) Perceptual Disturbances
-hallucination
-depersonalization
-derealization
-illusion

E) Thought
-Associations (tangential, loose associations, clang)
-flight of ideas
-racing thoughts
-neologism
-blocking
-thought content (delusion, obsession, idea of reference)

F) Sensorium & Cognition
-Alertness/lvl of consciousness
-Orientation, memory, concentration/attention
-fund of knowledge
-abstract thinking (concrete)
-capacity to read/write
-visuospatial ability
-Fund of information and intelligence

G) Impulse Control
H) Judgement and Insight
I) Reliability
-judgement, insight and nil insight

Lab Assesments: R/O other medical causes for psychiatric illness

CBCs with diff., U/A, LFTs, chemistry. ECG/CT scan

Suicide Assessment

Ask Q's:
1. Do you have any thoughts of harming yourself?
2. How would you do it?
3. Any previous attempts?

-Watch med refill freq
-Caregiver/family members questions (giving away possessions?)

-Rating scales are tools that "translate" subjective data (hallucinations etc) into objective data
-assist in diagnosis of specific disorders
-used in clinical research, pt care, and administrative purposes

Drawbacks:
-time commitment
-inability of pts to tolerate interview
-repeated ratings needed over time
-clinician vs. pt rating

Sensitivity, specificity, reliability,
and validity are important

Sensitivity: test ability to detect a symptom or illness is present

Specificity: test ability to determine that a symptom or illness is absent when the person does have the illness

Reliability: the score on the scale reflects the hypothetical "true" score vs. interference from outside
-reports as correlation coefficient (0-1.0, with <0.7 being unreliable)
-interrater agreement - training

Validity:
-ability of the scale to measure what is designed to measure
-content: assess appropriate disease aspects
-concurrent: correlate with diagnosis or clinical change
-construct: measures symptom traits vs. specific symptoms

Psychosis Rating Scales

PANSS:
assess both positive/negative sxs

BPRS:
More general type of assessment

CGI:
not specific for this disease, but can be used in ALL other psych disorders. FDA req this scale to be used in addition to others. Clinician rated.

SANS:
specific for negative sxs, used with the BPRS

Depression/Bipolar

HAM-D: Oldest scale, still used

MADRS: more popular for clinical drug trials

Beck & Zung: used by pt

Young Mania Rating scale

Anxiety

HAM-A: generalized anxiety
YBOC: obsessive-comp only
Zung SAS: gen anx (pt rated)
SPAAS: panic disorder only

Adverse effects measurements

SAFETEE: gen assessment (N/V, diarrhea)
MED watch: FDA reporting
AIMS and DISCUS: tardive dyskinesia for antipsych drugs
Simpson-angus EPS scale: antipsychotic drug effect (parkinson's and dystonia)
BAS: antipsych drug effect (akathisia)

Cognition rating/eval scales

Mini-mental status exam (MMSE)
Information memory concentration (IMC)
Clock drawing
Alzheimer's disease assessment scale (ADAS)

Others:

agitation: medical condition w/o a definitive diagnosis

Webster's: emotional upset or disturbance

Meds are often used - be more specific w/ symptoms