Mental Status Assessment: Ch. 5 Flashcards
What is included in a mental status assessment (ABC + T) and when is it done?
done during the interview
-Appearance: posture, body movements, dress, grooming and hygiene (use caution), pupils
- Behavior: Level of Consciousness (LOC), facial expression, eye contact, speech, mood and affect
- Cognition: orientation (name, place, time, situation), attention span (ask to do a series of tasks), recent memory (verifiable events), remote memory, new learning (4 unrelated word test)
- Thought process: perception of current situation
- Abstract reasoning: ability to think beyond the literal; use metaphors, diagrams, symbols, shapes. eg: what is the difference between a doctor and a nurse?
- Judgement: realistic health goals, future plans
When is a full mental status exam used?
When the patient shows signs of:
- anxiety and/or depression
- family members are concerned
- Brain lesion
- aphasia
- symptoms of psychiatric illness
- Hx of substance abuse or violence
Aphasia and the 3 specific types
Abnormal language comprehension and production secondary to brain damage
1- Broca’s or Expressive aphasia: trouble producing language (spoken, manual, or written)
comprehension of language generally remains intact.
2- Wernickie’s or Receptive aphasia: trouble understanding written or spoken language.
Producing connected speech is not very affected, however often what they say doesn’t make a lot of sense or they pepper their sentences with non-existent or irrelevant words.
3- Global aphasia: The most common and severe form. Spontaneous speech is absent or reduced to a few stereotyped words or sounds. Comprehension is absent or reduced to only the person’s own name and a few select words. Repetition, reading, and writing are severely impaired. Prognosis for language recovery is poor
Level of Consciousness: ALOSC
- Alert
- Lethargic: drowsy, somnolent (abnormally drowsy)
- Obtunded: stimulus needed to get attn. eg: shaking shoulder
- Semi-comatose: pain stimulus needed to get attn. eg: pinching
- Comatose: cannot be roused
Thought process perception abnormalities: Echolalia Neologism Confabulation Circumlocution Flight of ideas Blocking
- Echolalia: Imitation, repeats others’ words or phrases, often with a mumbling, mocking, or mechanical tone (eg: autism)
- Neologism: Coining a new word; invented word has no real meaning except for the person
- Confabulation: A person who is confusing things they have imagined with real memories. A person who is confabulating is not lying but has fabricated, misinterpreted, or distorted events
- Circumlocution: Round-about expression, substituting a phrase when unable to think of name of object.
- Flight of ideas: when a person starts talking and they sound jittery, anxious, or very excited (eg: bipolar, schizophrenic)
- Blocking: Sudden interruption in train of thought, unable to complete sentence, seems related to strong emotion. (eg: schizophrenic)
Dysphonia
Abnormal voice
The voice can be described as hoarse, rough, raspy, strained, weak, breathy, or gravely
Dysarthia
Abnormal articulation - Slurred speech
A motor speech disorder in which the muscles that are used to produce speech are damaged, paralyzed, or weakened
GAD-7
7 questions screening for depression.
GAD-7 is an initial screening test.
If first 2 questions are “several days” proceed with full questionnaire.
PHQ-9
More invasive than the GAD-7
If first 2 questions are “several days” proceed with full questionnaire.
what do you do when screening for suicidal thought
ask open-ended questions
“have you ever felt that life is not worth living?”
“do you have a plan?” (if yes, they are HIGH RISK & inform a mental health professional)
4 Unrelated Word Test
1- say 4 unrelated words (eg: Apple, Cup, Shoe, Wagon)
2- have the patient repeat them back, then do something else
3- have them repeat them back @ 5, 10 & 30 minute intervals
MMSE
Mini-Mental State Examination
- detector of cognitive dysfunction
- pt. must be able to read, write, and see
- do not use for pt. with low edu.
- score 24-30 no impairment
MoCa
Montreal Cognitive Assessment
- detector of cognitive dysfunction
- accounts for edu. level
- score 26-30 no cognitive impairment
Denver II Screening Test
what it is
who it is used for
what does it measure?
Detects developmental delays in infants and pre-schoolers
-examines: gross motor, language, fine motor adaptive, person-social skills
Mini- Cog, what it is and who it is used for
Quick screening for dementia in otherwise healthy older adults
- 3 unrelated item recall @ 5, 10, 30min (3 points poss.)
- clock drawing, with given time (2 points poss.)
- score < 3 screen for dementia
Phobia
Strong, persistent, irrational fear of an object or situation; feels driven to avoid it. Is aware that the fear is irrational (“I know I’m being silly… but…”)
Hypochondriasis
Morbid worrying about his or her own health; feels sick with no actual basis for that assumption
Obsession
Unwanted, persistent thoughts or impulses; logic will not purge them from consciousness; experienced as intrusive and senseless
eg: Violence (parent having repeated impulse to kill a loved child); contamination (becoming infected by shaking hands)
Compulsion
Unwanted repetitive, purposeful act; driven to do it; behavior thought to neutralize or prevent discomfort or some dreaded event
eg: Handwashing, counting, checking and rechecking, touching
Delusions
Firm, fixed, false beliefs; irrational; person clings to delusion despite objective evidence to contrary
Glasgow Coma Scale, what is it, who is it used for, what does the test look for?
Quantitative tool used for older adults with confusion
Tests LOC
It gives a numeric value to the patient’s response in eye opening, best verbal response, and best motor response
Delirium
Acute, quit onset
- Could be due to: Hypoglycemia, fever, dehydration, hypotension; infection, adverse drug reaction, head injury, pain, emotional stress, substance abuse
Depression
Difficulty concentrating, forgetfulness, inattention, lethargy, fatigue, lack of motivation; may sleep poorly and awaken in early morning
Generalized Anxiety Disorder (GAD)
A pattern of excessive worrying.
-Characterized by: restlessness, muscle tension, diarrhea, palpitations, tachypnea, hypervigilance, fatigue, or sleep disturbance.
Agonsia
Loss of the ability to identify objects or people.
Organic Disorders vs Psychiatric Illness
Organic: caused by brain disease of known specific organic cause.
e.g: delirium, dementia, alcohol and drug intoxication, and withdrawal
Psychiatric: an organic etiology has not yet been established
e.g: anxiety disorder or schizophrenia
Panic Attack
- What is it?
- Symptoms
- Duration
-A defined period of intense fear, anxiety, and dread
-dyspnea, choking, chest pain, increased heart rate, palpitations, nausea, and sweating.
fear of going crazy, dying, or impending doom.
-Sudden onset, lasts about 10 minutes, then subsides.
