Flashcards in Chapter 5: Mental Status Assessment Deck (19)
What are organic disorders?
Due to brain disease of known specific organic cause (e.g., delirium, dementia, alcohol and drug intoxication and withdrawal)
What are psychiatric mental illnesses?
Organic etiology has not yet been established (e.g., anxiety disorder or schizophrenia)
Mental status assessment documents a dysfunction and determines how that dysfunction affects self-care in everyday life
Mental status functioning is inferred through an assessment of an individual's behaviors such as:
Mood and affect
What are the 4 main headings of mental status assessment? (ABCT)
T: thought processes
What are some situations where a full mental status examination is necessary?
Patients whose initial screening suggests an anxiety disorder or depression
Behavioral changes, such as memory loss, inappropriate social interaction
Brain lesions: trauma, tumor, cerebrovascular accident or stroke
Aphasia: impairment of language ability secondary to brain damage
Symptoms of psychiatric mental illness, especially with acute onset
What are some factors from the health history that could affect interpretation of findings?
Known illnesses or health problems, such as alcoholism or chronic renal disease
Medications with side effects of confusion or depression
Educational and behavioral level: note that factor as normal baseline, and do not expect performance on mental status exam to exceed it
Responses indicating stress in social interactions, sleep habits, drug and alcohol use
What objective data pieces for appearance are observed?
grooming and hygiene
What objective data pieces for behavior are observed?
level of consciousness
mood and affect
What objective data pieces for cognitive function are observed?
What is the four unrelated words test?
Highly sensitive and valid memory test
Requires more effort than recall of personal or historic events, and avoids danger of unverifiable recall
Pick four words with semantic and phonetic diversity; ask person to remember the four words
To be sure person understood, have him or her repeat the words
Ask for the recall of four words at 5, 10, and 30 minutes
Normal response for persons younger than 60 is an accurate 3- or 4-word recall after 5, 10, and 30 minutes
What are the additional testing methods for persons with aphasia?
what is aphasia?
loss of ability to speak or write coherently or to understand speech or writing due to a cerebrovascular accident
What is the word comprehension test for a patient with aphasia?
point to articles in the room or articles from pockets and ask patient to name them
What is the reading test for a patient with aphasia?
ask person to read available print; be aware that reading is related to educational level
What is the writing test for a patient with aphasia?
ask person to make up and write a sentence; note coherence, spelling, and parts of speech
How do you screen for suicidal thoughts?
When the person expresses feelings of sadness, hopelessness, despair, or grief, it is important to assess any possible risk of physical harm to himself or herself
Begin with more general questions; if you hear affirmative answers, continue with more specific probing questions
Have you ever felt so blue you thought of hurting yourself or do you feel like hurting yourself now?
Do you have a plan to hurt yourself? How would you do it?
What would happen if you were dead?
How would other people react if you were dead?
What is the mini mental state exam?
Concentrates only on cognitive functioning, not on mood or thought processes
Standard set of 11 questions, requires only 5 to 10 minutes to administer
Useful for both initial and serial measurement, so worsening or improvement of cognition over time and with treatment can be assessed
Good screening tool to detect dementia and delirium and to differentiate these from psychiatric mental illness
Normal mental status average 27; scores between 24 and 30 indicate no cognitive impairment
What should be taken into account for care of the aging adult and mental health.
Check sensory status before assessing any aspect of mental status
Vision and hearing changes due to aging may alter alertness and leave the person looking confused
When older people cannot hear your questions, they may test worse than they actually are
One group of older people with psychiatric mental illness tested significantly better when they wore hearing aids