Mental Health Assessment Flashcards
What does mental health consist of?
Combination of:
Cognitive functioning
& Emotional functioning
What is optimal functioning?
When we obtain simultaneous life satisfaction in work, relationships and within the self
What are the essential life functions?
Social
Academic/ Work
Daily Activities
- This is a continuum, and we are not always in balance. Stressors/ life events will cause unbalance*
Factors affecting mental health
Economic and social
Unhealthy lifestyle choices
Exposure to violence
Personality
Spiritual
Cultural
Neurological system changes
Psychosocial development
Mental disorders
They can be organic vs. psychiatric
* Delirium vs Dementia
* anxiety vs schizophrenia
Mental functioning is assessed through what?
Behaviors
*consciousness, language, mood and affect
* orientation & attention
* Memory & abstract reasoning
* Thought process- content & perception
What are the components of the MH status exam?
Systemic check of emotional and cognitive functioning
* integrate into physical exam & history
* 4 main headings
A_B_C_T
What does A-B-C-T stand for?
Appearance
Behavior
Cognition
Thought processes
What are some causes of altered mental status?
Severe illness
Chronic dementia
Depression
Brain injury
Intoxication
NOTE: if we do not know the cause we can check with the MMSE
What is substance abuse?
Harmful use of psychoactive substances, including alcohol and illicit drugs
(WHO)
* Dependence syndrome, which results in a vicious cycle
* Abuse becomes the priority in life and results in avoidance of responsibilities & physical withdrawal
What Subjective data are we collecting?
Biographical information- baseline
Hx of present concern
FHx
PMHx
Neurological vs Psychological
What are some questions that will help delve into this aspect of life?
Describe your typical day to me.
Describe your eating, caffeine, and EtOH habits to me.
What are your sleep patterns like?
When did you last have a bowel movement? Is that normal for you?
What is your role within your family?
Please describe your current stressors to me.
Do you currently have or have you ever had suicidal ideation?
When is a full MH screening necessary?
When initial screening suggests depression or anxiety
Behavioral changes have occurred- memory loss, social interactions have become inappropriate
Brain lesions- trauma, CVA, tumor
Aphasia- impairment of language secondary to brain damage
Psychiatric illness symptoms- especially if acute in onset
What are some factors that affect interpretation of the findings?
Known illnesses- alcoholism or CKD
Medications- SE of confusion or depression
Educational & behavioral level- if baseline
Stress responses observed in social, sleep, drug & EtOH use
What objective data do we collect for appearance?
Posture- relaxed, erect
Body movements- deliberate, coordinated, smooth, and even
Dress- appropriate for the occasion, setting, season, gender, and social group
Grooming & hygiene- disheveled, congruence with age
What objective data do we collect for Behavior?
Level of consciousness: (Alert, awake, and oriented x1 <- specify!)
Alert
Lethargic/ somnolent
Obtunded
Stupor/ Semi- Coma
Coma
Delirium (Acute confusional state)
Facial expression:
Appropriate to situation
Comfortable eye contact (social norm may preclude this)
What are additional behavioral components?
Speech quality: Pacing, articulation & word choice
Dysphonia- Voice problem, difficulty, and discomfort with talking. With unusual pitch or volume- caused by laryngeal issues
Dysarthria- Articulation problem, distorted speech sounds, unintelligible
Aphasia- comprehension and production defect d/t brain damage. Language disturbance caused by defect in word choice or comprehension problems.
Mood & affect: body language, facial expression, and direct questioning.
Objective data that demonstrates cognitive function
Orientation- Person, place, time & circumstance
Attention span- the ability to concentrate, complete thoughts, flight of ideas. Anxiety, fatigue, and intoxication affect this
Recent memory- ask questions that you can corroborate, looking for confabulation and memory loss
Remote memory- Ask for verifiable past history that is relevant to the patient
** This is lost in Alzheimers, dementia or cerebral cortex damage
Objective data: thought processes & content
Is the way they think logical?
What do they think about?** ideas & beliefs **and choice of words
Perceptions- ask how people treat them: do they feel like people are talking about or watching them?
Evaluating a patient’s judgement
Ability to compare and evaluate alternatives–> reach an appropriate decision.
What is their judgment about short & long-term goals?
Are they likely to act on hallucinations if present? Do they have the
capacity for violence?
Are their goals realistic, keeping their health in mind?
How can we ask sensitive questions without upsetting the patient?
Normalize them:
“we ask all of our patient’s about this, regardless of their situation so that we do not miss anything important”
Use screening tools
Anxiety, depression, suicidal thoughts, domestic violence
Example of screening tool for Anxiety?
**GAD-7 **
Patient scores from 0-21 based on their answers to questions
Mild anxiety 0-5
Moderate 6-10
Moderately severe 11-15
Severe 16-21
Example of a screening tool for Depression?
**PHQ-20 **
0-6 any score greater than 3 is positive
Beck Depression Scale
Edenborough
The patient Health Questionnaire
Example of screening for suicide
Patient Safety Screener (PSS-3)
Domestic- Intimate Partner Violence
Universal Violence Prevention Screening Protocol
Partner Violence Screen
** Seniors & men can be can also be victims of violent relationships``
Developmental Considerations
**Denver II screening test: **
Birth to 6 yrs- slow language, behavioral, cognitive and psychosocial
Behavioral checklist:
7-11 yrs- 5 areas: mood, play, school, friends & family
Adolescents: use ABCT
Aging Adults
Check sensory, vision & hearing
* confusion is common and easily misdiagnosed
* The presence of delirium can have serious effects
* Presence of dementia has decreased
MUST determine whether delirium vs dementia if cognitive impairment is present
* This can happen when social isolation occurs–>, especially since retiring
Delirium
Onset: Acute
Course: fluctuating
Duration: Hours to weeks
Consciousness: Altered
Attention: Impaired
Psychomotor changes: Increased or decreased
Reversibility: Usually
Dementia
Onset: Insidious
Course: Progressive
Duration: Months to years
Consciousness: Usually clear
Attention: Normal except when severe
**Psychomotor changes: **Normal
Reversibility: Irreversible
Depression
Onset: Acute or insidious
Course: May be chronic
Duration: Months to years
Consciousness: Clear
Attention: May be decreased
Psychomotor changes: Slowed in severe cases
Reversibility: Usually
Health Promotion
Information about tools
Substance abuse treatment
Referrals:
* Hotlines
* Caregiver respite
* Treatment centers
* Medical referral
