Lecture 5 Mental Health Flashcards
Mental Health
Balance in emotional and cognitive abilities that allow a person to manage life’s stressors
Mental Status
Component of mental health that includes emotional and cognitive functioning
Mental illness/disorder
Severe enough to cause disfunction
co-occurring symptoms that may involve alterations in thought, experience, and emotion … serious enough to cause distress and impair functioning
If managed not illness
Indication for a full mental health exam
Abnormality in mood, behaviour, memory loss, inappropriate social interactions
Brain Lesions
Aphasia (without language) (stroke)
Factors Affecting Findings
Health Problem (Substance use, alcoholism, losing mental status)
Medication
Baseline educational and behavioural level
Personal History
Mental Status Exam
Structured way of observing and describing a person’s current state of mind
Reflects the examiner observation and impressions at the time of the interview, an evaluation of the individuals current state
Mental status exam: Components (emotional/cognitive)
Appearance (E)
Behaviour (E)
Cognition (C)
Thought processes (C)
Appearance (PBDG) (E)
Posture (erect , relaxed)
Body movements (Voluntary, deliberate, coordinated, smooth, even)
Dress(Appropriate for season, age, social group, fits and put on appropriately)
Grooming and hygiene (Clean, well groomed )
Behaviour CFSM/A (E)
Level of Consciousness
Facial Expression (appropriate to situation, eye contact)
Speech (effort, voice level, pace, articulation, word choice
Mood and Affect (how someone feels and emotional expression)
Level of Consciousness
Alert Lethargic Obtunded stupor Coma
Alert
Awake or readily aroused
Lethargic
drowsy but opens eyes to speech, respond to questions then falls asleep
when not stimulated
Obtunded
opens eyes to loud shout or shake, respond slowly, speech mumbled, confused
Stupor
responds only to shake or pain, groans, reflexes present
Coma
completely unconscious, no response to pain, +/- reflexes
Aphasia
Without speech
Dysphasia
Diffcult speech
Dysphonia
Abnormal voice
Dysarthria
Abnormal articulation
Mood
How someone feels(sustained emotion)
Overall emotion
Affect
Emotional expression (display of feelings)
Affect should be appropriate to mood and change with topics
Abnormal: Flat, irritable, labile( rapid shift of emotion, intense happiness followed by intense sadness) , in appropriate
Cognitive (OAIRRN) (C)
Orientation (time, place, person, self)
Attention span
Immediate memory
Recent memory (24 hours)
Remote memory
New learning (5m,10,30)(person under 60= 3 or 4, over 80 = 2) (no rhyming words when using four unrelated word test)
Note only use verifiable events
Insight
Ability to recognize consequences
Judgement
Ability to evaluate options and reach a logical decision (impulse)
Thought Process (C)
- Though process- the WAY the PT thinks
- Thought content – WHAT the pt says
- Perception- pts awareness of reality
- *Know page 100 (Jarvis, 2014) Tables 6-4 & 6-5 (FOR MIDTERM)
Thought Process
Should be logical, goal directed coherent, and relevant
o Abnormal: blocking, confabulation, clanging
Thought Content
o Should be consistent and logical
o Abnormal: Obsessions compulsions, fears, delusions (false beliefs attached to a genuine perception with no rational, thinks theyre superman)
Perception
o Should be consistently aware of reality
o Abnormal: Illusions (have an external stimuli, see shadows thinks theres someone, its just clothes), hallucinations (no external stimuli, is not there)
Mental Status exam and the Older adult
• Important to conduct a brief mental status exam on all older individuals
• Check sensory status before assessing
o They cant hear you theyre not doing bad
• No decrease in knowledge, intelligence, remote learning and vocabulary. Recent memory and response times may decrease somewhat.
MoCA or the Set Test
o Fruits, animals colours and towns o State 10 in each category o 1 point for each category o Nobody with a score greater then 25 have dementia Draw back is it’s a verbal test • Aphasia
Mini-mental state exam
• Screening for cognitive impairment • Disadvantages: o May not identify mild cognitive impairment o Does not identify changes in existing dementia • Advantages: • Short administration time o Easy to use o Inexpensive
Mental Health History
- Nutritional patterns
- Sleep
- Activity
- Interpersonal relationships
- Spirituality
- Coping/Stress management
RISK ASSESSMENTS
Screen for:
Suicidal Thoughts
Assaultive/ Homicidal ideation
Elopement Risk
Make them wear hospital clothes
Suicidal Thoughts (IPLAS)
Intent- Do you have thoughts of harming yourself
Plan- do you have a plan to harm yourself
Lethality- What do you plan to use
Access- Do you have access to the means
Safe Contract- will you agree to be safe while here
Risk Factors for Suicide
• Precise plan with access to lethal meaning in the next 24-48 hours • Prior attempts • Depression, hopelessness • Social withdrawal • Self-mutilation • Verbal suicide message • Death themes in art, jokes, writing • Family history of suicide o Those with a plan have a higher chance of doing it
Aphasia testing
Word comprehension, reading, writing
