Chapter 5: Mental Status Assessment

Question 1

defining mental status

Answer 1

-is a person’s emotional and
cognitive functioning.
-Optimal functioning aims toward simultaneous life satisfaction in work, caring relationships, and within the self
-Usually, mental status strikes a balance between good and bad days, allowing person to function
socially and occupationally
-Consciousness, language, mood, and affect
-Orientation and attention
-Memory and abstract reasoning
-Thought process, through content, and perception

Question 2

mental disorder

Answer 2

Clinically significant behavioral emotional or cognitive syndrome
that is associated with significant distress or disability involving
social, occupational, or key activities

Question 3

organic disorders

Answer 3

Due to brain disease of known specific organic cause (e.g.,
delirium, dementia, alcohol and drug intoxication, and withdrawal)

Question 4

Psychiatric mental illnesses

Answer 4

-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

Question 5

components of mental status examination

Answer 5

-Full mental status examination is a systematic check of emotional and cognitive functioning
-Usually, mental status can be integrated within the context of the health history interview
-Four main headings of mental status assessment: A-B-C-T
 Appearance
 Behavior
 Cognition
 Thought processes

Question 6

ABCT

Answer 6

Appearance
 Behavior
 Cognition
 Thought processes

Question 7

when a full mental status exam is necessary

Answer 7

-Initial screening: Suggests an anxiety disorder or depression
-Behavioral changes: 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

Question 8

Factors That Could Affect
Interpretation of Findings

Answer 8

-Known illnesses or health problems: Such as alcoholism or chronic renal disease
-Medications: Side effects of confusion or depression
-Educational and behavioral level: Note factor as normal baseline
-Stress responses observed in: social interactions, sleep habits, drug and alcohol use

Question 9

exam sequence of steps

Answer 9

-Data Collection
-Assess accurately and assure validity
-Basic function (consciousness and language)
-Sequence of steps forms a hierarchy in which the most basic functions are assessed
first

Question 10

objective data for mental status

Answer 10

-Appearance, behavior, cognitive functions, and thought processes
-Determination of normal versus abnormal findings

Question 11

the four unrelated word test

Answer 11

-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

Question 12

what is aphasia

Answer 12

loss of ability to speak or write
coherently or to understand speech or writing due to a cerebrovascular accident
-word comprehension
-reading
-writing

Question 13

Thought Processes, Content, and
Perceptions

Answer 13

-Thought processes: Way person thinks should be logical, goal directed, coherent, and relevant; should complete thoughts
-Thought content: What person says should be consistent and
logical.
-Perceptions: Person should be consistently aware of reality;
perceptions should be congruent with yours.

Question 14

what are the two most
common mental health disorders seen in individuals seeking health care

Answer 14

anxiety and depression

Question 15

what is GAD-7

Answer 15

-Generalized anxiety disorder scale (GAD-7)
-Consists of 7 itemized scale
-Higher the score, greater the likelihood
-First 2 questions relate to core anxiety.
-Greater or equal than 3 indicates diagnosis

Question 16

tools that can be used for depression disorders in the clinical setting

Answer 16

-Patient Health Questionnaire-2 (PHQ-2):
* Asks 2 questions about depressed mood and anhedonia (lack of interest).
* Serves as a screening tool to use full PHQ-9 tool

-PHQ-9:
* Series of 9 questions requiring adding column totals that relate to frequency of occurrence of symptoms
* Higher the score, the greater the likelihood of functional
impairment or clinical diagnosis

Question 17

screening for suicidal thoughts

Answer 17

ABS
-Assess for possible risk for harm if the person expresses feelings of sadness, hopelessness, despair, or grief.
-Begin with more general questions and proceed if you hear affirmative answers
-Share any concerns you have about a person’s suicide ideation with a mental health professional.

Question 18

mini-mental state exam (MMSE)

Answer 18

-Concentrates only on cognitive functioning

-Standard set of 11 questions requires only 5 to 10 minutes to administer:
* Useful for both initial and serial measurement
* 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

Question 19

Montreal Cognitive Assessment (MoCA)

Answer 19

-Examines more cognitive domains, more sensitive to mild cognitive impairment
-Ten minutes to administer
-Total score of 30 with a score of greater to or equal than 26
considered normal

Question 20

child mental status

Answer 20

-Follow A-B-C-T guidelines as for adults, with consideration for developmental milestones
-Abnormalities often problems of omission; child does not achieve expected milestone

Question 21

screenings for infants and children

Answer 21

-Denver II screening test gives a chance to interact directly with child to assess mental status:
- For child from birth to 6 years of age, Denver II helps identify those who may be slow to develop in behavioral, language, cognitive, and psychosocial areas
-An additional language test is the Denver Articulation Screening
Examination

-“Behavioral Checklist” for school-age children, ages 7 to 11, is tool given to parent along with the history:
-Covers five major areas: mood, play, school, friends, and family
relations
-It is easy to administer and lasts about 5 minutes

Question 22

screening test for adolescents

Answer 22

Follow same A-B-C-T guidelines as for adults

Question 23

testing aging adults

Answer 23

-Follow same A-B-C-T guidelines for the younger adult with these additional considerations:

-Behavior: level of consciousness: Glasgow Coma Scale is useful in testing consciousness in aging persons in whom confusion is common

-Cognitive functions: orientation

-Cognitive functions: new learning: In people of normal cognitive function, age-related decline occurs in performance in the Four
Unrelated Words Test

Question 24

Aging Adults: Supplemental Mental
Status Testing

Answer 24

Mini-Cog
 Reliable and quick instrument to
screen for cognitive impairment in
healthy adults
 Consists of three-item recall test
and clock-drawing test

Question 25

abnormal findings

Answer 25

Altered level of consciousness
 Speech disorders
 Mood and affect abnormalities
 Anxiety disorders
 Delirium, depression, and dementia
 Thought process abnormalities
 Thought content abnormalities
 Perception abnormalities
 Characteristics of eating disorders
 Childhood mental disorders