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Mental Status

Assessment
What is Mental Status ?
A person’s emotional and cognitive
functioning.

 Mental disorder “A significant


behavioral or psychological pattern
associated with distress or disability and has
a significant risk of pain, disability, or death,
or a loss of freedom”.
Assessment of an individual’s
behaviors:
 Consciousness- being aware of one’s own feelings and
thoughts.
 Language- the humanness of a person depends on his
ability to communicate.
 Mood and Affect- expressions of feelings or state of
mind.
 Orientation- awareness in relation to self.
 Attention- ability to focus; power of concentration.
•Abstract reasoning- ability to analyze the things
that observed.
•Thought process- the way a person thinks.

•Thought content- what the person thinks.

•Perceptions- awareness of objects through five


senses.
•Memory- ability to lay down and store
experiences.
Components of Mental Status
Examination.
A-appearance
B-behavior
C-cognitive function
T-thought process and perceptions
Assessing mental health
 Appearance
 Posture
 Anxiety – sitting on edge of bed, tense muscles, frowning,
restless, pacing (Hyperthyroidism?)
 Depression – sitting slumped in a chair, slow walk, dragging
feet
 Body movements
 Normal – voluntary, deliberate, coordinated, smooth and even
 Anxiety – restless, fidgety
 Depression – apathy, slow movements
 Schizophrenia – bizarre gestures, facial grimaces
 Dress
 Eccentric dress occurs with schizophrenia or manic syndrome
 Hygiene
 Note change from previously well-groomed appearance to one
that is disheveled - depression
 Obsessive compulsive disorder – meticulously dressed and
groomed
Assessing Mental Health
 Behavior
 Consciousness (LOC)
 Facial expression
 Look is appropriate for the situation

 Flat, masklike expression in Parkinson’s and


depression
 Language – physical ability to speak, word choice
 Mood and affect
 Mood – more temporary expression of emotions

 Affect – more permanent display of feelings


Assessing Mental Health
 Cognitive Function
 Orientation – person, place, time
 Disorientation occurs with dementia, delirium
 Attention – give orderly instructions and ask pt. to perform
 Memory – short and long term
 Abstract reasoning
 Problem solving and reasoning abilities
 Must keep in mind patient’s education level
 Thought Processes and Perceptions
 Thought process – Logic. How a person thinks.
 Thought content – What a person thinks.
 Perceptions
 How do people treat you? What do people say when they talk about
you?
Assessing Mental Health
 Suicide precautions
 Risk factors
 Prior suicide attempts
 Depression
 Verbal messages to kill self
 Death themes in talk, jokes
 Giving away possessions
 Assessing
 “Have you ever thought about hurting yourself?”
 “Do you plan to hurt yourself now?”
 “Have you ever hurt yourself in the past?
Mini-Mental State Examination
Assessing Mental Status of the
Aging Adult
 1. Conduct brief exam of older people admitted to the
hospital.
 2. Check physiologic status before assessing any aspect
of mental status
 3. Assessing behavior
LOC- The Glasgow Coma Scale is used for aging
persons in the hospital
 4. Cognitive Functions
Orientations- assess if pt. knows where he/she is; and
the present period.
5. Use set test as supplemental mental status exam for
people 65-85 years old.
a. Ask to name 10 items each categories of sets:
 Fruits
 Animals
 Colors
 Towns
b. Do not hurry or prompt a person
 Maximum total is 40
 A score >25 means a person has no dementia
 Score <15 indicate dementia
 Scores between 15 and 24 show less association
c. Do not use set test for patients with hearing impairment.
Documentation of MSA
 Appearance- Person’s posture is erect; dress and
grooming are appropriate for age.
 Behavior- Person is alert, w/ appropriate facial
expression and understandable speech.
 Cognitive Functions-Oriented to time, person, place.
Recent and remote memory intact; can recall 4 unrelated
words at 5-10 and 30 minutes intervals.
 Thought processes- perceptions and processes are
logical and coherent.
LOC Abnormalities
 GCS – Glasgow Coma Scale
 Common terms when assessing
consciousness
 Alert – to person, place, and time
 Lethargic – drifts off frequently. Must
be aroused. Frequently effect of
sedation
 Obtunded – frequent sleep, difficult to
arouse, incoherent speech
 Stupor – responds only to vigorous
shaking and pain, groans and
mumbles
 Coma – unconscious with little or no
response to stimuli. Little or no reflex
response.
GCS 15 – normal person
GCS <7 – coma
Speech Disorders
 Dysphonia – difficulty or discomfort using
voice to talk
 Dysarthria – disorder of articulation in
which the speech sounds are distorted.
 Aphasia – language defect in
processing
 Global aphasia – little or no speech and
comprehension
 Broca’s aphasia – can understand
language, but difficulty speaking. Grammar
problems.
 Wernicke’s aphasia – problem
comprehending words. Can still articulate
well.
Mood and Affect Abnormalities
 Flat affect – no emotional response
 Inappropriate affect – wrong emotion for the situation
 Depression – sadness
 Depersonalization – loss of identity. “I don’t feel real”
 Elation – joy and optimism, overconfidence
 Euphoria – inappropriate elation
 Anxiety – worried, uneasy, nervous
 Fear – worried, uneasy, apprehensive
 Irritability – annoyed, easily provoked
 Rage – furious, loss of control
 Lability – rapid shift of emotions
Thought abnormalities

Process Content
 Confabulation – make up  Phobia – irrational fear of
events an object
 Loose associations –  Hypochondrias – phobia of
shifting between unrelated having diseases.
ideas  Obsession – unwanted and
persistent thoughts
 Flight of ideas – unrelated
ideas but connected usually  Compulsion – unwanted
and persistent actions.
by a play on words
 Delusions – False beliefs,
 Word salad – incoherent often of persecution or
mixture of words grandiose
Abnormalities of Perception
 Hallucination – Sensory perception for which
there are no external stimuli. May be visual,
auditory, tactile, olfactory, gustatory.
 Delusion – Misperception of an actual
existing stimulus, by any sense.

Schizophrenia
Delirium, Dementia, and Amnesia
 Delirium
 Consciousness change – reduced awareness of environment with
reduced ability to focus, sustain, or shift attention
 Cognition change
 Develops over a short period of time (hours to days)
 Dementia
 Memory impairment
 One or more of the following:
 Aphasia – language disturbance
 Apraxia – impaired ability to carry out motor activities despite intact motor
function
 Agnosia – impaired ability to recognize or identify objects despite intact
sensory function
 Executive functioning disturbance – planning, organizing, sequencing,
abstracting
 Alzheimer’s, Parkinson’s, HIV, cerebrovascular disease
 Amnesia
 Memory impairment without other disorders
 May be caused by trauma or substance induced
Substance Use Disorders
Substance: agents taken nonmedically to alter
mood or behavior
 Intoxication – ingestion of substance produces
maladaptive behavior changes due to effects on
CNS
 Abuse – Daily use needed to function. Inability to
stop. Impaired social and occupational functioning
 Dependence – physiologic dependence on
substance
 Tolerance – requires increased amount of
substance to produce same effect
 Withdrawal – cessation of substance produces
physiologic symptoms
Effects of Common
Substances
 Alcohol, sedatives, and hypnotics (CNS depressants)
 Symptoms – unsteady gait, incoordination, impaired judgement
 Withdrawal – tremor of hands, eyelids. Tachycardia, elevated BP,
sweating, headache, insomnia, anxiety, N&V, hallucinations,
delusions
 Nicotine (mild stimulant)
 Symptoms – increased systolic BP, increase HR,
vasoconstriction, loss of appetite, dizziness
 Withdrawal – vasodilation, headaches, irritability, anxiety,
nervousness
 Marijuana
 Symptoms – reddened conjunctivae, tachycardia, dry mouth,
increased appetite, euphoria, anxiety, slowed time perception
 Withdrawal – ? restlessness, decreased appetite
Effects of Common
Substances
 Cocaine and Amphetamines (psychostimulants)
 Symptoms – Pupillary dilation, tachycardia or bradycardia,
elevated or decreased BP, N&V, weight loss, euphoria,
agitation, aggressiveness
 Withdrawal – Anxiety, depression, irritability, fatigue
 Opiates (morphine, heroin)
 Symptoms – pinpoint pupils, decreased BP, pulse,
respirations, and temperature, lethargy, psychomotor
retardation, inattention, impaired memory
 Withdrawal – Dilated pupils, lacrimation, tachycardia,
elevated BP, sweating, diarrhea, irritability, depression
Anxiety Disorders
 Panic attack
 Intense fear or discomfort develops within 10 minutes
 Symptoms
 Palpitations, sweating, trembling, SOB, feeling of choking, chest pain, nausea,
dizziness
 Agoraphobia
 Anxiety about being in a place or situation where escape might be difficult
or where help might not be available
 Being outside of home, in a crowd, on a bridge, in a car, bus, or train
 Specific phobias
 Phobias of specific objects provokes an anxiety response
 OCD (Obsessive-Compulsive)
 PSD (Posttraumatic Stress Disorder)
 Experience or witness of actual or threatened death or serious injury of
self or others
 Recurrent recollections of event followed by distress
 Generalized Anxiety Disorder
 Persistent general anxiety
Mood Disorders
Depression Mania
 5 or more present during  Persistently elevated or

the same 2 week period irritable mood lasting 1


 Depressed mood week or more with:
 Diminished interest  Grandiosity
 Weight loss  Decreased sleep
 Insomnia  Talkativeness
 Psychomotor agitation  Flight of ideas
 Fatigue  Distractibility
 Feelings of worthlessness  Agitation
 Diminished ability to think  Pleasurable activities
 Thoughts of death