Mental Health Assessment, Cultural, Social & Spiritual Considerations

Question 1

What are the components of Mental health assessment?

Answer 1

Appearance
Behavior
Cognitive Function
Thought

Question 2

What are the components of Mental health assessment? Part 2 (Appearance)

Answer 2

Appearance

• Posture
  - erect, position is relaxed
• Body movements
  - voluntary, deliberate, coordinated, smooth, even
• Dress
  - appropriate for setting, season, age, gender, and social group
  - clothing fits and put on properly
• Grooming and hygiene
  - pt is clean and well-groomed, hair is neat and clean, nails are clean
  - women have moderate or no makeup; men are shaved, or well-trimmed

Question 3

What are the components of Mental health assessment? Part 3 (Behaviour)

Answer 3

Behavior

• Level of consciousness
  - awake, alert, aware of stimuli from environment; responds appropriately to stimuli
• Facial expression
  - appropriate to situation and changes with the topic; some comfortable eye contact
• Speech
  - pt should be able to make laryngeal sounds effortlessly
  - makes conversation appropriately
  - pt should not be answering with one-word responses all the time
  - moderate pace of conversation, stream of talking is fluent
  - clear and understandable articulation
  - word choice is effortless, ability to complete sentences
• Mood and affect
  - assess body language and affect displays
  - ask patient “how do you feel today?” and “how do you feel most days?”
  - ask about length of mood and if it changes constantly
  - pt’s affect should be appropriate to the stated mood and change appropriately with topics

Question 4

What are the components of Mental health assessment? Part 4 (Cognitive function)

Answer 4

Cognitive Functions

• Orientation
  
  • ask pt: “some people have trouble with dates while in the hospital. Do you know today’s date?”
  • to assess self, ask for pt id and DOB
  • eg able to keep up with time, place, person, self
• Attention span
  
  • pt should be able to complete a thought without wandering; pt should not be easily distracted while you are talking
  • alternatively, can give pt a series of directions to follow in the correct sequence
• Immediate memory
  
  • pt should be able to make sense of what is going on
  • say a sentence and ask pt recall it
  • can also do first part of 4 new words test; ask pt to recall 4 unrelated words
• Recent memory
  
  • 24-hour recall of diet or what time pt arrived at agency
• Remote memory
  
  • ability to recall past events in pt’s life
  • “do you remember the date of your wedding”
  • “tell me about your childhood”
    
    • VERIFY LATER IF PT IS CONFABULATING
• New learning - 4 unrelated words test
  
  • tests ability to recall 4 unrelated words; pts with dementia will often score 0
  • can test pts ability to recall those words in different times
• Insight
  
  • ability to recognize one’s own illness, need for treatment, and consequences of one’s behaviour as stemming from an illness.
  • ask pt: “do you think you need to be in the hospital right now”
  • can also ask in the beginning “why do you think you were admitted to the hospital today?”
• Judgment
  
  • ability to choose a logical course of action based on insight

Questions to ask?
- ask pt: “what are your plans for the future?” as a general open-ended question
- ask pt: “what are your plans when you get discharged from hospital?” or “what do you think might be the best course of action about your condition?”
- i plan to get connected, make friends, see a therapist once a week, etc.
- can also ask pt “what are you going to do about it?” or “what do you plan to do about it?” “what are your plans to take better care of yourself?”
- “do you take any medications? why do/don’t you take them?”

Question 5

What are the components of Mental health assessment? Part 5 (Thought)

Answer 5

Thought

• Thought processes
  
  • ask yourself if pt makes sense, if you can follow what pt is saying; you should not be confused as to what the pt is trying to get at
  • Pt should be logical, goal-directed, coherent, and relevant; can complete a thought
  • assess if pt can answer your questions correctly; no loose derailment
  • assess it pt needs to be steered back to topic multiple
    times
• Thought content
  
  • what pt says should be consistent and logical
  • to identify obsessions or compulsions, ask pt:
    
    • “how often do you wash your hands or count things over and over?”
    • “do you perform specific actions to reduce certain thoughts?”
    • ask questions to explore these obsessions further
• To determine any fears that cause the pt to avoid certain situations, ask about them
• To determine any delusions, ask
  - “do you have any thoughts that other people think are strange?”
  - “do you have any special powers or abilities?”
  - “do you think someone is out to get you?”
  - “have you felt like someone is trying to steal your thoughts?”
  - “do you think that people want what you have or what you own?”
• Perceptions
  
  • pt should be consistently aware of reality, and his or her perceptions should be congruent with yours; no hallucinations
  • ask pt:
    
    • “how do people treat you?”
    • “do you feel as if you are being watched, followed, or controlled?”
    • “is your imagination very active?”
    • “have you heard someone call you by your name while you’re alone?
  • if pt’s answers suggest hallucination, ask these
    
    • “do you see/hear things that people might not see/hear?” follow up with “are you aware that you are experiencing these things?”
    • “do the voices sometimes tell you to do things?”
      
      • “what do you do when the voices tell you to do things?” → can show insight if pt ignores commands
• suicide ideations
  
  • ask pt: “have you ever felt so down that you thought of hurting yourself?” → guarantee their safety all the time
    
    • if pt says yes, ask pt if they plan to follow through → guarantee their safety again
    • also assess if pt’s method can be carried out; does pt have access to pills they were describing?
  • ask pt: “what do you think would happen if you did end your own life?”
  • do not assume pt is suicidal; always ask pt and ascertain.

Question 6

When to administer additional testing for paraphasia/aphasia?

Answer 6

• If pt states made-up words, has to replace a word they can’t remember with something else, etc
• test pt’s:
  • word comprehension
    
    • point to things in the room and ask pt to identify them
  • reading
    
    • ask pt to read something in print
  • writing
    
    • “describe in a sentence what a flower looks like”
    • ask pt to compose a sentence; note coherence, spelling, and parts of speech