Mental status Flashcards
What do we assess during mental status screening?
- Take a thorough history
- Observe physical appearance and behavior
- Investigate cognitive functioning
- Observe speech and language
- Evaluate emotional stability
Why do PTs assess mental status?
- Design best plan of care
- Safety
- Assist in writing proper goals
- Pt may need to be referred
When is mental status assessed?
- When the patient enters the office
- During physical examination
- During interventions/treatment
Area responsible for: Motor cortex (speech formation, Broca’s area [expressive aphasia]), Decision making, Problem solving, Ability to concentrate, Short term memory, Awareness of self
Goal-oriented behaviors and drive, Emotions and affect
Frontal lobe of cerebrum
Area responsible for Receiving and processing sensory information
parietal lobe
Area responsible for: Perception and interpretation of sounds, Comprehension of spoken and written language (Wernicke’s area [receptive aphasia]), Integration of behavior, emotion, and personality, Long-term memory
Temorpal lobe
Mediates patterns of behavior for survival:
- Mating
- Fear
- Aggression
- Affection
Limbic system
Area responsible for: Reticular activating system - Important for consciousness
Brainstem
What does the NS look like in infants and children?
- All neurons present, but not all connections made
- Full myelination takes several years
- Nervous system sensitive to insults: Infections, Trauma (shaken baby syndrome), Chemical imbalance
What does the NS look like in adolescents?
- Continued intellectual maturation
- Abstract thinking develops
- Judgment begins to develop with education, intelligence, and experience
- Develop set of values
What age should we not see decline in cognitive function before?
60
- decline before this age indicates a systemic or neurological disorder
Where do you seen declines in older adults? what tends to remain intact?
Declines:
- Problem-solving ability
- Short term memory
- Information processing or new concepts
Intact:
- Verbal skills
- Inventories of available information
- Long term memory
Level of consciousness where pt is aware of surroundings, oriented x 3 (person, place, year), and cooperative
Conscious
Level of consciousness where pt has inappropriate responses to questions, and decreased attention span and memory
Confusion
Level of consciousness where pt who is Drowsy, fall asleep easily, but once aroused, responds appropriately
Lethargy
Level of consciousness where pt is near-unconsciousness
but arousable to verbal, visual, or painful stimuli for short periods; Slowed motor or moaning responses to stimuli
Stupor
Level of consciousness where pt is not awake, not aware, “unarousable unresponsiveness”, and has decorticate or decerebrate posturing
Coma
- decerebrate = worst prognosis, indicates brainstem injury
- decorticate = cortical pathways disturbed
Acute confusional state that fluctuates; Marked anxiety; Impaired memory and attentiveness; Rambling and irrelevant conversation; Misperceptions, illusions, hallucinations, delusions; Rapid mood swings, fearful, suspicious; Is reversible
Delirium
- may be due to medication, alcohol/drug withdrawal, severe infection, electrolyte/metabolic disorder, brain injury
Used to quantify consciousness; Evaluates function of cerebrum and brainstem; Can be repeated to assess improvement or deterioration
Glasgow coma scale
-eye opening, verbal response, motor response
What glasgow coma scale score is a severe head injury? moderate? mild?
Severe = 3-8 Moderate = 9-12 Mild = 13-15
Temporary alteration in mental status due to head trauma; Symptoms may disappear quickly or take several weeks; An athlete should not return to activity until all signs and symptoms have resolved
Concussion
What are two big screening questions for depression? yes to both questions indicates referral
- Over the past 2 weeks have you felt down, depressed, or hopeless?
- Over the past 2 weeks have you felt little interest or pleasure in doing things?
In the geriatric depression scale, what score indicates depression?
5
Biochemical imbalance in brain; Elevated and euphoric or irritable and agitated mood that lasts longer than one week
Mania
Marked anxiety or fear that interferes with personal, social, and occupational functioning; Most common psychiatric disorder
Anxiety disorder
- many people recognize that the anxiety is unreasonable
Adolescent or early adult onset; Severe, persistent, psychotic syndrome that results in an impaired reality
Schizophrenia
Significant sub-average general intellectual functioning; Delayed developmental milestones – motor and speech Deficits in adaptive behavior and academic performance
Intellectual disability
Behavioral disorder; Increased motor activity, difficulty sustaining attention and organizing tasks, disruptive behavior, poor impulse control, poor school performance, low self-esteem; Not related to low intelligence; Onset before age 7, more common in boys
Attention Deficit Hyperactivity Disorder (ADHD)
Impaired social interactions, impaired language, lack of awareness of others, poor eye contact, aversion to being held/touched, odd and repetitive behaviors; Developmental disorder; Unknown etiology; Identified prior to age 3; More boys than girls; Great deal of current research
Autism Spectrum Disorder
Dementia of Alzheimer type – \_\_\_ Vascular dementia (recurrent ischemic strokes) – \_\_\_ Other dementias – \_\_\_
70%
20%
10%
What 4 categories of history do we take?
- History of present illness (Disorientation, confusion, depression, anxiety)
- Past medical history (Neurologic disorder, psychiatric disorder, brain surgery, brain injury, chronic disease, progressive disease)
- Family history (Psychiatric disorders, mental illness, Alzheimer’s, intellectual disability, autism, alcoholism)
- Personal and social history
(Emotional status, social or family problems, ability to cope, education/intellectual level, use of alcohol/drugs, sleeping and eating patterns)
What aspects of physical appearance and behavior do we need to pay attention to when assessing mental status?
- Grooming and hygiene
- Emotional status
- Nonverbal communication (body language)
What tools are used to screen for cognitive function?
- Mini-Cog (give 3 words, draw clock, then ask to recall words; abnormal clock or inability to recall = impaired)
- 6CIT – 6 item Cognitive Impairment Test
- MMSE - Mini Mental State Examination
- SLUMS – St. Louis University Mental Status Examination
- Montreal Cognitive Assessment
What speech and languages skills are observed in assessing mental status?
- Voice quality (Volume, quality, pitch)
- Articulation (Dysarthria)
- Comprehension (Receptive aphasia (Wernicke’s area))
- Coherence (Expressive aphasia (Broca’s area))
Impaired speech, a lot of effort to speak, know what they want to say but can’t articulate, speech mostly nouns and verbs
expressive aphasia
- unable to write, but can read
Fluent speech but uses words inappropriately, speech may be incomprehensible, can hear words but can’t comprehend the meaning
receptive aphasia
- unable to read and write
What aspects of emotional status are observed in assessing mental status?
- Mood and feelings (Do they correspond to the current situation?)
- Thought process (Is it logical and easy to follow?)
