Neurontin (Gabapentin)
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PSYCHIATRIC DIMENSIONS OF MEDICAL PRACTICE: CLINICAL
ASSESSMENT-HALLUCINATIONS AND DELUSIONS AND INSTRUCTIONS FOR ADMINISTRATION OF MINI-MENTAL STATE EXAMINATION
Medical and surgical patients who develop hallucinations or delusions are almost always delirious. A hallucination is a perception without a stimulus (e.g., the patient sees people in the room when no one is there). Hallucinations are distinguished from illusions, in which stimuli are present, but misidentified (e.g., the patient sees an intravenous line as a snake). A delusion is a fixed, false, idiosyncratic belief (e.g., the patient is convinced, despite reassurance from family members and staff, that her physicians are trying to kill her).
Orientation:
(1) Ask for the date. Then ask specifically for parts omitted, for example, “Can you also tell me what season it is?” One point for each correct.
(2) Ask in turn “Can you tell me the name of this hospital?” (town, county, etc.). One point for each correct.
Registration-Ask the patient if you may test his memory. Then say the names of 3 unrelated objects, clearly and slowly, about one second for each. After you have said all 3, ask him to repeat them. This first repetition determines his score (0-3), but keep saying them until he can repeat all 3, up to 6 trials. If he does not eventually learn all 3, recall cannot be meaningfully tested.
Attention and calculation-Ask the patient to begin with 100 and count backwards by 7. Stop after 5 subtractions (93, 86, 79, 72, 65). Score the total number of correct answers.
If the patient cannot or will not perform this task, ask him to spell the word “world” backwards. The score is the number of letters in correct order. E.g. dlrow = 5, dlorw = 3.
RECALL-Ask the patient if he can recall the 3 words you previously asked him to remember. Score 0-3.
Language-Naming: Show the patient a wrist watch and ask him what it is. Repeat for a pencil. Score 0-2.
Repetition: Ask the patient to repeat the sentence after you. Allow only one trial. Score 0 or 1.
3-Stage command: Give the patient a piece of plain blank paper and repeat the command. Score 1 point for each part correctly executed.
Reading: On a blank piece of paper, print the sentence “Close your eyes”, in letters large enough for the patient to see clearly. Ask him to read it and do what it says. Score 1 point only if he actually closes his eyes.
Mental Disorders
Epilepsy Copying: On a clean piece of paper, draw intersecting pentagons, each side about 1 in and ask him to copy it exactly as it is. All 10 angles must be present and 2 must intersect to score 1 point. Tremor and rotation are ignored.
Estimate the patient’s level of sensorium along a continuum, from alert on the left to coma on the right.
*7/172/2*
