week 3

Question 1

what is a comprehensive assessment?

Answer 1

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.

Question 2

what is a mental status exam (MSE)?

Answer 2

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

Question 3

what are the components of a MSE?

Answer 3

• General observations (appearance, behaviour, etc.)
• Speech characteristics
• Mood & Affect
• Thoughts
• Content & process
• Perception
• Sensorium/cognition
• Insight
• Judgment

Question 4

what is pressured speech?

Answer 4

rapid speech w/ lots of words & hard to interpret; commonly seen in MANIA (form of bipolar disorder)

Question 5

what is mood?

Answer 5

subjective emotion experienced by pt. *self-reported by pt. themselves

Question 6

what is affect?

Answer 6

objective assessment; the facial expression of an emotion

Question 7

what does labile mean?

Answer 7

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

Question 8

what is thought content?

Answer 8

the content of your thoughts; what you’re talking about

Question 9

what is thought process?

Answer 9

how your thoughts are formed & expressed

Question 10

what does homicidal ideation mean?

Answer 10

thoughts of harming someone *inquire about a plan/intent (probe for more details)

Question 11

what does delusion mean?

Answer 11

the belief of false/unreal thoughts

Question 12

list the types of delusions.

Answer 12

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

Question 13

what is poverty of thought?

Answer 13

mental stateof having lack ofthoughts& havingfeelingsofemptiness

*pt. is slow to respond

Question 14

what is an obsession?

Answer 14

a repetitive thought, emotion, or impulse

Question 15

what is depersonalization?

Answer 15

belief that self or body is strange/unreal *feels disconnected from self

Question 16

what does “flight of ideas” mean?

Answer 16

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

Question 17

what does “preservation “ mean?

Answer 17

a persistent response

Question 18

what does “echolalia” mean?

Answer 18

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?”

Question 19

what does “clang association” mean?

Answer 19

rhyming

ex: “my feet are cold; cold, bold, told. the bell tolled for me.”

Question 20

what does “thought blocking” mean?

Answer 20

loses train of thought

Question 21

what does “loose associations” mean?

Answer 21

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.”

Question 22

what does “word salad” mean?

Answer 22

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.”

Question 23

what does “neologism” mean?

Answer 23

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!“

Question 24

what does “circumstantiality” mean?

Answer 24

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

Question 25

what does “tangentiality” mean?

Answer 25

frequent digression; digress too much & never answers questions

Question 26

what are hallucinations?

Answer 26

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)

Question 27

what are illusions?

Answer 27

misinterpreting a sensory input

ex: looking at a hotdog, mistaken for a snake

Question 28

concrete vs. abstract thinking

Answer 28

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

Question 29

What are some challenges you could experience when performing a MSE? How you could address these challenges?

Answer 29

• Age; working w/ child speak w/in developmental level (usually done with parents depending on age)
• Culture
• Illness

Question 30

If someone is psychotic, which components of an MSE would suggest this?

Answer 30

Thought processes, behaviour, & speech

Question 31

what is the purpose of documenting?

Answer 31

the assessment data is used to plan care [in collaboration] w/ client & the health care team.

Question 32

what is the Manitoba Mental Health Act (MMHA)?

Answer 32

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

Question 33

explain FORM 1.

Answer 33

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

Question 34

explain FORM 2.

Answer 34

judge grants order for involuntary medical exam

Question 35

explain FORM 3.

Answer 35

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

Question 36

explain FORM 4.

Answer 36

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

Question 37

explain FORM 6.

Answer 37

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)

Question 38

explain FORM 9.

Answer 38

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!

Question 39

what do you need to be able to administer medication against pts. wishes?

Answer 39

form 9 + consent from SDM + physician’s order for medication

exception: CAN give meds w/o consent in the case of an emergency

Question 40

explain FORM 13.

Answer 40

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

Question 41

explain FORM 14.

Answer 41

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

Question 42

explain FORM 15.

Answer 42

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)

Question 43

explain FORM 18.

Answer 43

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)

Question 44

what does “not criminally responsible” mean?

Answer 44

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

Question 45

what is bill 5 (amendment to the MMHA)

Answer 45

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!