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Mental Status Assessment By InnaKorda, MD, Institute of Nursing, TSMU Mental Health Mental status definition: A person’s emotional and cognitive function Mental disorder definition: “A significant behavioral or psychological pattern associated with distress or disability and has a significant risk of pain, disability, or death, or a loss of freedom” (APA, 1994) Can a mental disorder be assessed? How? •You must believe what your pt. tells you, must take them seriously if they say they want to kill themselves. •Suicide precautions may be implemented by having a sitter or restraints. How do you know if a person has a mental disorder or is just having a crisis in his or her life? You don’t know, that’s why we assess mental health. Theoretical vs. Practical Assessing Mental Health 1. 2. 3. 4. Appearance Behavior Cognitive function Thought process and perceptions Assessing mental health Appearance Posture Anxiety – sitting on edge of bed, tense muscles, frowning, restless, pacing (Hyperthyroidism?) Depression – sitting slumped in a chair, slow walk, dragging feet Body movements Normal – voluntary, deliberate, coordinated, smooth and even Anxiety – restless, fidgety Depression – apathy, slow movements Schizophrenia – bizarre gestures, facial grimaces Dress Eccentric dress occurs with schizophrenia or manic syndrome Hygiene Note change from previously well-groomed appearance to one that is disheveled - depression Obsessive compulsive disorder – meticulously dressed and groomed Assessing Mental Health Behavior Consciousness (LOC) Facial expression Look is appropriate for the situation Flat, masklike expression in Parkinson’s and depression Language – physical ability to speak, word choice Mood and affect Mood – more temporary expression of emotions Affect – more permanent display of feelings Assessing Mental Health Cognitive Function Orientation – person, place, time (A&O x 3) Attention – give orderly instructions and ask pt. to perform Memory – short and long term Abstract reasoning Disorientation occurs with dementia, delirium Problem solving and reasoning abilities Must keep in mind patient’s education level Thought Processes and Perceptions Thought process – Logic. How a person thinks. Thought content – What a person thinks. Perceptions How do people treat you? What do people say when they talk about you? Assessing Mental Health Suicide precautions Risk factors Prior suicide attempts Depression Verbal messages to kill self Death themes in talk, jokes Giving away possessions Assessing “Have you ever thought about hurting yourself?” “Do you plan to hurt yourself now?” “Have you ever hurt yourself in the past? Mini-Mental State Examination LOC Abnormalities GCS – Glasgow Coma Scale Common terms when assessing consciousness Alert – to person, place, and time Lethargic – drifts off frequently. Must be aroused. Frequently effect of sedation Obtunded – frequent sleep, difficult to arouse, incoherent speech Stupor – responds only to vigorous shaking and pain, groans and mumbles Coma – unconscious with little or no response to stimuli. Little or no reflex response. GCS 15 – normal person GCS <7 – coma Speech Disorders Dysphonia – difficulty or discomfort using voice to talk Dysarthria – disorder of articulation in which the speech sounds are distorted. Aphasia – language defect in processing Global aphasia – little or no speech and comprehension Broca’s aphasia – can understand language, but difficulty speaking. Grammar problems. Wernicke’s aphasia – problem comprehending words. Can still articulate well. Mood and Affect Abnormalities Flat affect – no emotional response Inappropriate affect – wrong emotion for the situation Depression – sadness Depersonalization – loss of identity. “I don’t feel real” Elation – joy and optimism, overconfidence Euphoria – inappropriate elation Anxiety – worried, uneasy, nervous Fear – worried, uneasy, apprehensive Irritability – annoyed, easily provoked Rage – furious, loss of control Lability – rapid shift of emotions Thought abnormalities Process Confabulation – make up events Loose associations – shifting between unrelated ideas Flight of ideas – unrelated ideas but connected usually by a play on words Word salad – incoherent mixture of words Content Phobia – irrational fear of an object Hypochondrias – phobia of having diseases. Obsession – unwanted and persistent thoughts Compulsion – unwanted and persistent actions. Delusions – False beliefs, often of persecution or grandiose Abnormalities of Perception Hallucination – Sensory perception for which there are no external stimuli. May be visual, auditory, tactile, olfactory, gustatory. Delusion – Misperception of an actual existing stimulus, by any sense. Schizophrenia Delirium, Dementia, and Amnesia Delirium Consciousness change – reduced awareness of environment with reduced ability to focus, sustain, or shift attention Cognition change Develops over a short period of time (hours to days) Dementia Memory impairment One or more of the following: Alzheimer’s, Parkinson’s, HIV, cerebrovascular disease Amnesia Memory impairment without other disorders May be caused by trauma or substance induced Aphasia – language disturbance Apraxia – impaired ability to carry out motor activities despite intact motor function Agnosia – impaired ability to recognize or identify objects despite intact sensory function Executive functioning disturbance – planning, organizing, sequencing, abstracting Substance Use Disorders Substance: agents taken nonmedically to alter mood or behavior Intoxication – ingestion of substance produces maladaptive behavior changes due to effects on CNS Abuse – Daily use needed to function. Inability to stop. Impaired social and occupational functioning Dependence – physiologic dependence on substance Tolerance – requires increased amount of substance to produce same effect Withdrawal – cessation of substance produces physiologic symptoms Effects of Common Substances Alcohol, sedatives, and hypnotics (CNS depressants) Symptoms – unsteady gait, incoordination, impaired judgement Withdrawal – tremor of hands, eyelids. Tachycardia, elevated BP, sweating, headache, insomnia, anxiety, N&V, hallucinations, delusions Nicotine (mild stimulant) Symptoms – increased systolic BP, increase HR, vasoconstriction, loss of appetite, dizziness Withdrawal – vasodilation, headaches, irritability, anxiety, nervousness Marijuana Symptoms – reddened conjunctivae, tachycardia, dry mouth, increased appetite, euphoria, anxiety, slowed time perception Withdrawal – ? restlessness, decreased appetite Effects of Common Substances Cocaine and Amphetamines (psychostimulants) Symptoms – Pupillary dilation, tachycardia or bradycardia, elevated or decreased BP, N&V, weight loss, euphoria, agitation, aggressiveness Withdrawal – Anxiety, depression, irritability, fatigue Opiates (morphine, heroin) Symptoms – pinpoint pupils, decreased BP, pulse, respirations, and temperature, lethargy, psychomotor retardation, inattention, impaired memory Withdrawal – Dilated pupils, lacrimation, tachycardia, elevated BP, sweating, diarrhea, irritability, depression Anxiety Disorders Panic attack Intense fear or discomfort develops within 10 minutes Symptoms Agoraphobia Anxiety about being in a place or situation where escape might be difficult or where help might not be available Palpitations, sweating, trembling, SOB, feeling of choking, chest pain, nausea, dizziness Being outside of home, in a crowd, on a bridge, in a car, bus, or train Specific phobias Phobias of specific objects provokes an anxiety response OCD (Obsessive-Compulsive) PSD (Posttraumatic Stress Disorder) Experience or witness of actual or threatened death or serious injury of self or others Recurrent recollections of event followed by distress Generalized Anxiety Disorder Persistent general anxiety Mood Disorders Depression 5 or more present during the same 2 week period Depressed mood Diminished interest Weight loss Insomnia Psychomotor agitation Fatigue Feelings of worthlessness Diminished ability to think Thoughts of death Mania Persistently elevated or irritable mood lasting 1 week or more with: Grandiosity Decreased sleep Talkativeness Flight of ideas Distractibility Agitation Pleasurable activities Isn’t everyone suffering from a mental disorder???