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)
