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MSE of Uncooperative PT

This document outlines how to perform a mental status examination (MSE) on an uncooperative patient. It describes assessing 9 areas: 1) general reaction and posture, 2) facial movements and expression, 3) eyes and pupils, 4) reaction to what is said or done, 5) muscular reactions, 6) emotional responsiveness, 7) speech, 8) writing, and 9) vitals. For each area, it provides specific observations to make and considerations for interpreting the patient's behavior, such as whether it is consistent or variable over time. The goal is to evaluate the patient's mental status as comprehensively as possible despite their lack of cooperation.

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Gurvinder Kalra
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738 views16 pages

MSE of Uncooperative PT

This document outlines how to perform a mental status examination (MSE) on an uncooperative patient. It describes assessing 9 areas: 1) general reaction and posture, 2) facial movements and expression, 3) eyes and pupils, 4) reaction to what is said or done, 5) muscular reactions, 6) emotional responsiveness, 7) speech, 8) writing, and 9) vitals. For each area, it provides specific observations to make and considerations for interpreting the patient's behavior, such as whether it is consistent or variable over time. The goal is to evaluate the patient's mental status as comprehensively as possible despite their lack of cooperation.

Uploaded by

Gurvinder Kalra
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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M.S.E.

Gurvinder Kalra, MD, DPM


Psychiatrist
LRH-MHS
MSE in un-cooperative patient
MSE in un-cooperative patient
• Spontaneous acts
• Voluntary postures
1) General reaction / posture
• Constancy?
2) Facial movement / expression • Behaviour towards examiner

3) Eyes / pupils

4) Reaction to what is said / done

5) Muscular reactions

6) Emotional responsiveness

7) Speech

8) Writing

9) Vitals
General reaction and posture

Spontaneous acts

• Any occasional show of activities/assaultiveness.


• Is the patient neat or untidy?
• Does the patient eat voluntarily or should be fed.
• Does the patient dress himself /require assistance.
• Does the actions show initial retardation or consistent
slowness throughout?
General reaction and posture

Voluntary postures

• Comfortable
• Natural
• Constrained
• Awkward
• What does the patient do when placed in awkward
position?
General reaction and posture

Behavior towards examiner

• Resistive
• Evasive
• Irritable
• Apathetic
• Compliant

Is the behaviour constant or variable with time?


Do any special occurrences influence patient’s behaviour?
Facial movements / expression
• Alert / Attentive
• Smiling
• Placid
• Mask-like
• Stolid, sulky, scowling
• Anxious / Perplexed
• Distressed
• Tearful
• Grimacing

Is the facial expression constant or variable with time?


Eyes & pupils
• Eyes open / closed: resistance?
• Attention to examiner & movement of eyes?
• Response to sudden movement of hand towards eyes?
• Gaze: fixed / evasive (furtive glances)
• Blinking of eyes / flickering of eye lids?
• Rolling of eyeballs upwards?
• Sensory reaction of pupils
• Is there corneal irritability (+ tears)
Reaction to what is said / done
• Response to commands
• Are motions slow / sudden / natural
• Reaction to pin pricks
• Automatic obedience?
• Echopraxia repeat
• Echolalia
Muscular reactions
• Test for
• Rigidity (lead-pipe / cog-wheel)
• Waxy flexibility
• Reflexes
• Flexibility of neck muscles, muscles of jaw / shoulders / elbows /
fingers / LLs.
• Gegenhalten / mitgehen / mitmachen
• Does distraction / command influence the reactions?
• Mouth usually open / closed? Resistance to opening /
closing mouth?
• Protrusion of lips……?
• Holding / drooling of saliva.
• Retention of urine / feces or soiling & wetting?
• Does indicate when wants to go to toilet?
Emotional responsivness
• When family members speak / personal facts
mentioned.
• Humor / jokes/ reference to family / sad news
• Unexpected stimuli like clapping sound / flash of
lights.

Note whether there is ↑/↓ HR / RR / flushing / perspiration,


tears?
Speech
• Spontaneous speech?
• Mute: consistent or periods when speaks?
• Any effort to talk?

Note exact utterances with accompanying emo-reaction.


Writing
Offer paper / pencil
Vitals
• T, P, R, BP
MSE in un-cooperative patient
• Spontaneous acts
• Voluntary postures
1) General reaction / posture
• Constancy?
2) Facial movement / expression • Behaviour towards examiner

3) Eyes / pupils

4) Reaction to what is said / done

5) Muscular reactions

6) Emotional responsiveness

7) Speech

8) Writing

9) Vitals

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