Hays, Cha. 7: Initial Assessment in Counseling Flashcards
1
Q
What is a mental status examination?
A
Not a one-time assessment, usually conducted over time to see changes in mental status
2
Q
What are we concerned about when client walks in the door?
A
- Engaged in self-care?
- Alertness
- Speech
- Behavior
- Orientation
- Mood
- Affect
- Thought Processes
- Thought Content
- Memory / Ability to perform calculations, see abstract
- Sensorium / Sensory Distortions
- Judgement
- Anxiousness
- Chemical Use
3
Q
What do we mean by the client’s self-care?
A
- Well fed, well cared for, appropriate clothing for season, clean clothing, clean body
- For kids, does it look like they are being cared for?
4
Q
What do we mean by the client’s level of alertness?
A
- Are they attending to their environment and people around them?
- Delusional people (with hallucinations) have a hard time attending to other people when the “voices are talking”
- Drowsy?
- If so, why?
5
Q
What do we mean by the client’s speech?
A
- Are they normal in tone, volume, and quantity?
- Pressured-speech (and rapid)? Could be taking a stimulant, manic
- Coherent? Clear in speech, usually clear in thinking
- Slurred? Could be drinking, pain-meds, a downer
- Neologisms - made up words (common in psychosis)
- Word Salad - words put together that have no relationship
- Pronoun Reversal - Third person, but using pronouns (he or she) instead of their name
- Muteness - could be due to medical issue or refusal to talk
- Window into a person’s thinking, their thought-process
6
Q
What do we mean by the client’s behavior?
A
- Is person cooperative or resistant, how are they acting?
- There are many reasons why someone will refuse to cooperate, so it’ll only give you basic info, but not really insight into why they won’t cooperate
7
Q
What do we mean by the client’s orientation?
A
- Does person know the time, place, and who they are?
- Could be substance abuse, psychosis
- When looking at elderly people in nursing homes, they might be off on time and date because there are few references to this in that location. Take that into account
8
Q
What do we mean by the client’s mood?
A
- Mood generally currently and in last few months
- How severe the mood is, and do they reach a level of diagnosis or are they sub-clinical?
- Depressive people do worse in morning than afternoon
- Ask how they fill most of their day (what do they do)
- How long they’ve felt that way
- Depressed, agitated, manic
9
Q
What do we mean by the client’s affect?
A
- An indicator of mood, how the client looks
- Eye contact, excitable, tone change?
10
Q
What do we mean by the client’s thought processes?
A
- Do they have unrelated thoughts, bouncing from one topic to another rapidly
- Are they fixated on a specific thought or action (OCD, phobia, eating disordered, Asperger’s…)? Can be very difficult to break up the fixation
11
Q
What do we mean by the client’s thought content?
A
- Are they delusional, paranoid, phobic, hallucinating, suicidal, homicidal?
- If a person has persecution type delusions, you want to look into that but very stealthily (don’t get sucked into it)
12
Q
What do we mean by the client’s memory, ability to perform calculations, use abstract?
A
- Executive functioning: the ability to organize thoughts, think clearly, remember things, to plan
- Psychosis has impaired executive functioning
13
Q
What do we mean by the client’s sensorium or sensory distortions?
A
- Hallucinations (visual, auditory, kinesthetic, gustatory, and olfactory)
- You need to investigate these; if person is seeing a person and talking to them:
- “I would like to ask a question, but would like your permission. I’m sorry if this does not apply to you. Would you please introduce me to who you’re talking to?”
- If the person acknowledges voices, ask what the voices are saying
14
Q
What do we mean by the client’s judgment?
A
- Looking at behavior (past and current) to see how their judgment is
- Suicidal and homicidal persons - you do NOT want to mistake their judgment
15
Q
What do we mean by the client’s anxiousness?
A
- How anxious or nervous the client gets, how worried
- Difficulty sitting still, physical symptoms (sweaty, can’t catch breath, racing heart, stomachaches, headaches, TMJ, back pain, neck pain, joint pain, vertigo, muscle ticks, sleep disturbances)
