M6-7

• Attitude toward the examiner

  Note whether the patient appeared interested during the interview or, perhaps, if the patient appeared bored
• Mood


  Sustained emotion that the patient is experiencing
• Affect

  Expansive (contagious), euthymic (normal), constricted (limited variation), blunted (minimal variation), and flat (no variation)
• Speech

  Quality, quantity, rate, and volume of speech during the interview
• Thought process

  Looseness of association (irrelevance), flight of ideas (change topics), racing (rapid thoughts), tangential (departure from topic with no return), circumstantial (being vague, i.e. "beating around the bush" giving inordinately long responses that only eventually answer the stated question), word salad (nonsensical responses i.e., Jabberwocky), derailment (extreme relevance), neologism (creating new words), clanging (rhyming words), punning (talking in riddles), thought blocking (speech is halted), and poverty (limited content)
• Thought content

  Determine whether the patient is experiencing hallucinations
• Command-type hallucinations


  Inquire what the patient will do in response to these commanding hallucinations
• Types of hallucinations

  • Auditory (hearing things)
  • Visual (seeing things)
  • Gustatory (tasting things)
  • Tactile (feeling sensations)
  • Olfactory (smelling things)
• Delusions


  Thoughts that other people think are strange, beliefs of special powers or abilities, belief that the television or radio gives special messages
• Types of delusions

  • Grandiose (delusions of grandeur)
  • Religious (delusions of special status with God)
  • Persecution (belief that someone wants to cause them harm)
  • Erotomanic (belief that someone famous is in love with them)
  • Jealousy (belief that everyone wants what they have)
  • Thought insertion (belief that someone is putting ideas or thoughts into their mind)
  • Ideas of reference (belief that relatively ordinary or commonplace phenomenon are referring specifically to them)
• Obsessions and compulsions


  Afraid of dirt, washing hands often, counting things over and over, performing specific acts to reduce certain thoughts
• Phobias


  Fears that cause patients to avoid certain situations, such as fear of animals, needles, heights, snakes, public speaking, or crowds
• Suicidal ideation or intent


  Thoughts of wanting to harm or kill oneself, thoughts that one would be better off dead
• Homicidal ideation or intent


  Thoughts of wanting to hurt anyone, feelings or thoughts that someone were dead
• Mini-Mental State Examination (MMSE) or Folstein test


  Assesses sensorium and cognition
• Spontaneous speech


  May be noted, repetition (ho, its, ands, or buts) should be considered
• Comprehension


  Provide a simple instruction to patient, such as "Fold this paper in half" or "Squeeze my hand"
• Levels of consciousness

  • Coma, characterized by unresponsiveness
  • Stuporous, characterized by response to pain
  • Lethargic, characterized by drowsiness
  • Alert, characterized by full awareness
• Orientation


  Asking the patient questions about their name, where they are, the date, time, and why they are there
• Concentration and attention

  Ask the patient to subtract 7 from 100, then repeat the task from that response (serial 7s), or ask them to recite the months of the year backwards, and spell "world" forward and backward
• Reading and writing


  Ask the patient to write a simple sentence and read a sentence
• Visuospatial ability


  Have the patient draw interlocking pentagons and "use imaginary scissors"
• Memory

  Ask the patient about remote memory (first grade teacher), recent memory (dinner last night), and immediate recall (3 words)
• Abstract thought


  Assess the patient's ability to determine similarities and understand proverbs
• General fund of knowledge

  Test the patient's knowledge by asking questions about days in a week, last 5 presidents, or major Philippine island groups
• Intelligence

  Estimate the patient's intelligence quotient (below average, average, above average)
• Insight


  Assess the patient's understanding of their condition and attitude towards their illness and the clinician
• Judgment


  Estimate the patient's judgment based on history or an imaginary scenario
• Impulsivity


  Estimate the degree of the patient's impulse control by asking about doing things without thinking or planning
• Scales


  Used to measure pain by facial grimacing
• PAIN ASSESSMENT: THE FIFTH VITAL SIGN
• Patient's self-report Pain


  A sensation of physical or mental hurt or suffering that causes distress or agony to the one experiencing it
• It is whatever the patient says it is
• It exists whenever the patient says it does
• It is subjective in nature. Only the person experiencing it may describe it
• Pain


  A protective mechanism that provides warning signal for tissue injury and helps minimize injury
• Pattern theory


  Pain is perceived whenever the stimulus is intense enough
• Specificity theory


  1. There are specific nerve receptors for particular stimuli

  2. Nociceptors for noxious stimuli

  3. Thermoreceptors for heat or cold

  4. Mechanoreceptors for pressure, pulling or tearing sensation

  5. Chemoreceptors for chemicals
• Gate control theory

  1. There is a gate in the spinal cord called SUBSTANTIA GELATINOSA

  2. When the gate is open, pain stimulus is transmitted; thus, pain is perceived

  3. When the gate is close, pain stimulus is blocked; thus, no pain is perceived
• Affect theory


  Pain is emotional. The intensity of pain perceived depends on the value of the organ affected to the individual