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
