Chapter 5: Mental Status Assessment Flashcards
defining mental status
-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
mental disorder
Clinically significant behavioral emotional or cognitive syndrome
that is associated with significant distress or disability involving
social, occupational, or key activities
organic disorders
Due to brain disease of known specific organic cause (e.g.,
delirium, dementia, alcohol and drug intoxication, and withdrawal)
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
components of mental status examination
-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
ABCT
Appearance
Behavior
Cognition
Thought processes
when a full mental status exam is necessary
-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
Factors That Could Affect
Interpretation of Findings
-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
exam sequence of steps
-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
objective data for mental status
-Appearance, behavior, cognitive functions, and thought processes
-Determination of normal versus abnormal findings
the four unrelated word test
-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 is aphasia
loss of ability to speak or write
coherently or to understand speech or writing due to a cerebrovascular accident
-word comprehension
-reading
-writing
Thought Processes, Content, and
Perceptions
-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.
what are the two most
common mental health disorders seen in individuals seeking health care
anxiety and depression
what is GAD-7
-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
tools that can be used for depression disorders in the clinical setting
-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
screening for suicidal thoughts
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.
mini-mental state exam (MMSE)
-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
Montreal Cognitive Assessment (MoCA)
-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
child mental status
-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
screenings for infants and children
-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
screening test for adolescents
Follow same A-B-C-T guidelines as for adults
testing aging adults
-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
Aging Adults: Supplemental Mental
Status Testing
Mini-Cog
Reliable and quick instrument to
screen for cognitive impairment in
healthy adults
Consists of three-item recall test
and clock-drawing test
abnormal findings
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
