1. Mental Status Assessment
By InnaKorda, MD,
Institute of Nursing, TSMU

2. Mental Health
Mental status definition: A person’s emotional and cognitive function
Mental disorder definition: “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” (APA, 1994)
How do you know
if a person has a
mental disorder or
is just having a crisis
in his or her life?
Can a mental disorder
be assessed? How?
You don’t know, that’s why we assess mental health.
You must believe what your pt. tells you, must take them seriously if they say they want to kill themselves.
Suicide precautions may be implemented by having a sitter or restraints.

3. Theoretical vs. Practical

4. Assessing Mental Health
Appearance
Behavior
Cognitive function
Thought process and perceptions

5. 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

6. 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

7. Assessing Mental Health
Cognitive Function
Orientation – person, place, time (A&O x 3)
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?

8. 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?

9. Mini-Mental State Examination

11. LOC Abnormalities Alert – to person, place, and time
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

12. 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.

13. 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

14. Thought abnormalities
Process
Confabulation – make up events
Loose associations – shifting between unrelated ideas
Flight of ideas – unrelated ideas but connected usually by a play on words
Word salad – incoherent mixture of words
Content
Phobia – irrational fear of an object
Hypochondrias – phobia of having diseases.
Obsession – unwanted and persistent thoughts
Compulsion – unwanted and persistent actions.
Delusions – False beliefs, often of persecution or grandiose

15. 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

16. Delirium, Dementia, and Amnesia
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

17. 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

18. 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

19. 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

20. Anxiety Disorders Panic attack Agoraphobia Specific phobias
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

21. Isn’t everyone suffering
Mood Disorders
Mania
Persistently elevated or irritable mood lasting 1 week or more with:
Grandiosity
Decreased sleep
Talkativeness
Flight of ideas
Distractibility
Agitation
Pleasurable activities
Depression
5 or more present during the same 2 week period
Depressed mood
Diminished interest
Weight loss
Insomnia
Psychomotor agitation
Fatigue
Feelings of worthlessness
Diminished ability to think
Thoughts of death
Isn’t everyone suffering
from a mental disorder???