| Pitfall | Trzepacz’s Correction | |---------|------------------------| | Using the MSE as a checklist without integration | The MSE is a gestalt. One finding modifies another. Example: Paranoia (thought content) is more concerning if affect is flat (schizophrenia) vs. anxious (personality disorder). | | Testing memory before attention | “You cannot test memory in a patient who cannot attend.” Always begin cognitive testing with digit span. | | Overinterpreting a single response | A single odd proverb answer is not psychosis. Look for pervasive thought disorder across multiple domains. | | Ignoring the patient’s baseline | Always ask family or staff: “Is this change from their usual self?” Trzepacz calls this the “personal baseline” – essential for distinguishing delirium from dementia. |
Beyond "pressured" or "slowed," Trzepacz integrates neurolinguistic concepts. She guides the examiner to assess: The digital age hasn’t diminished the need for
When testifying in court, a poorly documented MSE is useless. Trzepacz’s work provides a standardized language (e.g., "The patient exhibited tangentiality, loose associations, and a second-person auditory hallucination") that holds up under cross-examination. "The patient exhibited tangentiality
The digital age hasn’t diminished the need for Trzepacz’s rigorous approach. In fact, it has amplified it. The digital age hasn’t diminished the need for
During telehealth visits, you cannot observe gait or posture fully. Trzepacz’s focus on speech (rate, rhythm, volume, latency) and thought process becomes the entire MSE. Her guidelines on assessing attention via digit span or serial 7s translate perfectly to video.