Psychological status example psychology. Mental status (condition)
Important: Generalization of psychopathological features is the basis of diagnosis.
Please note the following:
External state, behavior and
Changes in state of consciousness, attention, comprehension, memory, affect, stimuli/drive, and orientation
Disorders of perception and features of thinking
It is also important to establish the current mental state
An example of a possible description of the results of a psychic study
The patient, 47 years old, looks young in appearance (build and clothing). During the examination, she is open to communication, which is manifested both in facial expressions and gestures, and in the verbal sphere. She listens carefully to questions addressed to her and then answers them in detail, without deviating from the given topic.
Consciousness is clear, well oriented in space, time and in relation to the individual. Facial expressions and gestures are very animated and run parallel to the prevailing affect. Attention and concentration appear intact.
Further research does not indicate the presence of a memory disorder and the ability to remember and reproduce previously acquired experience. With a level of general intellectual development above average and a well-differentiated primary personality, rude verbal attacks attract attention: “old Velcro”, “chatter”, formal thinking seems intact, there is no preliminary evidence of the presence of fragmented thinking. However, the train of thought seems somewhat accelerated.
There is no reason to suspect the presence of a productive psychotic disorder in the form of a delusional phenomenon, hallucinatory manifestations or primary disturbances in the perception of one’s own “I”.
In the sphere of affect, attention is drawn to excitability, the degree of which is above average. When discussing topics that require increased emotional involvement of the patient, the latter tends to speak louder and more demanding, and the number of rude verbal attacks mentioned above increases. The ability to criticize seems reduced; there is no reason to assume an actual threat of suicide.
Supervision of patients with mental disorders.
Scheme for compiling a medical history.
Title page design.
Case history diagram
I. General information
1. Last name, first name, patronymic
2. Year of birth, age
3. Education
4. Marital status
5. Profession, place of work and position
6. Date of admission to hospital
II. Reason for referral to hospital
suicidal thoughts or suicide attempts
aggressiveness
refusal to eat for morbid reasons
inappropriate behavior
psychophysical helplessness with loss of self-care skills
forensic psychiatric, labor, military examination
convulsive and non-convulsive seizures with disturbance of consciousness
mental disorders not amenable to outpatient treatment
at the time of supervision
upon admission to the hospital
IV. Anamnesis:
life story
history of this disease, and in psychiatry it is conventionally divided into objective and subjective anamnesis.
Life story. The collection of information is carried out by age periods of life, starting with the family history and birth of the patient, and subsequently as it develops. They are interested in the character traits of close relatives. The incidence of mental illnesses in the family (delicately), nervous, somatic, and cases of suicide are identified. They find out the health status, illnesses, injuries of the patient’s mother during pregnancy, and how her birth proceeded. The moments when the supervised began to hold his head, sit, stand, walk, and speak his first words and phrases are recorded in time. The peculiarities of the child’s temperament are revealed through play activities. Describe development and behavior in kindergarten, at home, relationships with brothers and sisters. Indicate the age of entry into school; if it is delayed, then indicate the reason. School performance, both general and in specific subjects (exact sciences, humanities), favorite and least favorite subjects, whether classes were duplicated and for what reason. Describe the educational and work activities of a child or teenager and their appropriateness to their age. Indicate the number of completed classes. If training ends prematurely, the reason is clarified (financial difficulties, difficulties in learning). Further education (college, technical school, university). Describes the age of marriage, legal or civil. The main features of the patient’s relationship with his marital partner, their duration, and the reasons for the breakdown of marital relations (physical, material, psychological, cultural, sexual factors) are reflected. The number of children and the patient’s attitude towards them is determined . You should ask the man about the period of conscription into the army, demobilization, the reasons for the delay in conscription and early demobilization, how he endured the hardships of military service, whether there were incentives or penalties. It is necessary to ask about success in acquiring a specialty, attitude towards it (favorite, unloved), characteristics of work throughout life, relationships in work groups (good, conflicting), whether they changed their place of work and the reasons for this. Describe somatic diseases suffered in childhood, adolescence, and adulthood. Find out the attitude towards alcohol, tobacco, drugs. They clarify the frequency, dose, motives of the psychoactive substance consumed, how this consumption affected physical and mental health, and whether they were treated by narcologists. Conflict and other psychotraumatic situations that have arisen throughout life, the reaction to these situations, and seeking the help of a neurologist and psychiatrist are clarified.
History of the present illness. The circumstances preceding the first visit to a psychiatrist or the first hospitalization in a psychiatric hospital (mental trauma, concussion, somatic illnesses, etc.) are described. The initial manifestations of mental disorders and their connection with exogenous hazards (or the absence thereof) are identified. The further course of painful mental disorders is presented in a concise form based on epicrisis data, the reasons for hospitalization in psychiatric hospitals, indicating the duration of inpatient treatment and periods of stay at home before the actual hospitalization. At the same time, changes in the patient’s social status are noted (decrease, growth, stability).
Somatic condition. The therapist's conclusion from the hospital medical history is given.
Neurological condition. The conclusion of a neurologist from the hospital medical history is given.
V. Mental status.
This is the most important, central part of the medical history. Questioning is the leading method of psychiatric research. Questioning is inseparable from observation. When questioning the patient, we observe and ask questions that arise in connection with this. To diagnose the disease and establish all its features, it is necessary to carefully monitor the patient’s behavior; the expression of his face, the intonation of his voice, to catch his slightest changes, to note all the movements of the patient. Mental disorders in one form or another, often barely noticeable, affect the appearance of patients and their behavior. For example, the patient denies the presence of voices, but listens to something or at times covers his ears with his hands, or at times begins to speak into empty space, etc.
The study (writing) of mental status is carried out by sequentially studying the mental spheres of the patient. If the patient does not currently have a disturbance in any mental sphere, then one should ask whether there were any disturbances before; such anamnestic data should also be described in detail, as well as those that the patient currently has. Many years of experience in teaching psychiatry indicate the greatest feasibility of the following scheme for studying mental status:
1. Consciousness
2. Perception
3. Attention
5. Thinking
6. Intelligence
8. Motor-volitional sphere
9. Behavior.
At the end of each department, its condition is assessed. For example, “memory within normal limits”, “emotions without deviation from the norm.”
Consciousness. The patient’s condition is assessed by the curator by studying the signs of Jaspers (the presence of all of them indicates a violation of consciousness).
3.Attention. They ask the patient whether he is attentive or distracted, whether he can work (read) in a noisy environment, in cramped conditions. In a conversation, stability of attention, direction, concentration in the conversation, activity, degree of distractibility, and switchability are noted. Describe the identified symptoms (pathological rigidity, exhaustion, absent-mindedness, lack of attention).
4.Memory . They are interested in the patient’s state of memory, the predominant type of memory (mechanical memory, semantic, visual, auditory, motor). When collecting anamnesis from a patient, they compare the volume, accuracy, readiness, speed with which he describes his life history (long-term memory), the circumstances of the current hospitalization (short-term memory), and current events of the day (ability to fixate).
5. Thinking a person is expressed through speech. Speech, first of all, must be a means of communication and therefore understandable. The speech is described in terms of form: pace, harmony (are the words grammatically connected, are the judgments logical in meaning, are the conclusions consistent), purposefulness (whether the patient answers the questions asked in essence, how realistic his ideas are, what is important for the patient, what topic is more important to him) occupies). A conclusion is made about formal thinking disorders, and the corresponding symptoms are named. Then the content of the speech is described. Normal speech should reflect real events that are relevant to the patient, taking into account age and interests. The supervisor's attention is drawn to unusual, unrealistic judgments and conclusions, or to ideas that the patient is extremely obsessed with. The patient’s attitude towards his statements is noted, how convinced he is of the correctness of his words, how he substantiates his ideas, whether his criticality thinking. A conclusion is made about productive thinking disorders (obsessive, overvalued, delusional ideas, neologisms).
6. Intelligence. Normally, the level of intelligence depends on age, education received, and the conditions in which one was raised. When assessing the level and development of intelligence, one should take into account anamnestic information: the time when he began to hold his head up, sit, walk, talk, perform simple self-care activities, whether he studied in a auxiliary school. What was your performance at school, in which subjects did you excel? The intellectual level of a patient with higher education often becomes clear after collecting an anamnesis. In his story, the patient uses general and professional concepts, expresses judgments and conclusions. It should be noted how the patient understands the supervisor’s questions, immediately or after repetition, accurately or inaccurately. The stock of common knowledge is identified in accordance with the patient’s occupation, whether he is a rural resident or an urban resident. The test subject's level of awareness in everyday matters and ability to solve practical problems are determined. They find out the stock of school and professional knowledge and skills within the limits of the education received, whether the patient is able to clearly explain professional terminology and what the essence of his specialty is. The range of his intellectual interests is clarified. A decrease in intelligence is evidenced by a significant loss of previously acquired theoretical knowledge and practical skills, which leads to a decrease in social and professional level.
7. Emotions. Certain information is provided by the patient's answers to questions about what his mood is now, what it has been like most recently, how it fluctuates, how long they remember the offense, and how they react to it. If patients note a decrease in mood, carefully identify suicidal thoughts. Ask questions: " Do you sometimes have such a disgusting mood that you don’t even want to live? or “Do you have bad thoughts about doing something to yourself?” When describing the mood, attention is paid to the general facial expression and posture. Its predominant background, stability, and causality of a particular mood are noted. The patient’s emotional attitude to various objects of reality (to relatives, friends, colleagues, to work, service personnel, to himself) is clarified by asking about what feelings he experiences in relation to this, as well as by observing the patient’s facial expression when telling his story on relevant topics (in this case, the expression of joy, grief, sadness, fear, kindness, anger, etc. is indicated). During a clinical study of the patient’s emotional sphere, the following symptoms should be identified: hypothymia, depression, hyperthymia, euphoria, weakness, reactive lability, dysphoria, emotional monotony, flatness, apathy, anxiety, etc.
8. Motor-volitional sphere. The conversation reveals the patient’s volitional qualities. They ask about his persistence, suggestibility, and patience. Pay attention to appearance: carelessness in hairstyle, clothes, indirectly indicate a decrease in initiative. They find out the patient’s plans for the future and whether these plans correspond to real possibilities. Observe the behavior during the conversation (inactivity, fussiness, restlessness, natural posture. It is necessary to reflect both quantitative and qualitative aspects of the patient’s psychomotor skills. Any manifestations of mannerism (unnaturalness) of movements, their lack of purposefulness in the form of twitching, stereotypy are described. Excessive gesticulation or on the contrary - impoverishment of actions, their rigidity, gait style, coordination of actions.
9. Behavior. This section of mental status describes the patient’s behavior during examination and outside the supervision situation. They note the manner in which they behave in conversation with students, with the attending physician, and honey. staff, other patients (manifestations of arrogance, rudeness, flattery, politeness, culture). Behavior is observed when they arrive at the department. Pay attention to what the patient is doing (is he alone or is he talking with someone, if he is busy with work processes - how does he do it, eagerly or sluggishly), whether he is reading books, watching TV.
The patient's mental status should be written according to the following scheme: First, descriptions of any symptoms are given, and then their qualification and definition are given. For example, “the patient hears a female voice commenting on his thoughts, actions, sometimes ordering the patient to perform certain actions (verbal commentary and imperative hallucinations).” Or "the patient complains that every time he is left alone in the apartment, he feels a strong fear that something will happen to him, his heart will stop, no one will be able to help him, call an ambulance; he understands the groundlessness of his fears, but cannot overcome them (obsessive fears - cardiophobia)."
Protocol of pathopsychological examination.
Attention research.
Schulte tables (Appendix 1): the tables have randomly numbered cells. We ask the patient to count them in order using a pointer, noting the time it took to complete each table. If attention is impaired, counting is carried out with errors and for a long time.
Account according to Kraepelin. The patient is asked to mentally subtract from 100 by 7. The curator writes the number 100 and then waits for an answer, methodically evenly applying dots until he hears the full answer. The entry takes the following form: 100.... 93... 86.... etc. Incorrect answers are underlined. When attention is distracted, the number of errors is large at any point in the experiment. When attention is riveted, there are too long pauses.
Memory research.
Memorizing 10 words. The curator compiles a list of 10 five-letter words in advance and writes them in a column. The patient is given instructions (“Now I will read 10 words to you, try to remember as many as possible, not necessarily all 10, as many as possible”). The curator slowly reads the words, then records the words that the subject reproduced. Normally, 6-7 words are memorized the first time. Then the curator reads the words again and again records the results of memorization. There are five attempts in total. The results of the study are plotted on a coordinate grid: on the vertical axis - the number of words, on the horizontal - three points corresponding to three attempts. A memory curve is drawn. After 30 min. again asked to reproduce the words without reading them - delayed recall (long-term memory). The memory curve is drawn in the medical history.
The curator asks the patient to retell a story (read by him or watched on TV, listened to on the radio) and a conclusion is drawn about the development of a semantic type of memory.
Study of thinking.
Mental status qualification.
The curator must assess the patient's mental status in the form of a syndrome.
To do this, from all the symptoms identified during the study, it is necessary to determine the one that reflects the greatest depth of mental damage. Then, it is necessary to logically connect it with other symptoms that make up a single symptom complex. In this way, the leading (core) psychopathological syndrome is determined, which determines the overall clinical picture of this disease and is the initial prerequisite for diagnosis. For example, “Given that the patient has general and mental weakness, imbalance of mental processes, sleep disorders and autonomic disorders, this condition can be interpreted as asthenic syndrome.” Or the following example: "Given that the patient has visual pseudo-hallucinations. He complains that his wife, who now lives in Kemerovo, performs sexual acts with strangers. She deliberately shows him these scenes inside his head in order to irritate him). Ideational automatisms (a group of pests, using an apparatus, takes away from his thoughts), delirium of influence (with the help of the latest electronic technology they observe and experiment on him, directing his actions, causing atrophy of the genital organs, passing an electric current through them. This condition should be interpreted as Kandinsky-Clerambault syndrome).
If a patient has a complex syndrome (a combination of several), then each syndrome is described separately, and in the conclusion it is stated, for example, “ astheno-depressive syndrome", "hysterical state in a patient with dementia".
Rationale for diagnosis.
The medical history is signed by the curator.
An approximate description of a normal mental status (clinical and psychological description of the basic mental functions of a person).
He has no health complaints.
Consciousness . The patient correctly identifies himself, his location, the current date, and understands that he is talking with a student. Understands that he is being treated in a psychiatric hospital due to a mental disorder that occurred shortly before hospitalization and during the first days of his stay in the hospital. The patient's speech is clear, consistent, consciousness is not impaired.
Perception . No complaints about disturbances of sensations, perceptions, or ideas were identified. In a conversation he is approachable, adequate, calm, and answers questions asked. Perception is not impaired.
Attention . When questioned, no complaints about attention disorders were revealed. The patient is quite attentive and listens to questions with interest, does not get distracted, and answers evenly and with concentration.
a) Correctly and accurately counted the 25 drawn numbers in the Schulte tables.
b) 100... 93... 86... The counting is carried out evenly at a fairly fast pace, without errors.
Attention is not impaired.
Memory . No complaints of memory impairment were identified. Notes the predominance of visual memory over auditory and motor memory. He recalls quite fully, accurately and easily about his past life, the history of his illness, and current events. Remembers by specific figurative-semantic associations. Anamnestic data is given in accordance with objective data. Keeps memories fairly consistent in chronological order.
Results of psychological research:
a) Remembers 7 digits in the same order.
b) Memory curve 6,8,8,9,10... 8. Thus, the functions of memorization, storage, and reproduction are not impaired, both long-term and short-term memory are preserved, the figurative type of memory predominates.
Thinking . Speech is somewhat slower in tempo, logically and grammatically related to the essence of the questions asked, and reflects real and relevant life events for the patient. Judgments and conclusions are mostly of a concrete figurative nature, but there are also fairly general formulations on the topics raised in the conversation: in covering one’s profession, the political life of the country. Quite critically evaluates his personal characteristics and advantages, disadvantages, his mental experiences and actions in the past.
Results of psychological research (for progress, see protocol).
a) Assessment: the patient understands the abstract meaning of a simple proverb and logically (deductively) formulates a conclusion.
b) Evaluation: at the conceptual level, accurately and correctly compares concepts, is critical of the task of comparing incomparable concepts.
c) Assessment: concepts are formed correctly, i.e. by significant connections.
d) Assessment: well, defines concepts based on essential features.
e) Evaluation: traces a similar connection in word-concept pairs.
f) Assessment: Performs well on the deductive reasoning test.
Thus, no formal and productive thinking disorders were identified. Thinking at the abstract-logical level of development corresponding to education.
Intelligence . The patient talks about himself, using a fairly rich vocabulary, uses generalized concepts and professional terminology. He speaks quite fully and clearly about his profession, responsibilities, and gives reasons for his conclusions about relationships at work and in the family. He is keenly interested in political events in the country, reads newspapers, watches news on TV, and expresses his political positions. He is well versed in issues that concern his personality. He talks about activities in his free time (for example, he reveals knowledge and skills in housekeeping), the treatment being carried out, and gives fairly in-depth characteristics of the personal qualities of medical personnel.
Conclusion. The patient's knowledge and skills correspond to his age and level of education received. Intelligence preserved.
Emotions . There were no complaints of mood disorders or causeless fluctuations. He notes that he is a calm, but touchy person. The expression of the eyes and the entire face is consistent and mobile. Gestures are natural and varied. The pose is relaxed, changing. Emotional reactions are quite expressive, varied, and adequate to the subject of the conversation (a smile when talking about joyful topics, sadness when talking about misfortunes). The background mood is somewhat reduced, a prevailing feeling of sadness and regret about the lost time in the hospital.
No emotional disorders were identified.
Motor-volitional sphere . There were no complaints of appetite or sleep disorders. The patient is dressed neatly and has his hair neatly combed. During a conversation, he is restrained in his movements, quite mobile and active. Movements are purposeful, varied, coordinated. The gait is natural. He is interested in the outcome of the conversation, whether there will be a conversation with the assistant soon, whether this conversation will contribute to a faster discharge. Expresses a desire to be discharged as quickly as possible, meet with family, and begin work and household chores. He admits that he misses his children.
No disturbances in the motor-volitional sphere were identified.
Behavior The patient in the department is quite active. According to medical staff, he communicates with some patients. Willingly fulfills staff requests for cleaning premises and caring for other patients. He is polite and attentive in his interactions with staff and patients.
No behavioral disorders were identified.
Appendix 1
Schulte table
A.
| 23 | 6 | 18 | 11 | 9 |
| 8 | 14 | 2 | 25 | 21 |
| 15 | 19 | 1 | 17 | 4 |
| 22 | 3 | 10 | 24 | 13 |
| 5 | 12 | 16 | 7 | 20 |
Appendix 2.
Study of thinking.
a) Explain the figurative meaning of proverbs
b) Find similarities and differences between two concepts:
| Similarities | Difference |
|
| 1. Apple - cucumber | ||
| 2. Lake - river | ||
| 3. Bird - airplane | ||
| 4. Bus - tram | ||
| 5. Cheating is a mistake | ||
| Example: Girl - doll | Appearance | Alive, man inanimate, toy |
c) From the given 4 words, find 1 extra one that does not fit the other three, underline the extra one and name the rest of the common names.
| Explanation | General Name |
|||
| 1. Clock, alarm clock, stopwatch, coin | ||||
| 2. Boot, shoe, shoe, leg | ||||
| 3. Razor, knife, scissors, pen | ||||
| 4. Bag, briefcase, book, wallet | ||||
| 5. Clock, thermometer, scales, glasses | ||||
| 6. Sun, candle, light bulb, kerosene lamp | ||||
| Example: Table, chair, cup, bed | A cup is a utensil | Everything else is furniture. | ||
d) Each line has one word before the brackets and 5 words inside the brackets. Underline in each line those two words in brackets that indicate what the given object (before the brackets) always has, without which it cannot exist. Underline only 2 words.
For example: garden ( plant, gardener, dog, fence, Earth)
1. River (shore, fish, fisherman, mud, water)
2. City (car, buildings, crowd, street, bicycle)
3. War (airplane, guns, battle, guns, soldiers)
e) Come up with a fourth word for each line, which should be connected with the third, just as the second is with the first.
1. Day - lunch; evening -
2. Hunter - gun; fisherman -
3. Blind - sight; deaf -
Example: lamp - light; stove - (heat)
f) Draw a conclusion from two sentences.
Relevance.
Schizophrenia is an endogenous disease with a progradient course, which is characterized by changes in personality (autism, emotional impoverishment) and may be accompanied by the appearance of negative (decrease in energy potential) and productive (hallucinatory-delusional, catatonic and other syndromes) symptoms.
According to WHO, 1% of the entire world population suffers from manifest forms of schizophrenia. In terms of prevalence and social consequences, schizophrenia ranks first among all psychoses.
In the diagnosis of schizophrenia, several groups of symptoms are distinguished. The main (mandatory) symptoms of schizophrenia include the so-called Bleier symptoms, namely: autism, disorders of the flow of associations, disturbance of affect and ambivalence. Symptoms of the first rank include K. Schneider's symptoms: various manifestations of mental automation disorder (symptoms of mental automatism), they are very specific, but are not always found. Additional symptoms include delusions, hallucinations, senestopathies, derealization and depersonalization, catatonic stupor, psychic attacks (raptus). In order to identify the above symptoms and syndromes, it is necessary to assess the patient’s mental status. In this work, we highlighted a clinical case of a patient with schizophrenia, assessed his mental status and identified leading psychopathological syndromes.
Purpose of the work: to identify the main psychopathological syndromes of a patient with schizophrenia using a clinical case as an example.
Objectives of the work: 1) evaluate the patient’s complaints, medical history and life history; 2) assess the patient’s mental status; 3) identify leading psychopathological syndromes.
Results of the work.
Coverage of a clinical case: Patient I., 40 years old, was admitted to a psychiatric clinic in Kaliningrad in November 2017.
The patient’s complaints at the time of admission: at the time of admission, the patient complained about a “monster” that had entered her from outer space, spoke in a loud male voice in her head, sent some “cosmic energy” through her, performed actions for her (housework - cleaning, cooking, etc.), periodically speaks instead of her (in this case, the patient’s voice changes and becomes rougher); for “emptiness in the head”, lack of thoughts, deterioration of memory and attention, inability to read (“letters blur before the eyes”), sleep disturbance, lack of emotions; to the “expanding of the head”, which is caused by “the presence of a monster inside it.”
The patient's complaints at the time of examination: at the time of examination the patient complained of a bad mood, lack of thoughts in her head, impaired attention and memory.
History of illness: considers himself sick for two years. Signs of the disease first appeared when the patient began to hear a male voice in her head, which she interpreted as the “voice of love.” The patient did not experience any discomfort from his presence. She connects the appearance of this voice with the fact that she began a romantic relationship with a man she knew (which in fact did not exist), and pursued him. Because of her “new love” she divorced her husband. At home she often talked to herself, this alarmed her mother, who turned to a psychiatrist for help. The patient was hospitalized at Psychiatric Hospital No. 1 in December 2015 and remained in hospital for about two months. Reports that after discharge the voice disappeared. A month later, according to the patient, a “monster, an alien from outer space” settled in her, which the patient introduces as a “big toad.” He began to talk to her in a male voice (which came from her head), did household chores for her, and “stole all her thoughts.” The patient began to feel emptiness in her head, lost the ability to read (“letters began to blur before her eyes”), memory and attention sharply deteriorated, and emotions disappeared. In addition, the patient felt a “expansion of the head”, which she associates with the presence of a “monster” in her head. The listed symptoms were the reason for contacting a psychiatrist, and the patient was hospitalized in a psychiatric hospital for inpatient treatment.
Life history: no heredity, developed normally mentally and physically in childhood, an accountant by education, has not worked for the last three years. Denies bad habits (smoking, drinking alcohol). Not married, has two children.
Mental status:
1) External features: hypomimic, posture – straight, sitting on a chair, arms and legs crossed, condition of clothes and hairstyle – without any peculiarities;
2) Consciousness: oriented in time, place and one’s own personality, there is no disorientation;
3) Degree of accessibility to contact: does not show initiative in conversation, does not answer questions willingly, in monosyllables;
4) Perception: impaired, synestopathies (“bloating of the head”), pseudohallucinations (a man’s voice in the head) were observed;
5) Memory: remembers old events well, some recent, current events periodically fall out of memory (sometimes she cannot remember what she did before, what chores she did around the house), Luria square: the fifth time she remembered all the words, the sixth time she reproduced only two; pictograms: reproduced all expressions except “delicious dinner” (called “delicious breakfast”), drawings - without features;
6) Thinking: bradyphrenia, sperrung, delusional ideas of influence, the “fourth wheel” test - not based on an essential feature, understands some proverbs literally;
7) Attention: distractibility, test results using Schulte tables: first table – 31 seconds, then fatigue is observed, second table – 55 seconds, third – 41 seconds, fourth table – 1 minute;
8) Intelligence: preserved (the patient has a higher education);
9) Emotions: decreased mood, melancholy, sadness, tearfulness, anxiety, fear are noted (the predominant radicals are melancholy, sadness). Mood background: depressed, often cries, wants to go home;
10) Volitional activity: no hobbies, doesn’t read books, often watches TV, doesn’t have a favorite TV show, follows hygiene rules;
11) Drives: reduced;
12) Movements: adequate, slow;
13) Three main desires: expressed one desire - to return home to the children;
14) Internal picture of the disease: he suffers, but there is no criticism of the disease, he believes that the “alien” uses it to transmit “cosmic energy”, does not believe that he can disappear. Strong-willed attitudes towards cooperation and rehabilitation are present.
Clinical mental status assessment:
A 40-year-old woman has an exacerbation of an endogenous disease. The following psychopathological syndromes were identified:
Kandinsky-Clerambault syndrome (based on identified pseudohallucinations, delusional ideas of influence and automatisms - associative (impaired thinking, sperrung), synestopathic and kinesthetic);
Depressive syndrome (the patient often cries (hypotymia), bradyphrenia is observed, movements are inhibited - “depressive triad”);
Apathetic-abulic syndrome (based on pronounced emotional-volitional impoverishment).
Mental status assessment helps identify leading psychopathological syndromes. It must be remembered that a nosological diagnosis without indicating the leading syndromes is uninformative and is always questioned. Our work presented an approximate algorithm for assessing the mental status of a patient. A very important final stage in assessing mental status is to establish the presence or absence of criticism of the patient’s illness. It is quite obvious that the ability to recognize their illness varies greatly from patient to patient (even to the point of complete denial) and it is this ability that has the most important influence on the treatment plan and subsequent therapeutic and diagnostic measures.
References:
- Antipina A. V., Antipina T. V. INCIDENCE OF SCHIZOPHRENIA IN DIFFERENT AGE GROUPS // International Academic Bulletin. – 2016. – No. 4. – pp. 32-34.
- Gurovich I. Ya., Shmukler A. B. Schizophrenia in the taxonomy of mental disorders // Social and clinical psychiatry. – 2014. – T. 24. – No. 2.
- Ivanets N. N. et al. Psychiatry and addiction // News of science and technology. Series: Medicine. Psychiatry. – 2007. – No. 2. – pp. 6-6.
Attention- this is the ability to concentrate on any object. Concentration is the ability to maintain this concentration. While collecting anamnesis, the doctor must monitor the patient’s attention and concentration. In this way, he will be able to form a judgment of relevant abilities before the end of the mental status examination. Formal tests allow us to expand this information and make it possible to quantify with some certainty the changes that develop as the disease progresses. Usually they start with counting according to Kraepelin: the patient is asked to subtract 7 from 100, then subtract 7 from the remainder and repeat this action until the remainder is less than seven. The test execution time is recorded, as well as the number of errors. If it seems that the patient did poorly on the test due to poor knowledge of arithmetic, he should be asked to complete a simpler similar task or list the names of the months in in reverse order. The study of the direction and concentration of mental activity of patients is very important in various fields of clinical medicine, since many mental and somatic disease processes begin with attention disorders. Attention disorders are often noticed by patients themselves, and the almost everyday nature of these disorders allows patients to talk about them to doctors of various specialties. However, with some mental illnesses, patients may not notice their problems in the area of attention. The main characteristics of attention include volume, selectivity, stability, concentration, distribution and switching. Under volume
attention is understood as the number of objects that can be clearly perceived in a relatively short period of time. The limited scope of attention requires the subject to constantly highlight some of the most significant objects of the surrounding reality. This choice from a variety of stimuli, only some, is called selectivity of attention.
·
The patient shows absent-mindedness and periodically asks the interlocutor (doctor) again, especially often towards the end of the conversation. ·
The nature of communication is affected by noticeable distractibility, difficulty in maintaining and voluntarily switching attention to a new topic. ·
The patient's attention is held on one thought, topic of conversation, object for only a short time Sustainability of attention
- this is the subject’s ability not to deviate from directed mental activity and maintain focus on the object of attention. The patient is distracted by any internal (thoughts, sensations) or external stimuli (extraneous conversation, street noise, any object that comes into view). Productive contact may be virtually impossible. Concentration
is the ability to focus attention in the presence of interference. ·
Do you find it difficult to concentrate when doing mental work, especially at the end of the work day? ·
Do you notice that you are starting to make more careless mistakes in your work? Distribution of attention
indicates the subject’s ability to direct and focus his mental activity on several independent variables at the same time. Switching attention
represents a movement of its focus and concentration from one object or type of activity to others. ·
Are you sensitive to external interference when performing mental work? ·
Are you able to quickly switch attention from one activity to another? ·
Do you always manage to follow the plot of a film or TV show that interests you? ·
Do you often get distracted when reading? ·
Do you often notice that you mechanically skim through a text without catching its meaning? Attention research is also carried out using Schulte tables and a proof test. Attention disorders
Emotional disorders
Mood assessment begins with observation of behavior and continues with direct questions:
· What's your mood?
· How do you feel mentally?
If depression is detected, you should ask the patient in more detail about whether he sometimes feels close to tears (the actual tearfulness that actually exists is often denied), whether he has pessimistic thoughts about the present, about the future; whether he feels guilty about the past. Questions can be formulated as follows:
· What do you think will happen to you in the future?
· Do you blame yourself for anything?
Upon in-depth examination of the condition anxiety the patient is asked about somatic symptoms and thoughts accompanying this affect:
· Do you notice any changes in your body when you feel anxious?
Then they move on to consider specific points, inquiring about rapid heartbeat, dry mouth, sweating, trembling and other signs of autonomic nervous system activity and muscle tension. To identify the presence of anxious thoughts, it is recommended to ask:
· What comes to your mind when you feel anxious?
Likely responses involve thoughts of possible fainting, loss of self-control, and impending madness. Many of these questions are inevitably the same as those asked when collecting information for a medical history.
Questions about high spirits correlate with those asked for depression; Thus, a general question (“How are you feeling?”) is followed, if necessary, by corresponding direct questions, for example:
· Do you feel unusually energetic?
Elevated mood is often accompanied by thoughts reflecting excessive self-confidence, an inflated assessment of one's abilities and extravagant plans.
Along with assessing the dominant mood, the doctor must find out how your mood changes and whether it matches the situation. When there are sudden changes in mood, they say that it is labile. Any persistent absence of emotional reactions, usually referred to as dulling or flattening of emotions, should also be noted. In a mentally healthy person, the mood changes in accordance with the main topics discussed; he looks sad when talking about sad events, shows anger when talking about what made him angry, etc. If the mood does not coincide with the situation (for example, the patient giggles while describing the death of his mother), it is marked as inadequate. This symptom is often diagnosed without sufficient evidence, so it is necessary to record typical examples in the medical history. A closer acquaintance with the patient may later suggest another explanation for his behavior; for example, smiling when talking about sad events may be a consequence of embarrassment.
The state of the emotional sphere is determined and assessed during the entire examination. When studying the sphere of thinking, memory, intelligence, perception, the nature of the emotional background and volitional reactions of the patient are recorded. The peculiarity of the patient’s emotional attitude towards relatives, colleagues, roommates, medical staff, and his own condition is assessed. In this case, it is important to take into account not only the patient’s self-report, but also objective observation data on psychomotor activity, facial expressions and pantomime, indicators of tone and direction of vegetative-metabolic processes. The patient and those observing him should be asked about the duration and quality of sleep, appetite (reduced in depression and increased in mania), physiological functions (constipation in depression). During examination, pay attention to the size of the pupils (dilated in depression), the moisture of the skin and mucous membranes (dryness in depression), measure blood pressure and count the pulse (increased blood pressure and increased heart rate during emotional stress), find out the patient’s self-esteem (overestimation in a manic state and self-deprecation in depression).
Depressive symptoms
Depressed mood (hypotymia). Patients experience feelings of sadness, despondency, hopelessness, discouragement, and feel unhappy; anxiety, tension, or irritability should also be assessed as dysphoric mood. The assessment is made regardless of the duration of the mood.
· Have you experienced tension (anxiety, irritability)?
· How long did it last?
· Have you experienced periods of depression, sadness, or hopelessness?
· Do you know the state when nothing makes you happy, when everything is indifferent to you?
Psychomotor retardation. The patient feels lethargic and has difficulty moving. Objective signs of inhibition should be noticeable, for example, slow speech, pauses between words.
· Do you feel sluggish?
Deterioration of cognitive abilities. Patients complain of a deterioration in the ability to concentrate and a general deterioration in thinking abilities. For example, helplessness when thinking, inability to make a decision. Thinking disorders are largely subjective and differ from such gross disorders as fragmented or incoherent thinking.
· Do you experience any problems when thinking; decision making; performing arithmetic operations in everyday life; need to concentrate on something?
Loss of interest and/or desire for pleasure . Patients lose interest, the need for pleasure in various areas of life, and their sex drive decreases.
Do you notice any changes in your interest in your surroundings?
· What usually gives you pleasure?
· Does this make you happy now?
Ideas of low value (self-abasement), guilt. Patients derogatorily evaluate their personality and abilities, belittling or denying everything positive, talk about feelings of guilt and express unfounded ideas of guilt.
· Have you been feeling dissatisfied with yourself lately?
· What is this connected with?
· What in your life can be regarded as your personal achievement?
· Do you feel guilty?
· Could you tell us what you are accusing yourself of?
Thoughts about death, suicide. Almost all depressed patients often return to thoughts of death or suicide. Statements about the desire to go into oblivion, so that it happens suddenly, without the participation of the patient, “to fall asleep and not wake up,” are common. Considering ways to commit suicide is typical. But sometimes patients are prone to specific suicidal actions.
The so-called “anti-suicide barrier”, one or more circumstances that keep the patient from committing suicide, is of great importance. Identifying and strengthening this barrier is one of the few ways to prevent suicide.
· Is there a feeling of hopelessness, a dead end in life?
· Have you ever had the feeling that your life is not worth continuing?
· Do thoughts about death come to your mind?
· Have you ever had a desire to take your own life?
· Have you considered specific methods of suicide?
· What kept you from doing this?
· Have there been any attempts to do this?
· Could you tell us more about this?
Decreased appetite and/or weight. Depression is usually accompanied by changes, often a decrease, in appetite and body weight. Increased appetite occurs in some atypical depressions, particularly in seasonal affective disorder (winter depression).
· Has your appetite changed?
· Have you lost/put on weight lately?
Insomnia or increased sleepiness. Among night sleep disorders, it is customary to distinguish insomnia during the period of falling asleep, insomnia in the middle of the night (frequent awakenings, shallow sleep) and premature awakenings from 2 to 5 o'clock.
Disturbances in falling asleep are more typical for insomnia of neurotic origin; early premature awakenings are more common in endogenous depression with distinct melancholy and/or anxious components.
· Do you have problems sleeping?
· Do you fall asleep easily?
· If not, what prevents you from falling asleep?
· Do you ever wake up for no reason in the middle of the night?
· Do heavy dreams bother you?
· Are there premature morning awakenings? (Are you able to fall back to sleep?)
· What mood do you wake up in?
Daily mood fluctuations. Clarification of the rhythmic features of the mood of patients is an important differential sign of the endo- and exogeneity of depression. The most typical endogenous rhythm is a gradual decrease in melancholy or anxiety, especially pronounced in the morning hours throughout the day.
· What time of day is the most difficult for you?
· Do you feel heavier in the morning or evening?
Decreased emotional response manifested by poor facial expressions, range of feelings, and monotony of voice. The basis for the assessment is the motor manifestations and emotional response recorded during the questioning. It should be borne in mind that the assessment of some symptoms may be distorted by the use of psychotropic drugs.
Monotonous facial expression
· Facial expression may be incomplete.
· The patient's facial expression does not change or the facial response is less than expected in accordance with the emotional content of the conversation.
· Facial expressions are frozen, indifferent, the reaction to treatment is sluggish.
Decreased spontaneity of movements
· The patient appears very uncomfortable during the conversation.
· Movements are slow.
· The patient sits motionless throughout the conversation.
Poor or absent gestures
· The patient exhibits a slight decrease in the expressiveness of gestures.
· The patient does not use hand movements, bending forward when communicating something confidential, etc. to express his ideas and feelings.
Lack of emotional response
· Lack of emotional resonance can be tested by smiling or making a joke, which usually elicits a smile or laugh in return.
· The patient may miss some of these stimuli.
· The patient does not react to a joke, no matter how he is provoked.
· During a conversation, the patient detects a slight decrease in voice modulation.
· In the patient's speech, words have little emphasis on height or tone.
· The patient does not change the timbre or volume of his voice when discussing purely personal topics that can cause outrage. The patient's speech is constantly monotonous.
Anergy. This symptom includes a feeling of loss of energy, fatigue, or feeling tired for no reason. When asking about these disturbances, they should be compared with the patient's usual activity level:
· Do you feel more tired than usual when doing normal activities?
· Do you feel physically and/or mentally exhausted?
Anxiety disorders
Panic disorders. These include unexpected and causeless anxiety attacks. Somatovegetative symptoms of anxiety such as tachycardia, shortness of breath, sweating, nausea or discomfort in the abdomen, pain or discomfort in the chest, may be more pronounced than mental manifestations: depersonalization (derealization), fear of death, paresthesia.
· Have you ever experienced sudden attacks of panic or fear during which you felt very physically ill?
· How long did they last?
· What unpleasant sensations accompanied them?
· Were these attacks accompanied by fear of death?
Manic states
Manic symptoms . Elevated mood. The condition of patients is characterized by excessive cheerfulness, optimism, and sometimes irritability, not associated with alcohol or other intoxication. Patients rarely regard elevated mood as a manifestation of illness. At the same time, diagnosing a current manic state does not cause any particular difficulties, so it is necessary to ask more often about past manic episodes.
· Have you ever felt particularly elated at any time in your life?
· Did it differ significantly from your norm of behavior?
· Did your relatives and friends have any reason to think that your condition goes beyond just a good mood?
· Have you ever experienced irritability?
· How long did this condition last?
Hyperactivity . Patients find increased activity in work, family affairs, sexuality, and in making plans and projects.
· Is it true that you (were then) active and busier than usual?
· What about work, hanging out with friends?
· How passionate are you now about your hobby or other interests?
· Can (could) you sit still or do you want (want) to move all the time?
Acceleration of thinking / jump of ideas. Patients may experience a distinct acceleration of thoughts and notice that thoughts are ahead of speech.
· Do you notice the ease of thoughts and associations arising?
· Can we say that your head is full of ideas?
Increased self-esteem . The assessment of merits, connections, influence on people and events, power and knowledge is clearly increased compared to the usual level.
· Do you feel more confident than usual?
· Do you have any special plans?
· Do you feel any special abilities or new opportunities in yourself?
· Don't you think that you are a special person?
Decreased sleep duration. When assessing, you need to take into account the average for the last few days.
· Do you need fewer hours of sleep to feel rested than usual?
· How many hours of sleep do you usually get and how much now?
Super-attractiveness. The patient's attention is very easily switched to insignificant or irrelevant external stimuli.
· Do you notice that your surroundings distract you from the main topic of conversation?
