mental status terms Flashcards
Mental disorders
organic disorders
psychiatric mental disorders
caused by brain disease of known specific organic cause [e.g., delirium, dementia, alcohol and drug intoxication, and withdrawal
organic disorders
in which an organic etiology has not yet been established [e.g., anxiety disorder or schizophrenia
psychiatric mental disorders
Being aware of one’s own existence, feelings, and thoughts and of the environment. This is the most elementary of mental status functions.
Consciousness
Using the voice to communicate one’s thoughts and feelings. This is a basic tool of humans, and its loss has a heavy social impact on the individual.
Language
Both of these elements deal with the prevailing feelings. Affect is a temporary expression of feelings or state of mind, and mood is more durable, a prolonged display of feelings that color the whole emotional life.
Mood and affect
The awareness of the objective world in relation to the self, including person, place, and time.
Orientation
The power of concentration, the ability to focus on one specific thing without being distracted by many environmental stimuli.
Attention
The ability to lay down and store experiences and perceptions for later recall. Recent memory evokes day-to-day events; remote memory brings up years’ worth of experiences
Memory
Pondering a deeper meaning beyond the concrete and literal.
Abstract reasoning
The way a person thinks; the logical train of thought
Thought process
What the person thinks—specific ideas, beliefs, the use of words.
Thought content
An awareness of objects through the five senses
Perceptions
A B C T (mental status exam)
Appearance, Behavior, Cognition,
and Thought processes
This tests the person’s ability to lay down new memories. It is a highly sensitive and valid memory testAfter 5 minutes, ask for the recall of the four words. To test the duration of memory, ask for a recall at 10 minutes and at 30 minutes. The normal response for people younger than 60 years is an accurate three- or four-word recall after a 5-, 10-, and 30-minute delay
New Learning—The Four Unrelated Words Test.
loss of the ability to speak or write coherently or to understand peech or writing as a result of a stroke or brain damage
Aphasia
Word Comprehension.
Point to articles in the room, parts of the body,
Reading.
Ask the person to read available print
Writing.
Ask the person to make up and write a sentence describing the weather or their job. Note coherence, spelling, and parts of speech (the sentence should have a subject and a verb
Test for Aphasia
Ask yourself, “Does this person make sense? Can I follow what the person is saying?
Thought Processes.
What the person says should be consistent and logical.
Obsessions?, compulsions?
Thought Content.
The person should be consistently aware of reality. The perceptions should be congruent with yours.
How do people treat you?
• Do other people talk about you?
• Do you feel as if you are being watched, followed, or controlled?
• Is your imagination very active?
• Have you heard your name when alone
Perceptions. (hallucinating?)
7-item generalized anxiety disorder scale (GAD-7) listed in ≥8 on the GAD-7 may better identify patients with GAD.
Scores on the GAD-2 range from 0 to 6; a score of 0 suggests that no anxiety disorder is present, whereas a score ≥3 is suggestive of GAD
Anxiety Disorder Testing
4 most common Anxiety Disorder
Scores on the GAD-2 range from 0 to 6; a score of 0 suggests that no anxiety disorder is present, whereas a score ≥3 is suggestive of GAD
Patient Health Questionnaire-2 (PHQ-2), which entails asking two questions about depressed mood and anhedonia (little interest or pleasure in doing things)
Screening for Depression
If the person answers “several days” or higher, administer the full PHQ-919
score of 5 to 9 = minimal symptoms; 10 to 14 = minor depression; 15 to 19 = major depression, moderately severe; ≥20 = major depression
Screening for Depression (over several days)
Have you ever felt that life is not worth living?
• Have you ever thought of hurting yourself? If so, how often?
• Do you feel like hurting yourself now?
• Do you have a plan to hurt yourself?
• How would you do it?
• What would happen if you were dead?
• How would other people react if you were dead?
• Whom could you tell if you felt like killing yourself?
Screen for Suicidal Thoughts
Job and future plans should be realistic, considering the person’s health situation. In addition, ask the person to describe the rationale for personal health care and how he or she decided whether to comply with prescribed health regimens.
ex: tell me what you plan to do once youre discharged from hospital?
more interested in their daily or long-term goals
assess judgment
test of the cognitive functions of the mental status examination (memory, orientation to time and place, naming, reading, copying or visuospatial orientation, writing, and the ability to follow a three-stage command the person must be able to write and have no vision impairment. (for low education ppl)
-Scores that occur with dementia and delirium are classified as follows: 18-23 =
mild cognitive impairment; 0-17 = severe cognitive impairment
Normal -24-30
11 question test
less sensitive to mild cognitive impairment
good screening tool to detect dementia and delirium and to differentiate these from psychiatric mental illness.
Mini-Mental State Examination (MMSE)
mental assessment but more sensitive to mild cognitive impairment.
measure visuo-constructive ability, language function, memory, auditory attention, conceptual thinking, working memory and calculations, as well as speech/language
<26 mild cognitive impairment
Montreal Cognitive Assessment (MoCA),
mental status assessment of infants and children covers behavioral, cognitive, and psychosocial development and examines how the child is coping with his or her environment. Essentially you follow the same A-B-C-T guidelines
-test has 125 items arranged in chronologic order and displayed in groupings corresponding to recommended ages for health-maintenance visits.
Denver II scoring (scored normal, abnormal, questionable)
Designed to detect developmental delays in infants and preschoolers within four functions: gross motor, language, fine motor–adaptive, and personal-social skills
Denver II testing
Keep your beginning questions open ended > specific close ended
adolescent, follow the same A-B-C-T
is an acute confusional change or loss of consciousness and perceptual disturbance; it may accompany acute illness (e.g., pneumonia, alcohol/drug intoxication), and it is usually resolved when the underlying cause is treated.
Develops over a short period.
Person is exhibiting memory impairment or deficits
Occurs as a result of a medical condition, such as systemic infection
Delirium
is a gradual, progressive process, causing decreased cognitive function even though the person is fully conscious and awake; it is not reversible.
(not part of normal aging. Risk factors for dementia include racial and ethnic groups other than Caucasians, advanced age, women, singles, living alone, lower educational attainment, and lower income.)
Dementia
Behavior- LOC (Quantitate tool)
It gives a numeric value to the person’s response in eye opening, best verbal response, and best motor response.
Glasgow Coma Scale
You may consider aging persons oriented if they know generally where they are and the present period (i.e., consider them oriented to time if the year and month are stated correctly). Orientation to place is accepted with the correct identification of the type of setting (e.g., the hospital) and the name of the town.
(Cognitive Function)
Orientation
People in their 70s average two of four words recalled over 5 minutes. They will improve their performance at 10 and 30 minutes after being reminded by verbal cues
New learning (Four Unrelated Words Test)
consists of a 3-item recall test and a clock-drawing test (3-5 mins).
reliable, quick, and easily available instrument to screen for cognitive impairment in otherwise healthy older adults
score of <3 is indicative of dementia
the ability to plan, manage time, organize activities, and manage working memory
The Mini-Cog
Person’s posture is erect, with no involuntary body movements. Dress and grooming are appropriate for season and setting
Appearance
Person is alert, with appropriate facial expression and fluent, understandable speech. Affect and verbal responses are appropriate.
Behavior
Oriented to time, person, place. Able to attend cooperatively with examiner. Recent and remote memory intact. Can recall four unrelated words at 5-, 10-, and 30-minute testing intervals. Future plans include returning home and to local university once individual therapy is established and medication is adjusted.
Cognitive functions
Perceptions and thought processes are logical and coherent. No suicidal ideation.
Score on Mini-Mental State Examination is 28.
Thought process
Name called in normal tone of voice
b. Name called in loud voice
c. Light touch on person’s arm
d. Vigorous shake of shoulder
e. Painful stimuli
Glasgow Coma Scale (Stimuli)
Amount and quality of movement
b. Presence and coherence of speech
c. Opening of eyes and making eye contact
Glasgow Coma Scale (response)
ALERT
Awake or readily aroused; oriented, fully aware of external and internal stimuli and responds appropriately; conducts meaningful interpersonal interactions.
Glasgow Coma Scale
What the person does on cessation of your stimulus
Not fully alert; drifts off to sleep when not stimulated; can be aroused to name when called in normal voice but looks drowsy; responds appropriately to questions or commands but thinking seems slow and fuzzy; inattentive; loses train of thought; spontaneous movements are decreased.
Glasgow Coma Scale
What the person does on cessation of your stimulus
Lethargic (or Somnolent)
Sleeps most of time; difficult to arouse—needs loud shout or vigorous shake; acts confused when is aroused; converses in monosyllables; speech may be mumbled and incoherent; requires constant stimulation for even marginal cooperation.
Obtunded (GCS)
Spontaneously unconscious; responds only to persistent and vigorous shake or pain; has appropriate motor response (i.e., withdraws hand to avoid pain); otherwise can only groan, mumble, or move restlessly; reflex activity persists
Stupor or Semi-Coma (GCS)
Completely unconscious; no response to pain or any external or internal stimuli (e.g., when suctioned, does not try to push the catheter away); light coma has some reflex activity but no purposeful movement; deep coma has no motor response.
Coma (GCS)
Clouding of consciousness (dulled cognition, impaired alertness); inattentive; incoherent conversation; impaired recent memory and confabulatory for recent events; often agitated and having visual hallucinations; disoriented, with confusion worse at night when environmental stimuli are decreased
Delirium (Acute Confusional State) (GCS)
VOICE- disorder
Difficulty or discomfort in talking, with abnormal pitch or volume, caused by laryngeal disease. Voice sounds hoarse or whispered, but articulation and language are intact.
Dysphonia-speech disorder
ARTICULATION -disorder
Distorted speech sounds; speech may sound unintelligible; basic language (word choice, grammar, comprehension) intact.
Dysarthria-speech disorder
Language comprehension and production secondary to brain damage
True language disturbance; defect in word choice and grammar or defect in comprehension; defect is in higher integrative language processing.
APHASIA- Speech disorder
difficulty producing language
Types of Aphasia (expressive)
difficulty understanding language
Types of Aphasia (receptive)
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. Caused by a large lesion that damages most of combined anterior and posterior language areas.
recovery is poor
Global aphasia
Expressive aphasia. The person can understand language but cannot express himself or herself using language. This is characterized by nonfluent, dysarthric, and effortful speech. The speech is mostly nouns and verbs (high-content words) with few grammatic fillers, termed agrammatic or telegraphic speech. Repetition and reading aloud are severely impaired. Auditory and reading comprehensions are surprisingly intact. Lesion is in anterior language area called the motor speech cortex or Broca area.
Broca aphasia
Receptive aphasia. The linguistic opposite of Broca aphasia. The person can hear sounds and words but cannot relate them to previous experiences. Speech is fluent, effortless, and well articulated but has many paraphasias (word substitutions that are malformed or wrong) and neologisms (made-up words) and often lacks substantive words. Speech can be totally incomprehensible. Often there is a great urge to speak. Repetition, reading, and writing also are impaired. Lesion is in posterior language area called the association auditory cortex or Wernicke area.
Ex:after cva pt says, “I buy obie get spirding and take my train”
Wernicke aphasia
Lack of emotional response; no expression of feelings; voice monotonous and face immobile (topic varies mood doesn’t)
Flat affect (blunted affect)- (mood and affect)
Sad, gloomy, dejected; symptoms may occur with rainy weather, after a holiday, or with an illness; if the situation is temporary, symptoms fade quickly
Depression (mood and affect)
Loss of identity, feels estranged, perplexed about own identity and meaning of existence
I don’t feel real.” “I feel like I’m not really here.”
Depersonalization (lack of ego boundaries) (mood &affect)
Joy and optimism, overconfidence, increased motor activity; not necessarily pathologic
I’m feeling very happy.”
Can be a pathologic sign of mania.
Elation (mood & affect)
Excessive well-being; unusually cheerful or elated, which is inappropriate considering physical and mental condition; implies a pathologic mood
“I’m high.” “I feel like I’m flying.” “I feel on top of the world.”
Euphoria
Worried, uneasy, apprehensive from the anticipation of a danger whose source is unknown
“I feel nervous and high-strung.” “I worry all the time.” “I can’t seem to make up my mind.”
Anxiety
Worried, uneasy, apprehensive; external danger is known and identified ex: fear of flying in airplane
Fear
Annoyed, easily provoked, impatient
ex: Person internalizes a feeling of tension, and a seemingly mild stimulus “sets him (or her) off”
irritability
Furious, loss of control
Rage
The existence of opposing emotions toward an idea, object, person
ex:A person feels love and hate toward another at the same time
Ambivalence
Rapid shift of emotions (happy then cry then sad)
Lability
Affect clearly discordant with content of person’s speech
ex:Laughs while discussing admission for liver biopsy
Inappropriate affect
A defined period of intense fear, anxiety, and dread accompanied by signs of dyspnea, choking, chest pain, increased heart rate, palpitations, nausea, and sweating. Also has fear of going crazy, dying, or impending doom. Sudden onset, lasts about 10 minutes, then subsides.
Panic Attack (anxiety disorder)
An irrational fear of being out in the open or in a place from which escape is difficult (airport or airplane, car or bus, elevator, bridge). Fear is so intense that these places are avoided and person is reluctant to leave a safe place (home).
Agoraphobia (anxiety disorder)
A pattern of debilitating fear when faced with a particular object or situation (e.g., dogs, spiders, thunder or storms, enclosed spaces, heights, blood). Person knows it is irrational yet studiously avoids the feared object, thus becoming restricted in social or occupational activities.
Specific Phobia (anxiety disorder)
A persistent and irrational fear of being in social situations. Person anticipates being judged or criticized, feeling or looking foolish, feeling embarrassment, being unable to answer questions, or being unable to remember the lines or notes. Person studiously avoids social situations or endures them with intense anxiety.
Social Anxiety Disorder (Social Phobia)
A pattern of excessive worrying and morbid fear about anticipated “disasters” in the job, personal relationships, health, or finances. Characterized by restlessness, muscle tension, diarrhea, palpitations, tachypnea, hypervigilance(sensing threats aroud u>ptsd), fatigue, or sleep disturbance. Person devotes much time to preparing for anticipated catastrophe, has difficulty making decisions, and practices avoidance.
Generalized Anxiety Disorder (GAD)
A pattern of recurrent obsessions (intrusive, uncontrollable thoughts) and compulsions (repetitive ritualistic actions) done to decrease anxiety and prevent a catastrophe (e.g., contamination [fear of germs], violence, perfectionism, and superstitions). Intrusive thoughts and actions are time consuming, interfere with daily activities, and make the person feel humiliated or ashamed for giving in to them.
Obsessive-Compulsive Disorder (OCD) (type anxiety disorder)
This follows a traumatic event outside the range of usual human experience involving actual or threatened death (e.g., military combat, natural disaster [flood, tornado, earthquake], plane or train accident, violence [mugging, rape, bombing]). The person relives the trauma many times, intrusively and unwillingly. The same feelings of helplessness, fear, or horror recur. Avoidance of any trigger associated with the trauma occurs, and the person has hypervigilance, sleep problems, and difficulty concentrating, leading to feelings of being permanently damaged.
Posttraumatic Stress Disorder (PTSD) (axiety disorder)
Its a disturbance of consciousness
acute confusional state, potentially preventable in hospitalized persons. Characterized by disorientation, disordered thinking and perceptions (illusions and hallucinations), defective memory, agitation, inattention. (occurs sudden, hrs-days)
Delirium
is a chronic progressive loss of cognitive and intellectual functions, although perception and consciousness are intact. Characterized by disorientation, impaired judgment, memory loss (occurs over mnths)
Apraxia and agnosia occur with dementia.
Dementia
long-term depressed mood (≥2 weeks) with lack of pleasure; disturbed sleep and appetite; feelings of hopelessness, guilt, worthlessness, sadness, loneliness, and despair; suicide ideation.
Depression
Hypoglycemia, fever, dehydration, hypotension; infection, other conditions that disrupt body homeostasis; adverse drug reaction; head injury; change in environment (e.g., hospitalization); pain; emotional stress; substance abuse (altered cognition)
Cause/ contribution of delirium
Alzheimer disease, vascular disease, human immunodeficiency virus infection, neurologic disease, chronic alcoholism, head trauma (impaired abstract thinking) & flat; agitated mood (not reversible but progressive)
Cause/ contribution of dementia
Lifelong history, losses, loneliness, crises, declining health, medical conditions
Cause/ contribution of depression
“Forgot what I was going to say.”
Blocking (Thought Process Abnormalities)
Gives detailed description of his long walk around the hospital although you know Mr. J. remained in his room all afternoon.
Confabulation (Thought Process Abnormalities)
invented word has no real meaning except for the person
Neologism(Thought Process Abnormalities)
the thing you open the door with” instead of “key.”
Circumlocution(Thought Process Abnormalities)
Talks with excessive and unnecessary detail, delays reaching point;
Circumstantiality (Thought Process Abnormalities)
shifting from one topic to an unrelated topic
Loosening associations(Thought Process Abnormalities)
Take this pill? The pill is blue. I feel blue. (sings) She wore blue velvet.”
skipping from topic to topic, practically continuous flow of accelerated speech;
Flight of ideas (Thought Process Abnormalities)
Incoherent mixture of words, phrases, and sentences; illogical, disconnected, includes neologisms (sentence not making sense)
ex: Beauty, red-based five, pigeon, the street corner, sort of.”
Word salad(Thought Process Abnormalities)
Persistent repeating of verbal or motor response, even with varied stimuli.
ex: I’m going to lock the door, lock the door. I walk every day, and I lock the door. I usually take the dog, and I lock the door.
Perseveration(Thought Process Abnormalities)
Nurse: “I want you to take your pill.”
Patient (mocking): “Take your pill. Take your pill.”
Echolalia(Thought Process Abnormalities)
Word choice based on sound, not meaning; includes nonsense rhymes and puns.
ex:My feet are cold. Cold, bold, told. The bell tolled for me.”
Clanging (Thought Process Abnormalities)
Strong, persistent, irrational fear of an object or situation; feels driven to avoid it
ex:Cats, dogs, heights, enclosed spaces
Phobia(Thought Process Abnormalities)
obsession with idea of having a serious but undiagnosed medical condition.
ex: Preoccupied with the fear of having cancer; any symptom or physical sign means cancer
Hypochondriasis(Thought Process Abnormalities)
Violence (parent having repeated impulse to kill a loved child); contamination (becoming infected by shaking hands)
Unwanted, persistent thoughts or impulses
Obsession(Thought Process Abnormalities)
Unwanted repetitive, purposeful act;
ex; Handwashing, counting, checking and rechecking, touching. handwashing, are behaviors that the person feels driven to perform in response to an obsession
even tho hands are not dirty
Compulsion(Thought Process Abnormalities)
Firm, fixed, false beliefs; irrational; person clings to delusion despite objective evidence to contrary
ex: Person believes that he or she is famous,
Delusions(Thought Process Abnormalities)
Sensory perceptions for which there are no external stimuli; may strike any sense: visual, auditory, tactile, olfactory, gustatory
ex: seeing ghost
Hallucination (Perception Abnormalities)
Misperception of an actual existing stimulus, by any sense
ex: Folds of bedsheets appear to be animated
Illusion (Perception Abnormalities)
Intense fear of weight gain
• Distorted body image
• Restricted calories with significantly low body mass index
• Subtypes:
• Restricting (no consistent bulimic features)
• Binge eating/purging type (primarily restriction, some bulimic behaviors)
Anorexia Nervosa (characteristic of eating prblm)
Recurrent episodes of uncontrollable bingeing
• Inappropriate compensatory behaviors: vomiting, laxatives, diuretics, or exercise
Self-image largely influenced by body image
Bulimia Nervosa(characteristic of eating prblm)
Recurrent episodes of uncontrollable bingeing without compensatory behaviors
• Bingeing episodes induce guilt, depression, embarrassment, or disgust (eating out of stress)
Binge Eating (characteristic of eating prblm)
A common behavioral disorder with inappropriate inattention (short attention span, unable to complete tasks or follow directions, easily distracted), impulsiveness, and hyperactivity (restlessness and fidgeting(make small movements due to nervousness), excess talking). Present in two settings, home and school. Nearly 12% of adolescents ages 12-17 and 9.5% of children ages 6-11 have ADHD. The highest prevalence is in non-Hispanic white males.16
Attention-Deficit/Hyperactivity Disorder (ADHD) (Childhood Mental Disorders)
A disruptive set of behaviors characterized by negative, aggressive, angry, and irritable mood. Children with ODD lose their temper, argue with adults, refuse to obey adults’ requests or rules, deliberately annoy others, and blame their actions on others. They may be spiteful, vindictive, or malicious. Because they violate social norms, presence in school is difficult. It is also hard to make friends or to fit well in the family.
Oppositional Defiant Disorder (ODD) (Childhood Mental Disorders)
A complex neurologic and biological developmental disorder characterized by problems in social interactions and verbal and nonverbal communication. Dysfunctions range from mild to severe and include problems making and maintaining friends, strict adherence to rituals or routines, resistance to change, repetitive speech, poor eye contact, and motor mannerisms. Autism has a genetic component, appears in early childhood (by 2 or 3 years), is 4 times more common in boys than girls, and is not affected by race, family income, or educational level
Autism Spectrum Disorder (Childhood Mental Disorders)
A group of serious and complex psychological disorders affecting primarily adolescents. (1) Anorexia nervosa presents as a severely low body weight for height (low body mass index) and an intense fear of gaining weight. The person may eat very little food or binge and then purge food by vomiting. (2) Bulimia nervosa is the hallmark of a young person who binge eats and then compensates with self-induced vomiting, misuse of laxatives or diuretics, fasting, or excessive exercise. Both disorders leave the person severely underweight and at risk for electrolyte disturbances and other medical comorbidities. (3) People with binge-eating disorder use excessive food for comfort or to relieve stress and then feel extreme remorse. This leads to obesity.
Eating Disorder (Childhood Mental Disorders)
Posture Body movements Dress Grooming and hygiene Pupils
Appearance (Mental Status Assessment)
Level of consciousness
Facial expression
Speech (quality, pace, articulation, word choice)
Mood and affect
Behavior (Mental Status Assessment)
Orientation Attention span Recent and remote memory New learning—the Four Unrelated Words Test Judgment
Cognitive function (Mental Status Assessment)
Thought process
Thought content
Perceptions
Screen for suicidal thoughts
Thought process (Mental Status Assessment)
Perform
the Mini-Mental State Examination, MoCA, or the Mini-Cog (Mental Status Assessment)
Mania Syndrome
state of mind as high energy, excitement, euphoria over sustained period of time
characterized by at least 2 years of depressed mood for more days than not, accompanied by additional depressive symptoms
Dysthymic Disorder
characterized by one or more major depressive episodes, that is, at least 2 weeks of depressed mood or loss of interest accompanied by at least four additional symptoms of depression.
Major depressive disorder
ex: Pick up the pencil in your left hand, move it to your right hand, and place it on the table.”
evaluated by assessing the individual’s ability to concentrate and complete a thought or task without wandering
Attention span
