Chapter 7: Mental Health

Mental Status Examination

·      Appearance

·      Behavior

·      Speech

·      Mood & Affect (Refers to the state of mind, relative to how a person is feeling emotionally & the observable response to those feelings)

·      Thought process & content

·      Perception

·      Cognition

·      Insight & judgement

Common areas to evaluate

·      Depression

·      Anxiety (Individuals response to stress. Can range from no anxiety, severe anxiety and panic)

·      Suicidal Ideation

·      Substance Abuse/misuse

·      Psychotic Symptoms (hearing voices)

Risk Factors

-Depression

-Anxiety

Clinical manifestations

-Major depression

-Anxiety

-Obsessive-compulsive disorder (OCD)

Delusions (delirium)

-Disorder characterized by a disturbance in attention and awareness. Manifestations develop over a short period of time, represent an acute change from baseline attention and awareness, and tend to change in severity during the day.

-Assess type of delusion

-Assess for risk of harm to self or others

Dementia

-Neurocognitive disorder

-Characterized by failing memory, cognitive impairment, behavioral abnormalities, and personality changes. Commonly found in: Alzheimer’s disease, vascular disease, Parkinson’s disease, head injury and lou gehrig’s disease

Alzheimer’s Disease

• This is a cognitive disorder. The patient's mind and memory fail, but their physical body and muscles usually remain strong for a long time.

Lou Gehrig's Disease (ALS):

• This is a physical nerve disorder. The patient's muscles completely fail and paralyze them, but their mind and memory remain perfectly sharp.

Alzheimer’s disease vs Lou Gehrig’s disease

-Alzheimer’s disease destroys the mind

-Lou gehrig’s disease destroys the body

Memory recall: Immediate

-Ask the patient to repeat the names of three unrelated objects that are spoken slowly, such as “dog”, “cloud” and “apple”.

Memory recall: Recent

-Give the patient a short time to view four or five objects and explain that you will ask about these objects in a few minutes. After about 10 minutes, ask the patient to name the objects. All objects should be remembered.

Memory recall: Remote

-Ask the patient about his or her mother’s maiden name, high school attended, or a subject of common knowledge

Alcohol abuse

-CNS depressant

Major depression

-A persistently depressed mood lasting a minimum of 2 weeks

-Length of a depressive episode may be 5 to 6 months