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Assessment Exam3 > mental health > Flashcards

mental health Flashcards

1
Q

What is Mental Status

A
  • a persons emotional (feeling), and cognitive (knowing) function.
  • optimal functioning and optimal mental status aims toward simultaneous life satisfaction in work, caring relationships and within the self.
  • a good balance that allows functioning socially and occupationally
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2
Q

What is a mental disorder

A
  • apparent when a persons response is much greater than the expected reaction to a traumatic life event
  • It is a significant behavioral or physiological pattern that is associated with distress (a painful symptom), or a disability ( impaired functioning).
  • this pattern also has a significant risk of pain, disability, or death, or loss of freedom.
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3
Q

Organic disorders

A
  • are due to brain disease of known specific cause

- delirium, dementia, alcohol and drug intoxication and withdrawl

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4
Q

Psychiatric mental disorders

A
  • no organic etiology

- anxiety disorders, schizophrenia

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5
Q

What does a mental status assessment document?

A
  • documents a dysfunction and determines how it affects self-care in everyday life
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6
Q

Mental status functioning must be _______, through assessing an individuals behaviors. It can not be scrutinized directly like heart sounds, or skin characteristics.

A

Inferred

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7
Q

Consciousness

A

Being aware of one’s own existence, feelings, and thoughts and aware of the environment. This is the most elementary of mental status functions.

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8
Q

Language

A

Using the voice to communicate one’s thoughts and feelings. This is a basic tool of humans, and its loss has a heavy social impact on the individual.

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9
Q

Mood and Affect

A

Both of these elements deal with the prevailing feelings; affect is a temporary expression of feelings or state of mind, and mood is more durable, a prolonged display of feelings that color the whole emotional life.

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10
Q

Orientation

A

The awareness of the objective world in relation to the self.

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11
Q

Attention

A

The power of concentration, ability to focus on one specific thing without being distracted by environmental stimuli

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12
Q

Memory

A

The ability to lay down and store experiences and perceptions for later recall. Recent memory evokes day-to-day events; remote memory brings up years’ worth of experiences.

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13
Q

Abstract Reasoning

A

Pondering a deeper meaning beyond the concrete and literal.

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14
Q

Thought process

A

the way a person things, the logical train of thought

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15
Q

Thought content

A

WHAT the person thinks, specific ideas, beliefs, the use of words

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16
Q

Perceptions

A

An awareness of objects through the five senses

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17
Q

Mental status in the aging adult

A
  • aging process leaves parameters of mental status intact mostly
  • no decrease in general knowledge and little to no vocab loss
  • Response time may be slower than youth- takes longer to process info and react to it
  • performance on timed intelligence test may be lower for aging person due to time it takes to respond. Not because of intelligence decline .
  • recent memory is decreased with aging (24-hr recall, names of new acquaintances, etc.)
  • remote memory is not affected
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18
Q

Mental status exam is a systematic check of _____?

A

emotional and cognitive functioning

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19
Q

Mental status can usually be assessed how?

A
  • thought the context of the health history interview. This is sufficient for most people.
  • during the interview, keep in mind the 4 main headings of mental status assessment
    1. Appearance 2. Behavior 3. Cognition 4. Thought Processes (ABCT)
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20
Q

When is it necessary to perform a full mental status exam?

A
  • when you discover and abnormality in affect or behavior in the following situations:
    Patients whose initial brief screening suggests an anxiety disorder or depression.
    •Family members concerned about a person’s behavioral changes, such as memory loss, inappropriate social interaction.
    •Brain lesions (trauma, tumor, brain attack [also known as cerebrovascular accident or stroke]). A mental status assessment documents any emotional or cognitive change associated with the lesion. Not recognizing these changes hinders care planning and creates problems with social readjustment.
    •Aphasia (the impairment of language ability secondary to brain damage). A mental status examination assesses language dysfunction as well as any emotional problems associated with it, such as depression or agitation.
    •Symptoms of psychiatric mental illness, especially with acute onset.
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21
Q

In every mental status examination, what factors should you note from the health history that could affect your interpretation of the findings?

A
  • Any known illnesses or health problems, such as alcoholism or chronic renal disease.
  • Current medications whose side effects may cause confusion or depression.
  • The usual educational and behavioral level—note that factor as the normal baseline, and do not expect performance on the mental status examination to exceed it.
  • Responses to personal history questions, indicating current stress, social interaction patterns, sleep habits, drug and alcohol use.
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22
Q

How are the steps of the mental status assessment carried out?

A
  • It is performed in a hierarchy. Most basic functions (consciousness) are assessed first.
  • these must be assessed to ensure validity for the steps to follow
  • Example= if consciousness is clouded then the person cant be expected to have full attention to cooperate with new learning. Could lead to erroneous conclusions
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23
Q

What is included in assessing Appearance?

A
  1. Posture- should be erect, and position is relaxed
  2. Body Movements- should be voluntary, deliberate, coordinated, smooth, even.
  3. Dress- appropriate for setting, season, age, fits appropriately
  4. Grooming/Hygeine- clean, well groomed, clean nails, etc. Be careful to be sure this reflects S.E.S.
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24
Q

Abnormal Posture

A

Sitting on edge of chair or curled in bed, tense muscles, frowning, darting watchful eyes, restless pacing occur with anxiety and with hyperthyroidism. Sitting slumped in chair, slow walk, dragging feet occur with depression and some organic brain diseases.

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25
Q

Abnormal Body Movements

A

Restless, fidgety movements or hyperkinetic appearance occurs with anxiety.

Apathy and psychomotor slowing occur with depression and dementia.

Abnormal posturing and bizarre gestures occur with schizophrenia.

Facial grimaces.

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26
Q

Abnormal Dress

A

Inappropriate dress can occur with organic brain syndrome.

Eccentric dress combination and bizarre makeup occur with schizophrenia or manic syndrome.

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27
Q

Abnormal grooming/hygiene

A

Unilateral neglect (total inattention to one side of body) occurs following some cerebrovascular accidents.

Inappropriate dress, poor hygiene, and lack of concern with appearance occur with depression and severe Alzheimer disease. Meticulously dressed and groomed appearance and fastidious manner may occur with obsessive-compulsive disorders.

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28
Q

Assessing Behavior: Level of Consciousness

A

Person should be awake, alert, aware of stim from the environment and within self. Responds reasonably soon to stim.

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29
Q

Abnormal Findings: Level of Consciousness

A
  • loses track of conversation, falls asleep

- lethargic, drowsy, obtunded/confused

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30
Q

Assessing Behavior: Facial Expression

A
  • look is appropriate to stimulation and changes appropriately with topic. Comfortable eye contact unless precluded by cultural norm (American Indians)
31
Q

Abnormal Findings: Facial Expression

A
  • Flat, mask-like expression occurs with parkinsonism and also with depression.
32
Q

Assessing Behavior: Speech

A
  • Quality of Speech: note that person makes laryngeal sounds effortlessly and shares conversation appropriately
  • moderate pace, fluent stream of talking
  • Articulates, clear, understandable
  • effortless word choice, appropriate to education. Complete sentences, pauses to think.
33
Q

Abnormal Findings: Speech

A
  • Dysphonia is abnormal volume, pitch
  • Doesnt share conversation but monopolizes interview or is silent, secretive or uncommunicative
  • slow, mono speech with parkinsonism, depression. Rapid-fire, pressured, loud talking with manic syndrome
  • Dysarthria is distorted speech.
  • Misuses words, omits letters syllables
  • Aphasia: transposes words
  • Circumlocution or repetitious abnormal patters: neologism, echolalia
  • unduly long word finding or failure in word search= aphasia
34
Q

Assessing Behavior: Mood & Affect

A
  • Judged by body language and facial expression
  • Ask directly “how do you feel today?” or “how do you usually feel?”
  • mood should be appropriate to persons place and condition.
35
Q

Abnormal Findings: Mood and Affect

A
  • Manic syndrome= wide mood swings

- Schizophrenia= bizarre mood

36
Q

What is the Glasgow Coma Scale and why is is beneficial?

A
  • GCS is an accurate and reliable QUANTITATIVE tool used to determine level of consciousness
  • gives level of consciousness a numeric value.
  • Divided into (1)Eye Opening, (2) Verbal Response, (3) Motor Response
  • Total score reflects brains level of fx. Full fx=15
  • assesses functional state of the brain as a whole.
37
Q

Assess Cognitive Fx: Orientation

A
  • determined during interview when asking their address, phone number, health hx.
  • or can ask directly “what is the day today? Where are you right now? Where do you live? What time is it? What is your name? What building are we in? Etc…
  • Many hospitalized people have trouble with the exact date but are fully oriented on other items.
38
Q

Abnormal findings: Orientation

A

Disorientation occurs with delirium and dementia

  • orientation is usually lost in the following order:
    1. time, 2. place, 3.person (rarely).
39
Q

Assessing Cognitive fx: Attention Span

A
  • Give serious of directions and note that they follow the correct sequence. “take a sip of water with your left hand, then shift it to your right hand, and set it on the table”
    • Attention span is commonly impaired in people who are anxious, fatigues, drug intoxicated
40
Q

Abnormal findings: attention span

A
  • Digression from initial thought
  • irrelevant replies to a question
  • easily distracted
  • stimulus bound (any new stim quickly draws their attention)
  • confusion, negativism
41
Q

Assessing Cognitive Fx: Recent Memory

A
  • assess in context of interview with 24 hr diet recall or ask what time they arrived at the facility
  • ask questions you can corraborate to screen for a person who confabulates or makes up answers to fill in memory gaps for memory loss.
42
Q

Abnormal findings: recent memory

A
  • Recent memory deficit occurs with delirium, dementia, amnestic syndrome, or Korsakoffs syndrome in chronic alcoholism
43
Q

Assessing Cognitive Fx: Remote Memory

A
  • Ask the person verifiable past events

- ask them to describe their health, first job, birthday, anniversary, etc.

44
Q

Abnormal Findings: Remote Memory

A

-remote memory is lost when cortical storage area for that memory is damaged ( In Alzheimer dementia or any disease that damages the cerebral cortex)

45
Q

Assessing cognitive fx: New Learning

A

Four Unrelated Words Test

  • tests ability to lay down new memories
  • high validity
  • after 5 min ask them if they remember the words, then at 10 min, then 30, etc.
  • recent memory intact if can remember 3-4 words after a 30 min delay
46
Q

Abnormal Findings: New learning

A
  • People with Alzheimers dementia score a zero to one word recall.
  • impaired new learning also occurs with anxiety (due to inattention and distractibility)
  • Also occurs with depression (due to lack of effort mobilized to remember)
47
Q

Additional Tests for people with Aphasia

A

1) Word Comprehension.
- Point to articles in the room, parts of the body, articles from pockets, and ask the person to name them.
2) Reading.
- Ask the person to read available print. Be aware that reading is related to educational level. Use caution that you are not just testing literacy.
3) Writing.
- Ask the person to make up and write a sentence. Note coherence, spelling, and parts of speech (the sentence should have a subject and a verb).

48
Q

What is Aphasia?

A
  • loss of the ability to speak or write coherently
  • loss of ability to understand speech or writing
  • due to brain attack
  • it is a true language disturbance, defect in word choice and grammar, or a defect in comprehension
  • the defect is in higher integrative language processing
49
Q

Tests for higher intellectual functioning

A
  • measure problem solving and reasoning abilities
  • results are related to general intelligence *must consider educational and cultural background though
  • tests have been used to discriminate between organic brain disease and psychiatric disorders. Errors indicate organic dysfunction.* (widely used but validity is undetermined)
  • Abstract reasoning, proverb interpretation, hypothetical situations, calculation, etc.
50
Q

How is judgement assessed?

A
  • Judgement is safe decision making
  • Judgement is exerized when person can compare and evaluate alternatives in a situation and reach an appropriate course of action.
  • Be concerned about a persons judgement about daily goals or long term goals (such as likelihood of reacting to delusions/hallucinations, and capacity for violent behavior)
  • Asseses in context of interview by noting when person says job plans, social or family obligations, or plans for the future.
  • also ask about rationale for personal health care and how they decided whether or not to comply to health care regimen.
  • should be realistic goals and plans, etc.*
51
Q

Abnormal findings for Judgement

A

Impaired judgement= impulsive or unrealistic decisions, wish fulfillment occurs with: retardation, emotional dysfunction, schizophrenia, and organic brain disease.

52
Q

Assessing for thought processes

A
  • ask yourself “does this person make sense”
  • Can I follow what they are saying?
  • The WAY they think should be logical, goal directed, and relevant. Thoughts should be complete.
53
Q

Abnormal findings: Thought Processes

A
  • Illogical, unrealistic thought processes
  • Digression from initial thought
  • ideas run together
  • evidence of blocking ( person stops middle thought)
54
Q

Assessing Thought Content

A
  • WHAT the person says should be consistent and logical
55
Q

Abnormal Findings: Thought Content

A
  • Obessions and compulsions
56
Q

Assessing for Perceptions

A
  • they should be consistently aware of reality
  • Perceptions should be congruent with yours
    Ask:
    •How do people treat you?
    •Do other people talk about you?
    •Do you feel like you are being watched, followed, or controlled?
    •Is your imagination very active?
    •Have you heard your name when alone?
57
Q

Abnormal findings: Perceptions

A
  • Illusions, Hallucinations
  • Auditory and visual hallucinations occur with psychiatric and organic brain disease and with psychedelic drugs.
  • Tactile hallucinations occur with alcohol withdrawal.
58
Q

What is the Mini-mental state exam and what are abnormal scores?

A
  • A simplified assessment of cognition functions of the mental status exam (memory, orientation to time and place, naming, reading, copying/visuospacial orientation, writing, and follow 3-stage command.
  • quick, easy, includes only 11 Questions. 5-10 min.
  • useful for both initial and serial measurement to demonstrate worsening or improvement of cognition over time and with treatment. Only concentrates on cognitive fx, not mood or thought process.
  • valid detector of organic disease (use to ID dementia and delirium)
  • good to differentiate organic from psychiatric mental illness
  • Max score is 30. normal average=27, scores 24-30=no impairment.
  • ABNORMAL Scores occurring with dementia and delirium are classified as 18-23=mild cognitive impairment, 0-7= severe cognitive impairment
59
Q

Assessing the Aging Adult

A
  • Check sensory status before assessing mental status (vision and hearing may affect mental exam)
60
Q

When using the terms to describe level of consciousness, what is it important to do in order to maintain consistency?

A
  • all co workers should understand and agree of the definitions, and be consistent with their application.
    To increase clarity when using the terms, always:
    1) Record the level of the stimulus used to determine the LOC. (name called in normal voice/name called in loud voice/light touch on arm/vigorous shake on shoulder/pain applied)
    2) Record the persons response including amount and quality of movement, presence of coherent speech, and opening of eyes and making eye contact
    3) record what they do on cessation of your stimulus
61
Q

Define: Alert

A

Awake or readily aroused, oriented, fully aware of external and internal stimuli and responds appropriately, conducts meaningful interpersonal interactions.

62
Q

Define: Lethargic (somnolent)

A

Not fully alert, drifts off to sleep when not stimulated, can be aroused to name when called in normal voice but looks drowsy, responds appropriately to questions or commands but thinking seems slow and fuzzy, inattentive, loses train of thought, spontaneous movements are decreased.

63
Q

Define: Obtunded

A

(Transitional state between lethargy and stupor; some sources omit this level.)

Sleeps most of time, difficult to arouse—needs loud shout or vigorous shake, acts confused when is aroused, converses in monosyllables, speech may be mumbled and incoherent, requires constant stimulation for even marginal cooperation.

64
Q

Define: Stupor or Semi-coma

A

Spontaneously unconscious, responds only to persistent and vigorous shake or pain; has appropriate motor response (i.e., withdraws hand to avoid pain); otherwise can only groan, mumble, or move restlessly; reflex activity persists.

65
Q

Define: Coma

A

Completely unconscious, no response to pain or to any external or internal stimuli (e.g., when suctioned, does not try to push the catheter away), light coma has some reflex activity but no purposeful movement, deep coma has no motor response.

66
Q

Define: Acute Confusional State (Delirium) - not a LOC

A

Clouding of consciousness (dulled cognition, impaired alertness); inattentive; incoherent conversation; impaired recent memory and confabulatory for recent events; often agitated and having visual hallucinations; disoriented, with confusion worse at night when environmental stimuli are decreased.

67
Q

Hallucination

A

Sensory perceptions for which there are no external stimuli
- may strike any sense–> visual, tactile, olfactory, gustatory
Example= seeing image (ghost) of a person who is not there (visual) or hearing voices or hearing music (auditory)

68
Q

Illusion

A

Misperception of an actual existing stimulus, by any sense

Example: folds of bed sheets appear animated

69
Q

Delirium

A

1) Disturbance of consciousness–> reduced clarity of awareness of the environment, with reduced ability to focus or sustain or shift attention
2) Change in cognition–> memory deficit, disorientation, language distrubance, or development of a perceptual disturbance
3) The distrubance develops over a short period of time (usually hours or days) and tends to fluctuate during the course of the day

70
Q

What can “cause” delirium?

A

Delirium may be due to:

1) General medical conditions: infections, metabolic disorders (hypoxia, hypercarbia, hypoglycemia), fluid or electrolyte imbalances, liver or kidney disease, thiamine def., post-op states, hypertensive encephalopathy, or after seizures or head trauma
2) Substance induced: due to effects of drug abuse, medication, or toxin exposure

71
Q

Dementia

A

A. The development of multiple cognitive deficits manifested by both:
1) Memory impairment (impaired ability to learn new information or to recall previously learned information), and
2) One (or more) of the following cognitive disturbances:
- Aphasia (language disturbance)
- Apraxia (impaired ability to carry out motor activities despite intact motor function)
- Agnosia (failure to recognize or identify objects despite intact sensory function)
- Disturbance in executive functioning (i.e., planning, organizing, sequencing, abstracting)
B. The cognitive deficits must be sufficiently severe to cause impairment in occupational or social functioning and must represent a decline from a previously higher level of functioning.

72
Q

How are different types of dementia differentiated?

A
  • by their etiology
    1) senile dementia or SDAT ( characterized by gradual onset and continuing cognitive decline)
    2) cerebrovascular dementia (focal neurologic signs and Sx such as exaggeration of deep tendon reflexes, extensor plantar response, gait abnormalities, weakness of extremity)
    3) can also be caused by HIV, head trauma, Parkinsons, and others.
73
Q

Amnestic Disorder

A

A. The development of memory impairment (inability to learn new information or to recall previously learned information) in the absence of other significant cognitive impairments.
B. The memory disturbance causes significant impairment in social or occupational functioning and represents a significant decline from a previous level of functioning.
*This may be due to pathology (closed head trauma, penetrating missile wounds, surgical intervention, hypoxia, infarction of the posterior cerebral artery, herpes simplex encephalitis), or it may be substance induced (e.g., alcohol-induced amnestic disorder due to thiamine deficiency associated with prolonged, heavy ingestion of alcohol).

Assessment Exam3 (5 decks)

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