Chapter 5: Mental Status Assessment

Question 1

What are organic disorders?

Answer 1

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

Question 2

What are psychiatric mental illnesses?

Answer 2

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 3

Mental status functioning is inferred through an assessment of an individual’s behaviors such as:

Answer 3

Consciousness
Language
Mood and affect
Orientation 
Attention
Memory
Abstract reasoning
Thought process
Thought content
Perceptions

Question 4

What are the 4 main headings of mental status assessment? (ABCT)

Answer 4

A: appearance
B: behavior
C: cognition
T: thought processes

Question 5

What are some situations where a full mental status examination is necessary?

Answer 5

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

Question 6

What are some factors from the health history that could affect interpretation of findings?

Answer 6

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

Question 7

What objective data pieces for appearance are observed?

Answer 7

posture
body movements
dress
grooming and hygiene

Question 8

What objective data pieces for behavior are observed?

Answer 8

level of consciousness
facial expression
speech
mood and affect

Question 9

What objective data pieces for cognitive function are observed?

Answer 9

orientation
attention span
recent memory
remote memory

Question 10

What is the four unrelated words test?

Answer 10

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

Question 11

What are the additional testing methods for persons with aphasia?

Answer 11

word comprehension
reading
writing

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

Question 13

What is the word comprehension test for a patient with aphasia?

Answer 13

point to articles in the room or articles from pockets and ask patient to name them

Question 14

What is the reading test for a patient with aphasia?

Answer 14

ask person to read available print; be aware that reading is related to educational level

Question 15

What is the writing test for a patient with aphasia?

Answer 15

ask person to make up and write a sentence; note coherence, spelling, and parts of speech

Question 16

How do you screen for suicidal thoughts?

Answer 16

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?

Question 17

What is the mini mental state exam?

Answer 17

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

Question 18

What should be taken into account for care of the aging adult and mental health.

Answer 18

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

Question 19

What is the cognitive function of orientation with the aging adult?

Answer 19

Many aging persons experience social isolation, loss of structure without a job, change in residence, or some short-term memory loss
Aging persons may be considered oriented if they know generally where they are and the present period
Consider them oriented to time if year and month are correctly stated
Orientation to place is accepted with correct identification of the type of setting (e.g., the hospital and name of town)