mental status assessment

Question 1

older adult special considerations

Answer 1

• vision/hearing
• appropriate dress
• slow responses
• mild confusion in the new setting
• reminiscing
• short term memory hesitaiton
• risk of abuse

Question 2

cultural special considerations

Answer 2

• eye contact
• cultural beliefs
• facial expressino
• risk for under recognized depression

Question 3

what does mental status mean?

Answer 3

emotional and cognitive functioning, inferred through assessment of individual behaviors

Question 4

what individual behaviors should you assess in mental status

Answer 4

consciousness, language, mood and affect, orientation, memory and abstract reasoning, thought process through content and perception

Question 5

consciousness

Answer 5

awareness of one’s own existence, feelings, and thoughts and of the environment

Question 6

language

Answer 6

using the voice to communicate one’s thoughts and feelings

Question 7

mood and affect

Answer 7

both of these elements deal with prevailing feelings, mood is a prolonged display of feelings that colors the whole emotional life, whereas affect is a temporary expression of feelings

Question 8

orientation

Answer 8

awareness of the objective world in relation to the self

Question 9

attention

Answer 9

the power of concentration, the ability to focus on one specific things without being distracted

Question 10

memory

Answer 10

the ability to note and store experiences and perceptions for later recall, recent memory evokes day to day evenets, and remote brings up many years of experience

Question 11

abstract reasoning

Answer 11

pondering of a deeper meaning beyond the concrete and literal

Question 12

thought process

Answer 12

the way a person thinks, the logical train of thought

Question 13

thought content

Answer 13

what a person thinks, specific ideas, beliefs, and use of words

Question 14

perceptions

Answer 14

awareness of objects through any of the five senses

Question 15

what is a mental status examination?

Answer 15

the systematic check of emotional and cognitive function

Question 16

4 pillars of mental status exam

Answer 16

appearance, behavior, cognitive functions (conversations), thought process

Question 17

when is a full mental status exam necessary?

Answer 17

• initial screening detects anxiety or depression
• behavioral changes like memroy loss, inappropriate social interaction
• brain lesions like trauma, tumor, CV accident, stroke
• aphasia like impairement of language due to brain damage
• symptoms of psychiatric mental illness

Question 18

when should one proceed with acute assessment

Answer 18

any time there is a suspicion of mental health problems

Question 19

what should an acute assessment include

Answer 19

safety assessment, utilize touch cautiously, assume non threatening posture

Question 20

appearance components

Answer 20

overall appearance, posture, body movements, grooming and hygeine, dress

Question 21

behavior components

Answer 21

level of consciousness (lethargic, obtunded, stupor), facial expressions, speech, mood/affect

Question 22

lethargic

Answer 22

drowsy, oriented and appropriate but may be slow

Question 23

obtunded

Answer 23

hard to arouse, slow and confused responses, requires almost constant stimulation for even marginal cooperation

Question 24

stupor/semi coma

Answer 24

responds only to vigorous shake or pain, purposeful withdrawal to pain, slow or absent verbal responses

Question 25

cognitive function components

Answer 25

orientation, attention span, memory, aphasia, judgement

Question 26

immediate memory

Answer 26

say 4 words and ask them to repeat after you

Question 27

recent memory

Answer 27

remembering the words after about 5 minutes

Question 28

remote memory

Answer 28

occupation, birthday, place of birth

Question 29

what does thought process include

Answer 29

thought process, thought content, perception

Question 30

logic, relevance, organization of thoughts

Answer 30

assessed during conversation, should be able to organize thoughts and make connections between subjects

Question 31

abstract and concrete thinking

Answer 31

you can assess by asking a patient to interpret a proverb (ex: what does silver lining mean?)

Question 32

expected findings for thought content

Answer 32

reality based and rational thinking, denies irraitonal fears or obsessive thoughts

Question 33

perceptions normal findings

Answer 33

accurately perceives people and events, denies voices or seeing things others do not

Question 34

perceptions abnormal

Answer 34

hallucinations or delusions, BIG red flag

Question 35

ways to test insight and normal findings

Answer 35

"what do you think caused your current problem", normal findings: verablizes contribution of choices to current physical condition

Question 36

screenings for depression

Answer 36

PHQ-2 and PHQ-9, PHQ2 is broader while the 9 question is specific

Question 37

GAD-7

Answer 37

anxiety screening tool

Question 38

what is the problem with suicidal risk factors

Answer 38

someone can have all the risk factors and not commit suicide, someone can have none and commit suicide

Question 39

suicidal risk factors (9)

Answer 39

genetics, abuse, previous attempts, loss, serious illness, mediation, substance abuse, social isolation, impulsive/aggression

Question 40

supplemental mental status testing

Answer 40

mini-cog; MMSE, MoCA

Question 41

delirium vs. dementia

Answer 41

delirium is acute while dementia is progressive

Question 42

delirium

Answer 42

acute confusional change or loss of consciousness and perceptual disturbance, may accompany acute illness, usually resolved when underlying cause is treated

Question 43

dementia

Answer 43

gradual progressive process, causing decreased cognitive function even though the person is fully conscious and awake, not reversible

Question 44

red flags in mental status exam

Answer 44

acute change in mental status or level of consciousness, delusions and hallucinations, suicidal or homicidal thoughts

Question 45

red flags for general violence

Answer 45

new onset behaviors or changes in behavior; withdrawal, depression; agitation, hyperarousal; new displays of anger, noncompliance; sexualized behavior; bowel or bladder problems

Question 46

alcohol use and abuse

Answer 46

high incidence of occurrence across patient care settings; morbidity and mortality data reflect adverse consequences