Mental Status Examination, BNKN601 major collated exam

What is a Mental Status Examination?

an evaluation of your pt's current state of cognitive and emotional functionality.

What are the Purpose of MSE?

- provides an overview of the individuals functioning

- monitor changes over time

- Helps w/ diagnosis

- Helps w/ treatment

- Support multidisciplinary team

What are the components of the MSE?

■ Appearance

■ Behavior

■ Speech

■ Mood/Affect

■ Thought Process ■ Thought Content ■ Perceptual Disturbances

■ Cognition

■ Insight

■ Judgment/Impulse Control

What should we be looking for in Appearance ?

- Gender

- Sex

- Top-down analysis of appearance from head to toe

- anything odd?

What should we be looking for in Behavior & psychomotor activity ?

- Attitude of Pt

(cooperative, seductive, flattering, charming, eager to please, entitled, controlling, uncooperative, hostile, guarded, critical, antagonistic, childish)

- Eye contact

- activity level

- tics

- tremors

What should we be looking for in Speech ?

- Rate (pressured/slowed/ regular)

- articulation (dysarthria/ stuttering)

- accent/dialect

- volume (loudness or softness)

- Tone

What should we be looking for in Mood?

- Mood is the emotion that the patient tells you he feels, often in quotations.

What should we be looking for in Affect ?

an assessment of how the patient's mood appears to the examiner

- type of affect: Euthymic, euphoric, neutral, dysphoric

- how quick pt change states: sluggish—supple—labile.

- Quality : Flat, blunted, contricted, full, intense

- is the affect and mood congruent or not ?

What should we be looking for in Thought Process ?

The patient’s form of thinking—how he or she uses language and puts ideas together.

- Logical, coherent

- Circumstantiality

- Tangentiality

- Loosening of associations

- Flight of ideas

- Neologisms

- Word salad: Incoherent collection of words

- Clang associations

- Thought blocking

- Echolalia

What should we be looking for in Thought Content ?

- Poverty of Thought / Overabundance

- Delusions

- Suicidal Ideation

- Homocidal ideation

- Phobias

- Obsessions

- Compulsions

What should we be looking for in Perceptions?

- Hallucinations : ask all 5 senses

- Illusions

What should we be looking for in Cognition ?

- Orientation: To person, place, and time

- Memory : STM & LTM

- Attention/

Concentration: Ability to subtract serial 7s from 100 or to spell "world" backwards

- Abstract reasoning

What should we be looking for in Insight ?

- Patient's capacity to Acknowledge/Appreciate illness, Associated, implications

Consequences

What should we be looking for in Judgement ?

The patient's capacity to make appropriate decisions and appropriately act on them in social situations.

What is avolition?

lack of motivation

what is affective flattening

little expressed emotion

what can depression onset from

family history

personality

medical illness

drug and alcohol use

how do antidepressants work

Antidepressants work by balancing chemicals in your brain called neurotransmitters that affect mood and emotions. these include seritonin, dopamine and noradrenaline

what is diabetes

a lack of insulin causing glucose being unable to leave the body

Type one diabetes

Diabetes which is caused when the pancreas cannot make insulin.

risk factors for type one diabetes

age

family history

risk factors for type 2 diabetes

Obesity

Sedentary lifestyle and inactivity

Family history

Race (African American and Hispanic)

Age

History of gestational diabetes

PCOS

Hypertension

Hypercholesterolemia/Hyperlipidemia

symptoms of type one diabetes

high blood glucose

weight loss

glycosuria

polyuria

polydipsia

polyphagia

glycosuria definition

glucose in the urine due to kidneys not being able to stop it

Polyuria definition

excessive urination

Polydipsia definition

excessive thirst

Polyphagia definition

excessive hunger

Symptoms of hyperglycemia include

dry mouth, intense thirst, muscle weakness, and blurred vision

What is diabetic ketoacidosis?

A condition that occurs as the result of high blood sugar and insulin deficiency that is characterised by dehydration, altered mental status and shock

common signs and symptoms of psychosis

hallucinations.

delusions.

disorganized behavior

negative symptoms

common signs and symptoms of drug abuse

Feeling of exhilaration and excess confidence.

Increased alertness.

Increased energy and restlessness.

Behavior changes or aggression.

Rapid or rambling speech.

Dilated pupils.

Confusion, delusions and hallucinations.

Irritability, anxiety or paranoia.

common signs and symptoms of alcohol abuse

Frequently drinking a larger amount of alcohol or for longer than intended.

Wanting to cut down or control drinking but not being able to stop.

Spending a lot of time drinking and feeling sick from alcohol's aftereffects.

Experiencing strong cravings or urges to drink.

common signs and symptoms of alcohol withdrawl

Headache

Tremour

sweating

agitation

nausea

irritablity

common signs and symptoms of eating disorder

Alterations in Weight. ...

Preoccupation With Body Image. ...

Disruptions in Eating Patterns. ...

Preoccupation With Nutritional Content. ...

Changes in Exercise Patterns. ...

Mood Fluctuations.

Considerations of olanzapine

Some side effects include: weight gain, increased appetite, dry mouth, constipation, peripheral oedema, hypotension, sedation. Can pass into breast milk. Tell your doctor if you notice severe drowsiness, irritability, feeding problems, tremors, or unusual muscle movements in the nursing baby. should not consume alcohol. do not stop abruptly.

Considerations of risperidone

Monitor patient regularly for signs and symptoms of diabetes mellitus. increase the risk of diabetes, weight gain, high cholesterol, and high triglycerides. side effects include:

nausea.

vomiting.

diarrhea.

constipation.

heartburn.

dry mouth.

increased saliva.

increased appetite.

Side effects of mood stabilising medications

- Drowsiness- Metallic taste in mouth- Difficulty concentrating- Increased thirst- Dizziness- Headache- Dry mouth- GI upset- Nausea & vomiting- Fine hand tremor- Hypotension- Arrhythmias- Dehydration- Weight gain

Doffing order

gloves, gown, goggles, mask

Donning order

gown, mask, goggles, gloves

What is schitzophrenia

Schizophrenia is a disorder characterised by a major disturbance in thought, perception, cognition, and psychosocial functioning and is one of the most severe mental disorders. Research suggests a combination of physical, genetic, psychological and environmental factors can make a person more likely to develop the condition. it is a change in the level of 2 neurotransmitters: dopamine and serotonin

Anergia

lack of energy

Alogia

poverty of speech

what are the four drug groups

depressants

stimulants

canabis

hallucinogens

what are the 4 medication categories

anti-psychotic

anti-depressant

anti-anxiety

mood stabilizer

what kind of factors can influence development of addiction

genetic

social

psychological

cultural

personality

physiological

4 Ls that are effected by addiction

liver

lover

livelihood

law

Drug use continuum

nonuse, hazardous use, problem use, addiction

What is a brief intervention?

any interaction with patient that is trying to promote changes to risky behaviour.

what is Motivational Interviewing

a collaborative conversation style for strengthening a person's own motivation and commitment to change

what types of questions come under motivational interviewing

"Ultimately, it is your decision. So, what would you like to try?"

"How important is this to you?"

"That's a good point"

"What is it about your________ that others may see as reasons for concern?"

"If things worked out exactly as you like, what would be different?"

two (2) strategies a nurse could apply when working with people at each of the following stages of change:

(a) Contemplation

(b) Action

Stages of Change and the Professional's Motivational Interviewing Tasks handout

what is the anxiety cycle

thoughts, emotion, bodily sensation, action

managing anxiety

Acute management

Cognitive Behavioural Therapy

Problem solving

Behavioural therapy

Pharmacology

Counselling

Relaxation therapy

six step method to problem solving

Step 1. Identifying the problem

Step 2. Generating solutions through brainstorming

Step 3. Evaluating the solutions

Step 4. Choosing the optimal solution

Step 5. Planning

Step 6. Reviewing

Sections of MHA

Section 8 a and b =Application for assessment/Medical certificate

Sections 9 = Notice to attend an examination

Section 10 =Cert of prelim assessment

Section 11/12 = Assessment for up to 5 days

Section 13 = Further assessment for 14 days

Section 14 = Cert of final assessment

Section 15 = Further assessment for 14 days

Section 16 = Review of condition by Judge

(MHA, 1992)

what are reasons you cannot be placed under MHA

Political, religious or cultural beliefs or sexual preferences

Criminal or delinquent behaviour

Substance abuse

Intellectual Disability

impact of self discrimination

Discrimination of Families/ Whanau

Often Blamed for illness

Lack of tolerance and understanding

Guilt and Shame

Frustration

That they can't "fix it"

That services can't "fix it"

Exclusion of family/ whanau

impact of discrimination with families

Lack of education = Inaccuracy in knowledge = possibility of unhelpful/ abusive responses

Feeling responsible, ashamed of the reputation = less likely to ask for help

More likely to wait to long before accessing services

Feeling helpless to fix their loved one and frustrated that MH services can't either

impact of discrimination on community

Social avoidance and exclusion

Lack of tolerance and knowledge from public services (school, church, general hospitals, police)

Reputations being inherited.

Migrant populations

impact of discrimination on mental health services

Not being involved in clinical decisions

Lack of consultation

Exclusive treatment of individuals

Assumption of ignorance

Blamed for problem - Child and adolescent

ways to use language to reduce stigma

-avoid referring to people as their illness

-avoid extending the nature of the person's illness with terms such as chronic, persistent or severely

-avoid emotionally negative terms such as victim or suffering from emphasise abilities not limitations

-avoid offensive expressions such as psycho or crazy

-avoid metaphoric references to illnesses, such as schizophrenic situation

-refer to people as contributing community members, rather than as a burden or a problem.

principles of recovery

hope

journey

supportive

redifining who they are

active and ongoing

learn

educating themselves

manage stigma

what is trauma

the lasting adverse effects on a person's or collective's functioning and mental, physical, social, emotional or spiritual wellbeing, caused by events, circumstances or intergenerational historical traumatic experiences

trauma informed care.....

-Acknowledges the role that violence plays in the lives of people seeking mental health and addictions services

-Addressing the impact that traumatic events have had on peoples lives and relationships

-Recognising adaptive functions of "symptoms"

-Not based in medical models (e.g. diagnosis)

-Promotion of empowerment and 'self'

what is recovery

Recovery is when people can live well in the presence or absence of their mental illness

what does recovery not mean

- that the person will no longer experience symptoms

- that the person will no longer struggle

- that the person will not utilize mental health services

- that the person will not use medications

- that the person is completely independant

What is a personality disorder?

Should a person develop inflexible, maladaptive behaviours; e.g., manipulation, hostility, lying, poor judgment, and alienation that interfere with social or occupational functioning, the person exhibits signs and symptoms of personality disorder.

main influencing factors of personality disorders

- poor parenting

- rejection

- lack of love

- abuse

- family history

- PTSD

- genetic

what are the three cluster groups of personality disorder

a. odd or eccentric

b. dramatic, erratic or emotional

c. anxious or fearful

odd or eccentric personality disorders

Paranoid Personality Disorder

Schizoid Personality Disorder

Schizotypal Personality Disorder

dramatic, erratic or emotional personality disorders

antisocial personality disorder

Borderline Personality Disorder

Histrionic Personality Disorder

Narcissistic Personality Disorder

anxious or fearful personality disorder

Avoidant Personality Disorder

Dependant Personality Disorder

Obsessive-Compulsive Personality Disorder

Personality change due to another medical condition

nursing interventions for someone with personality disorder

- medication

- treatments (psychotherapy)

- group therapy

- counselling

- cognitive behaviour therapy

- therapeutic communities

- manage self harm

- communication

Syptoms of Hypoglycemia

Sweating, Hunger, Mental Confusion, Muscle Spasms, Coma, Convulsions and Death.

How is hypoglycemia treated?

If awake and able to follow commands: give orange juice or a packet of sugar followed by a more complex carbohydrate.

How is hyperglycemia treated?

insulin

What is borderline personality disorder?

A pervasive pattern of instability of personal relationships, self image and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts

assumptions made about borderline personality disorder

- its permanents

- always caused by abuse

- medications will not help

- they are manipulative

prenatal mental health

post partum depression

psychosis

bipolar

child Mental Health

anxiety

autism

depression

eating disorders

suicide

adolescent mental health

Depression

Anxiety

Eating disorders

Psychosis (Prodromal psychosis)

Alcohol and other drug abuse

Autistic spectrum

Adult mental health

Anxiety disorders

Mood disorders - depression and bipolar

Psychotic disorders

Personality disorders

Substance use disorders

older persons mental health

Depression

Delirium

Dementia

what is infant mental health

how well a child develops socially and emotionally from birth to three. Understanding infant mental health is the key to preventing and treating the mental health problems of very young children

Clozapine

atypical antipsychotic used to treat schizophrenia. Is a last resort medication. side effects are agranulocytosis, neutropenia, constipation (which can be severe), myocarditis and adverse metabolic effects, drowsiness, blurred vision, convulsions (seizures), or to have trouble with thinking or controlling body movements, which may lead to falls, fractures or other injuries. Must monitor closely as patients state can change rapidly.

Constipation.... assess for.... advise to

regular bowel movements

diet

exercise

other medication

drink water

go for walk

increase fibre

use laxatives (eg laxol)

barriers to recovery

- length of custodial sentence

- remanded to hospital from courts/ prison

- unresolved legal issues

- index or alleged offence

- hopelessness

- self stigma + stigma of being an offender

- isolation

- trauma

- medication non adherance

- cramped crowded conditions

What is a custodial sentence between prison and hospital?

A custodial sentence is a judicial sentence, imposing a punishment consisting of mandatory custody of the convict, either in prison or in some other closed therapeutic or educational institution

3 types of security in forensic mental health

environmental

procedural

relational

environmental security

This is how security is applied to the environment and the building

It includes:

The types of doors and locks, security cameras, fences and walls etc

procedural security

This is how policies, protocols and general conduct takes place.

It includes:

Counting cutlery before and after meals, completing searches when new patients or personal belongings arrive, contraband etc

Relational Security

Relational security is about your relationship with the patients

The 11 most important factors for recovery from mental illness:

1. Doing something worthwhile

2. Being involved in things not related to their own problems

3. Having ordinary discussions with others

4. Being included in and connected to communities

5. Being included in ordinary work roles and settings

6. Regaining belief in self

7. Recognising losses of rights, roles, responsibilities, decisions, potential, and support, then finding out what the person wants and how to achieve it

8. Making meaning out of ones experiences

9. Recognising that ones recovery is not the same as being cured, as it is a process with no end point

10. Being aware that recovery is an attitude, a way of approaching day-to-day challenges and being in control

10.

Order of donning PPE

1. Hand hygiene

2. Gown

3. Mask

4. Face shield/goggles

5. Hand hygiene

6. Gloves

Order of doffing PPE

1. Gloves

2. Hand hygiene

3. Face shield/goggles

4. Hand hygiene

5. Gown

6. Hand hygiene

7. Mask

8. MORE hand hygiene

Stable risk factors associated with suicide risk:

Age

Gender

Marital status

History

Family hx of suicide

Childhood adversity

Employment difficulties

Dynamic risk factors associated with suicide risk:

Mental state

Isolation

Recent loss

Recent experience of suicide with family/ friend

Adversity or stress

Access to means

Unauthorised leave or failure to return from leave

Protective risk factors associated with suicide risk:

Help seeking behaviours

Strong and dependable social supports

Positive engagement with services

Stable employment and accommodation

Prolonged abstinence from substances

7 areas that need to be considered in relation to clinical scenarios and applying ethical reasoning:

1. Rights - e.g The right to healthcare, and rights to privacy and confidentiality

2. Autonomy - Promotes the right of the client to make their own decisions and implies the client will take responsibility of decisions made

3. Beneficence and Non-Maleficence: Doing good and the duty to do no harm.

4. Justice: Refers to fairness

5. Fidelity: Means to be faithful to agreements and responsibilities one has undertaken.

6. Veracity: Refers to telling the truth.

7. Trust and Reciprocity: Trust that colleagues will act in ways that are mutually supportive and do no harm to each other.

Meaning of Section 30 MHA92

In-patient treatment order: Directs patients to reside in the hospital. The patient cannot leave, this is an involuntary status.