Mental Health Assessment

Question 1

What does mental health consist of?

Answer 1

Combination of:
Cognitive functioning
& Emotional functioning

Question 2

What is optimal functioning?

Answer 2

When we obtain simultaneous life satisfaction in work, relationships and within the self

Question 3

What are the essential life functions?

Answer 3

Social
Academic/ Work
Daily Activities

• This is a continuum, and we are not always in balance. Stressors/ life events will cause unbalance*

Question 4

Factors affecting mental health

Answer 4

Economic and social
Unhealthy lifestyle choices
Exposure to violence
Personality
Spiritual
Cultural
Neurological system changes
Psychosocial development

Question 5

Mental disorders

Answer 5

They can be organic vs. psychiatric
* Delirium vs Dementia
* anxiety vs schizophrenia

Question 6

Mental functioning is assessed through what?

Answer 6

Behaviors
*consciousness, language, mood and affect
* orientation & attention
* Memory & abstract reasoning
* Thought process- content & perception

Question 7

What are the components of the MH status exam?

Answer 7

Systemic check of emotional and cognitive functioning
* integrate into physical exam & history
* 4 main headings
A_B_C_T

Question 8

What does A-B-C-T stand for?

Answer 8

Appearance
Behavior
Cognition
Thought processes

Question 9

What are some causes of altered mental status?

Answer 9

Severe illness
Chronic dementia
Depression
Brain injury
Intoxication
NOTE: if we do not know the cause we can check with the MMSE

Question 10

What is substance abuse?

Answer 10

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

Question 11

What Subjective data are we collecting?

Answer 11

Biographical information- baseline
Hx of present concern
FHx
PMHx

Neurological vs Psychological

Question 12

What are some questions that will help delve into this aspect of life?

Answer 12

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?

Question 13

When is a full MH screening necessary?

Answer 13

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

Question 14

What are some factors that affect interpretation of the findings?

Answer 14

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

Question 15

What objective data do we collect for appearance?

Answer 15

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

Question 16

What objective data do we collect for Behavior?

Answer 16

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)

Question 17

What are additional behavioral components?

Answer 17

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.

Question 18

Objective data that demonstrates cognitive function

Answer 18

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

Question 19

Objective data: thought processes & content

Answer 19

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?

Question 19

Evaluating a patient’s judgement

Answer 19

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?

Question 20

How can we ask sensitive questions without upsetting the patient?

Answer 20

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

Question 21

Example of screening tool for Anxiety?

Answer 21

**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

Question 22

Example of a screening tool for Depression?

Answer 22

**PHQ-20 **
0-6 any score greater than 3 is positive
Beck Depression Scale
Edenborough
The patient Health Questionnaire

Question 23

Example of screening for suicide

Answer 23

Patient Safety Screener (PSS-3)

Question 24

Domestic- Intimate Partner Violence

Answer 24

Universal Violence Prevention Screening Protocol
Partner Violence Screen

** Seniors & men can be can also be victims of violent relationships``

Question 25

Developmental Considerations

Answer 25

**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

Question 26

Aging Adults

Answer 26

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

Question 27

Delirium

Answer 27

Onset: Acute
Course: fluctuating
Duration: Hours to weeks
Consciousness: Altered
Attention: Impaired
Psychomotor changes: Increased or decreased
Reversibility: Usually

Question 28

Dementia

Answer 28

Onset: Insidious
Course: Progressive
Duration: Months to years
Consciousness: Usually clear
Attention: Normal except when severe
**Psychomotor changes: **Normal
Reversibility: Irreversible

Question 29

Depression

Answer 29

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

Question 30

Health Promotion

Answer 30

Information about tools
Substance abuse treatment
Referrals:
* Hotlines
* Caregiver respite
* Treatment centers
* Medical referral