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

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Presentation on theme: "Mental Status Assessment By InnaKorda, MD, Institute of Nursing, TSMU."— Presentation transcript:

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

2 Mental Health Mental status definition: A person’s emotional and cognitive function How do you know if a person has a mental disorder or is just having a crisis in his or her life? 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) Can a mental disorder be assessed? How? 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. You don’t know, that’s why we assess mental health.

3 Theoretical vs. Practical

4 Assessing Mental Health 1. Appearance 2. Behavior 3. Cognitive function 4. 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

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11 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

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 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 Delirium, Dementia, and Amnesia

17 Substance Use Disorders 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 Substance: agents taken nonmedically to alter mood or behavior

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 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 Mood Disorders 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 Mania Persistently elevated or irritable mood lasting 1 week or more with: Grandiosity Decreased sleep Talkativeness Flight of ideas Distractibility Agitation Pleasurable activities Isn’t everyone suffering from a mental disorder???


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