week 3 Flashcards
what is a comprehensive assessment?
Includes a complete health hx & physical exam; considers psychological, emotional, social, spiritual, ethnic, & cultural aspects of health; attends to the meaning of the client’s health–illness experience; & evaluates how all this affects the individual’s daily living.
what is a mental status exam (MSE)?
Systematic assessment of the individual’s affect, behavior, & cognitive processes
- Includes both objective & subjective data collection
- Provides info for assessment, diagnosis & response to treatment
*all new admissions require a FULL MSE
what are the components of a MSE?
- General observations (appearance, behaviour, etc.)
- Speech characteristics
- Mood & Affect
- Thoughts
- Content & process
- Perception
- Sensorium/cognition
- Insight
- Judgment
what is pressured speech?
rapid speech w/ lots of words & hard to interpret; commonly seen in MANIA (form of bipolar disorder)
what is mood?
subjective emotion experienced by pt. *self-reported by pt. themselves
what is affect?
objective assessment; the facial expression of an emotion
what does labile mean?
erratic, unstable, quickly changing mood; common to rapid cycling forms of bipolar disorder in adults, & mood disorders in young children
ex: client began as upbeat & excited, then changed to concerned/anxious quickly after
what is thought content?
the content of your thoughts; what you’re talking about
what is thought process?
how your thoughts are formed & expressed
what does homicidal ideation mean?
thoughts of harming someone *inquire about a plan/intent (probe for more details)
what does delusion mean?
the belief of false/unreal thoughts
list the types of delusions.
Thought Insertion:
- pt. constantly complains of having disturbing, violent thoughts & claims thoughts are being sent to her by the president.
Thought Broadcasting:
- pt. believes that everybody can hear what she’s thinking (thinks people can literally hear her think out loud)
Ideas of Reference:
- pt. listens to a news broadcast about obesity & he thinks/believes it’s about him (feeling targeted)
Ideas of influence:
- pt. believes his mom is making him swear at his roommate
Other types:
- Paranoid delusions
- Grandiose delusions
- Religious delusions
- Nihilism
what is poverty of thought?
mental stateof having lack ofthoughts& havingfeelingsofemptiness
*pt. is slow to respond
what is an obsession?
a repetitive thought, emotion, or impulse
what is depersonalization?
belief that self or body is strange/unreal *feels disconnected from self
what does “flight of ideas” mean?
multiple thoughts & ideas are generated spontaneously, w/o obvious connection; often occurs in manic states
*common w/ mania (bipolar disorder)
ex: “I read passages, I read areas, chapters, I don’t have the time. When was the last time I watched a baseball game? I’m watching you all the time.”
*time is a theme here
what does “preservation “ mean?
a persistent response
what does “echolalia” mean?
repeating words back to you (like a parrot)
Ex: You greet a new patient by asking, “How are you feeling today?” They reply, “Today? Feeling today? How are YOU feeling today?”
what does “clang association” mean?
rhyming
ex: “my feet are cold; cold, bold, told. the bell tolled for me.”
what does “thought blocking” mean?
loses train of thought
what does “loose associations” mean?
says a bunch of words that aren’t connected; lacking logic & jumps from 1 topic to another
*could be a s/s of schizophrenia
ex: “My boss is angry w/ me & it wasn’t even my fault. I saw that movie too, Lassie. I felt really bad about it. But she kept trying to land the airplane & she never knew what was going on.”
what does “word salad” mean?
words & phrases are randomly arranged & lack logical connections/meaning, resulting in incoherent & unintelligible speech
ex: “Birds & fishes, red based five, pigeon, the street corner, sort-of, mud & stars.”
what does “neologism” mean?
the creation/use of new words/phrases that only makes sense to pt.; made-up words not understood by others
ex: “jolmet, jingom monad, frustionating!“
what does “circumstantiality” mean?
digressions to unnecessary details in thought & speech before talking about the main idea
excessive talking about details/info (but answers eventually); talks too much to answer a simple question
what does “tangentiality” mean?
frequent digression; digress too much & never answers questions
what are hallucinations?
having false sensory perceptions
- Auditory *hearing things
- Visual *seeing things
- Olfactory *smelling things
- Gustatory *tasting things
- Tactile/somatic *feeling things
***assess for command hallucinations: auditory hallucinations that instruct a pt. to act in specific ways (can be life-threatening)
what are illusions?
misinterpreting a sensory input
ex: looking at a hotdog, mistaken for a snake
concrete vs. abstract thinking
Concrete thinking: focuses on the real & obvious.
- ex: statue of liberty
Abstract thinking: higher-level thinking; involves processing theoretical concepts & allows us to make connections & see patterns.
- ex: the statue signifies justice
What are some challenges you could experience when performing a MSE? How you could address these challenges?
- Age; working w/ child speak w/in developmental level (usually done with parents depending on age)
- Culture
- Illness
If someone is psychotic, which components of an MSE would suggest this?
Thought processes, behaviour, & speech
what is the purpose of documenting?
the assessment data is used to plan care [in collaboration] w/ client & the health care team.
what is the Manitoba Mental Health Act (MMHA)?
mandatory admission & treatment for pts. that need psych help; exists to promote justice to pts. w/ mental illness
*should only be used if there’s no other way to keep pt. safe & deemed mentally incompetent/unstable
explain FORM 1.
application form for an order for a involuntary medical exam; presented to a judge for approval for FORM 2
MUST MEET CRITERIA:
- possible mental disorder *needs enough evidence
- danger to self or others, & at risk for mental/physical deterioration
- unwilling to be checked by a physician/psychiatrist
ex: concerned family suggests to client to seek mental health help; not agreeable to go voluntarily = form 1 should be filled up w/in 24 hrs
explain FORM 2.
judge grants order for involuntary medical exam
explain FORM 3.
police/peace officer action (detain); allows police to search for, notify, & take client into custody [brought to a facility] to get medical help/assessed.
this form is given to the client (indicated why they’re being detained, where they’re being taken to, & states their right to get a lawyer) *valid for 1 week
before getting admitted into a facility, client MUST be assessed w/in 24 HRS after police brings them into ED
explain FORM 4.
application form for PHYSICIAN for involuntary psychiatric assessment; can admit involuntary pts. (if psychiatrist determined; can be discharged & sent home based on ax OR if agreeable to orders) *valid for 1 week
MUST MEET CRITERIA:
- suffering from mental disorder
- danger to self or others, & at risk for mental/physical deterioration
- unwilling to go or isn’t mentally competent to consent
ONCE APPROVED & ADMITTED: - assessment has to occur w/in 72 hrs (3 days)
- if not done w/in timeframe, pt. has the right to leave
explain FORM 6.
form for a certificate for involuntary admission (valid for 21 days or 3 weeks)
- signed by psychiatrist (can’t be signed by the same MD who signed form 4)
*can be renewed if longer than 3 weeks (FORM 7)
explain FORM 9.
form to officially deem client as incompetent to make own treatment decisions (request
for certificate); MD determines competence & completes certificate [if applicable] & files it w/ the medical director
*needs to have a substitute decision maker/proxy (SDM; pt. & SDM have rights to appeal decision)
ONLY OCCURS IN THE HOSPITAL!
what do you need to be able to administer medication against pts. wishes?
form 9 + consent from SDM + physician’s order for medication
exception: CAN give meds w/o consent in the case of an emergency
explain FORM 13.
application form for a client who wants to leave against medical advice (LAMA)
*must first be assessed by psychiatrist (w/in 24 hrs) to determine whether discharge is granted, not granted, or status changes to involuntary
explain FORM 14.
application form for an order for the return of a person absent w/o permission; allows police to be called to find & return client back to facility (regardless of being voluntary/involuntary)
voluntary patients MUST be assessed regarding their mental status ASAP
explain FORM 15.
application form to allow a client to leave the facility (to obtain leave certificate or extension of leave)
allows pt. to get treatment in community but w/ certain conditions; voluntary agreement (if pt. goes against conditions, someone can call & be brought back to facility)
explain FORM 18.
application form completed by involuntary client to appeal or review their status (voluntary/involuntary) under MMHA
who is part of the review board? (including pt.)
- lawyer
- psychiatrist
- neutral party (NEITHER lawyer or psychiatrist)
what does “not criminally responsible” mean?
under the Criminal Code of Canada: nobody is criminally responsible for an act committed while suffering from a mental disorder that caused the person to be incapable of realizing the nature & quality of the act of knowing that it was wrong
what is bill 5 (amendment to the MMHA)
medical director of a psych facility may disclose info in a clinical record to any person to prevent/lessen risk of serious harm to the pts. health/safety or that of another person.
*allows loved ones to follow up w/ client!
