Presentation on theme: "Mental Status Assessment"— Presentation transcript:
1 Mental Status Assessment By InnaKorda, MD,Institute of Nursing, TSMU
2 Mental HealthMental status definition: A person’s emotional and cognitive functionMental 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 knowif a person has amental disorder oris just having a crisisin his or her life?Can a mental disorderbe 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.
4 Assessing Mental Health AppearanceBehaviorCognitive functionThought process and perceptions
5 Assessing mental health AppearancePostureAnxiety – sitting on edge of bed, tense muscles, frowning, restless, pacing (Hyperthyroidism?)Depression – sitting slumped in a chair, slow walk, dragging feetBody movementsNormal – voluntary, deliberate, coordinated, smooth and evenAnxiety – restless, fidgetyDepression – apathy, slow movementsSchizophrenia – bizarre gestures, facial grimacesDressEccentric dress occurs with schizophrenia or manic syndromeHygieneNote change from previously well-groomed appearance to one that is disheveled - depressionObsessive compulsive disorder – meticulously dressed and groomed
6 Assessing Mental Health BehaviorConsciousness (LOC)Facial expressionLook is appropriate for the situationFlat, masklike expression in Parkinson’s and depressionLanguage – physical ability to speak, word choiceMood and affectMood – more temporary expression of emotionsAffect – more permanent display of feelings
7 Assessing Mental Health Cognitive FunctionOrientation – person, place, time (A&O x 3)Disorientation occurs with dementia, deliriumAttention – give orderly instructions and ask pt. to performMemory – short and long termAbstract reasoningProblem solving and reasoning abilitiesMust keep in mind patient’s education levelThought Processes and PerceptionsThought process – Logic. How a person thinks.Thought content – What a person thinks.PerceptionsHow do people treat you? What do people say when they talk about you?
8 Assessing Mental Health Suicide precautionsRisk factorsPrior suicide attemptsDepressionVerbal messages to kill selfDeath themes in talk, jokesGiving away possessionsAssessing“Have you ever thought about hurting yourself?”“Do you plan to hurt yourself now?”“Have you ever hurt yourself in the past?
11 LOC Abnormalities Alert – to person, place, and time GCS – Glasgow Coma ScaleCommon terms when assessing consciousnessAlert – to person, place, and timeLethargic – drifts off frequently. Must be aroused. Frequently effect of sedationObtunded – frequent sleep, difficult to arouse, incoherent speechStupor – responds only to vigorous shaking and pain, groans and mumblesComa – unconscious with little or no response to stimuli. Little or no reflex response.GCS 15 – normal personGCS <7 – coma
12 Speech DisordersDysphonia – difficulty or discomfort using voice to talkDysarthria – disorder of articulation in which the speech sounds are distorted.Aphasia – language defect in processingGlobal aphasia – little or no speech and comprehensionBroca’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 responseInappropriate affect – wrong emotion for the situationDepression – sadnessDepersonalization – loss of identity. “I don’t feel real”Elation – joy and optimism, overconfidenceEuphoria – inappropriate elationAnxiety – worried, uneasy, nervousFear – worried, uneasy, apprehensiveIrritability – annoyed, easily provokedRage – furious, loss of controlLability – rapid shift of emotions
14 Thought abnormalities ProcessConfabulation – make up eventsLoose associations – shifting between unrelated ideasFlight of ideas – unrelated ideas but connected usually by a play on wordsWord salad – incoherent mixture of wordsContentPhobia – irrational fear of an objectHypochondrias – phobia of having diseases.Obsession – unwanted and persistent thoughtsCompulsion – 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 attentionCognition changeDevelops over a short period of time (hours to days)DementiaMemory impairmentOne or more of the following:Aphasia – language disturbanceApraxia – impaired ability to carry out motor activities despite intact motor functionAgnosia – impaired ability to recognize or identify objects despite intact sensory functionExecutive functioning disturbance – planning, organizing, sequencing, abstractingAlzheimer’s, Parkinson’s, HIV, cerebrovascular diseaseAmnesiaMemory impairment without other disordersMay be caused by trauma or substance induced
17 Substance Use Disorders Substance: agents taken nonmedically to alter mood or behaviorIntoxication – ingestion of substance produces maladaptive behavior changes due to effects on CNSAbuse – Daily use needed to function. Inability to stop. Impaired social and occupational functioningDependence – physiologic dependence on substanceTolerance – requires increased amount of substance to produce same effectWithdrawal – cessation of substance produces physiologic symptoms
18 Effects of Common Substances Alcohol, sedatives, and hypnotics (CNS depressants)Symptoms – unsteady gait, incoordination, impaired judgementWithdrawal – tremor of hands, eyelids. Tachycardia, elevated BP, sweating, headache, insomnia, anxiety, N&V, hallucinations, delusionsNicotine (mild stimulant)Symptoms – increased systolic BP, increase HR, vasoconstriction, loss of appetite, dizzinessWithdrawal – vasodilation, headaches, irritability, anxiety, nervousnessMarijuanaSymptoms – reddened conjunctivae, tachycardia, dry mouth, increased appetite, euphoria, anxiety, slowed time perceptionWithdrawal – ? 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, aggressivenessWithdrawal – Anxiety, depression, irritability, fatigueOpiates (morphine, heroin)Symptoms – pinpoint pupils, decreased BP, pulse, respirations, and temperature, lethargy, psychomotor retardation, inattention, impaired memoryWithdrawal – 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 minutesSymptomsPalpitations, sweating, trembling, SOB, feeling of choking, chest pain, nausea, dizzinessAgoraphobiaAnxiety about being in a place or situation where escape might be difficult or where help might not be availableBeing outside of home, in a crowd, on a bridge, in a car, bus, or trainSpecific phobiasPhobias of specific objects provokes an anxiety responseOCD (Obsessive-Compulsive)PSD (Posttraumatic Stress Disorder)Experience or witness of actual or threatened death or serious injury of self or othersRecurrent recollections of event followed by distressGeneralized Anxiety DisorderPersistent general anxiety
21 Isn’t everyone suffering Mood DisordersManiaPersistently elevated or irritable mood lasting 1 week or more with:GrandiosityDecreased sleepTalkativenessFlight of ideasDistractibilityAgitationPleasurable activitiesDepression5 or more present during the same 2 week periodDepressed moodDiminished interestWeight lossInsomniaPsychomotor agitationFatigueFeelings of worthlessnessDiminished ability to thinkThoughts of deathIsn’t everyone sufferingfrom a mental disorder???