mental status assessment Flashcards
older adult special considerations
- vision/hearing
- appropriate dress
- slow responses
- mild confusion in the new setting
- reminiscing
- short term memory hesitaiton
- risk of abuse
cultural special considerations
- eye contact
- cultural beliefs
- facial expressino
- risk for under recognized depression
what does mental status mean?
emotional and cognitive functioning, inferred through assessment of individual behaviors
what individual behaviors should you assess in mental status
consciousness, language, mood and affect, orientation, memory and abstract reasoning, thought process through content and perception
consciousness
awareness of one’s own existence, feelings, and thoughts and of the environment
language
using the voice to communicate one’s thoughts and feelings
mood and affect
both of these elements deal with prevailing feelings, mood is a prolonged display of feelings that colors the whole emotional life, whereas affect is a temporary expression of feelings
orientation
awareness of the objective world in relation to the self
attention
the power of concentration, the ability to focus on one specific things without being distracted
memory
the ability to note and store experiences and perceptions for later recall, recent memory evokes day to day evenets, and remote brings up many years of experience
abstract reasoning
pondering of a deeper meaning beyond the concrete and literal
thought process
the way a person thinks, the logical train of thought
thought content
what a person thinks, specific ideas, beliefs, and use of words
perceptions
awareness of objects through any of the five senses
what is a mental status examination?
the systematic check of emotional and cognitive function
4 pillars of mental status exam
appearance, behavior, cognitive functions (conversations), thought process
when is a full mental status exam necessary?
- initial screening detects anxiety or depression
- behavioral changes like memroy loss, inappropriate social interaction
- brain lesions like trauma, tumor, CV accident, stroke
- aphasia like impairement of language due to brain damage
- symptoms of psychiatric mental illness
when should one proceed with acute assessment
any time there is a suspicion of mental health problems
what should an acute assessment include
safety assessment, utilize touch cautiously, assume non threatening posture
appearance components
overall appearance, posture, body movements, grooming and hygeine, dress
behavior components
level of consciousness (lethargic, obtunded, stupor), facial expressions, speech, mood/affect
lethargic
drowsy, oriented and appropriate but may be slow
obtunded
hard to arouse, slow and confused responses, requires almost constant stimulation for even marginal cooperation
stupor/semi coma
responds only to vigorous shake or pain, purposeful withdrawal to pain, slow or absent verbal responses
cognitive function components
orientation, attention span, memory, aphasia, judgement
immediate memory
say 4 words and ask them to repeat after you
recent memory
remembering the words after about 5 minutes
remote memory
occupation, birthday, place of birth
what does thought process include
thought process, thought content, perception
logic, relevance, organization of thoughts
assessed during conversation, should be able to organize thoughts and make connections between subjects
abstract and concrete thinking
you can assess by asking a patient to interpret a proverb (ex: what does silver lining mean?)
expected findings for thought content
reality based and rational thinking, denies irraitonal fears or obsessive thoughts
perceptions normal findings
accurately perceives people and events, denies voices or seeing things others do not
perceptions abnormal
hallucinations or delusions, BIG red flag
ways to test insight and normal findings
“what do you think caused your current problem”, normal findings: verablizes contribution of choices to current physical condition
screenings for depression
PHQ-2 and PHQ-9, PHQ2 is broader while the 9 question is specific
GAD-7
anxiety screening tool
what is the problem with suicidal risk factors
someone can have all the risk factors and not commit suicide, someone can have none and commit suicide
suicidal risk factors (9)
genetics, abuse, previous attempts, loss, serious illness, mediation, substance abuse, social isolation, impulsive/aggression
supplemental mental status testing
mini-cog; MMSE, MoCA
delirium vs. dementia
delirium is acute while dementia is progressive
delirium
acute confusional change or loss of consciousness and perceptual disturbance, may accompany acute illness, usually resolved when underlying cause is treated
dementia
gradual progressive process, causing decreased cognitive function even though the person is fully conscious and awake, not reversible
red flags in mental status exam
acute change in mental status or level of consciousness, delusions and hallucinations, suicidal or homicidal thoughts
red flags for general violence
new onset behaviors or changes in behavior; withdrawal, depression; agitation, hyperarousal; new displays of anger, noncompliance; sexualized behavior; bowel or bladder problems
alcohol use and abuse
high incidence of occurrence across patient care settings; morbidity and mortality data reflect adverse consequences
