mental status exam

assessment

Referred to as psychosocial assessment in psychiatric mental health nursing

assessment

Construct a picture of the client’s current emotional state, mental capacity, and behavioral function

Client participation and feedback

Client’s health status

Client’s previous experiences/misconceptions about healthcare

The client’s ability to understand

Nurse’s attitude and approach

factors influencing assessment

Comfortable, private, and safe for client and nurse

Fairly quiet with few distractions

Isolated location

environment when conducting assessment

warm - up

establish rapport

prepare the patient for the main task

opening phase (3)

Screening of the problems: chief complaints, symptoms, severity, course, stressors

Follow–up of preliminary impressions

History: longitudinal course, premorbid personality and social history, family history, medical history

middle phase (3)

prepare the patient for closure:

• Feedback

• Treatment contract

end phase

rapport

how the interviewer and the patient relate

continuation

general lead

echoing

reflecting

curbing

refocusing

dealing with resistance

revealing some and concealing embarrassing items

acceptance

expression of understanding

confrontation

focus the patient’s attention on the resistance

looping

approach the problem from a different angle

exaggeration

decrease patient’s concern by putting it into perspective

induction to bragging

patient making good impressions

defense

totally denying the embarrassing items even to himself

mental status exam

Cornerstone in the evaluation of any patients with a medical, neurological, or psychiatric disorder that affects thought, emotion, or behavior

mental status exam

Used to detect changes or abnormalities in a person’s intellectual functioning, thought content, judgment, mood, and affect and can be used to identify possible lesions in the brain

mental status exam

Represents a cross-section of the patient’s psychological life and the total of the nurse's observations and impressions at the moment

mental status exam

involves observing the patient’s behavior and describing it in an objective, nonjudgmental manner

mental status exam

Basis for future comparison to facilitate tracking of the patient’s progress over time

mental status exam

AN EVALUATION OF THE PATIENT’S CURRENT STATE

general description

Appearance, Speech, Motor Activity, and Interaction during an interview

emotional state

Mood and Affect

thinking

Thought content and Thought process

experiences

Perceptions

sensorium and cognition

Level of consciousness, Memory, Level of concentration and calculation, Information and intelligence, Judgment, Insight

Apparent age

Manner of dress

Cleanliness

Posture

Gait

Facial expressions

Eye contact

Pupil dilation or constriction

The general state of health and nutrition

what to look for in appearance

rate

amount

volume

characteristics

aspects of speech

pressured speech

manic often show what kind of speech

level of activity

type of activity

unusual gestures or mannerism

aspects of motor activity

excessive body movement

type of body movement that may be associated with anxiety, mania, stimulant abuse

little body movement

type of body movement may suggest depression, organicity, catatonic schizophrenia, or drug-induced stupor

Repeated motor movements or compulsions

may indicate OCD

compulsions may indicate OCD-Repeated picking of lint or dirt off clothing

sometimes associated with delirium or toxic conditions

mood

self-report of the prevailing emotional state and reflects the patient’s life situation

ask simple, non-leading questions and rate pt mood on a scale of 0 to 10

how to document mood

hopelessness

Most people with depression describe feeling

elation

is common in those with mania

affect

Apparent emotional tone

RANGE, DURATION, INTENSITY, and APPROPRIATENESS

affect can be describe in terms of

flat affect

the absence of emotional expression

schizophrenics

flat affect is found in

lability

shifting from one affect to another quickly

manics

lability affect is found in patients with

incongruent affect

emotional response not congruent with speech content

hallucinations

false sensory impressions or experiences

Auditory

hallucinations in schizophrenics

Visual

hallucinations in organicity

tactile

hallucination associated with organic mental disorders, cocaine abuse, delirium tremors

command

tell the patient to do something

illusion

false perception or false response to stimulus

thought content

The specific meaning expressed in the patient’s communicationth

thought content

Refers to the “what” of the patient’s thinking

thought process

“how” of the patient’s self expression

speech

though process is observed through

thought process

Patterns or forms of verbalization rather than the content

delusions

False belief that is firmly maintained even though it is not shared by others or is contradicted by social reality

religious

belief that one is favored by a higher being or is an instrument of that being

somatic

belief that one’s body or part of one’s body are diseased or distorted

grandoise

belief that one possesses greatness or special powers

paranoid

excessive or irrational suspicion

thought broadcasting

belief that one’s thoughts are being aired to the outside world

thought insertion

belief that thoughts are being placed into one’s mind by outside people or influences

depersonalization

feeling of having lost self identity and that things around the person are different, strange and unreal

hypochondriasis

somatic overconcern with and morbid attention to details of body functioning

ideas of reference

incorrect interpretation of causal incidents and external events as having direct personal references

magical thinking

belief that thinking equates with doing, characterized by lack of realistic relationship between cause and effect

nihilistic ideas

thoughts of nonexistence and hopelessness

obsession

idea, emotion, or impulse that repetitively and insistently forces itself into consciousness, although it is unwelcome

phobia

morbid fear associated with extreme anxiety

circumstanial

thought and speech associated with excessive and unnecessary detail that is usually relevant to a question, and an answer is eventually provided

flight of ideas

over-productive speech characterized by rapid shifting from one topic to another and fragmenting ideas

loose association

lack of a logical relationship between thoughts and ideas that renders speech and thought inexact, vague, diffuse, and unfocused

neologism

new word or words created by the patient, often blend of other words

perseveration

involuntary, excessive continuation or repetition of a single response, idea, or activity; may apply to speech or movement, but most often verbal

tangential

similar to circumstantial but the person never answers the original question

thought blocking

sudden halt in the train of thought or in the middle of a sentence

word salad

series of words that seem totally unrelated

confused

sedated

stuporus

levels of consciousness

orientation x3

what to note if the patient answers correctly, note

memory

The ability to recall past experiences

remote memory

recall of events, information, and people from the distant past

recent memory

recall of events, information, and people from the past week or so

immediate memory

Recall of information or data to which a person was just exposed

confabulation

making up stories to recount situations or events that cannot be remembered

concentration

ability to pay attention

calculation

the ability to do simple math

Linguistic

Logical-mathematical

Spatial

Musical

Bodily-kinesthetic

Interpersonal

Intrapersonal

7 different types of intelligence

to assess the ability to conceptualize and abstraction

reason why we have to let pt explain series of proverbs

ask the patient to list similarities between a series of paired objects.

what do we ask If the patient’s educational attainment is below eighth grade

The last five presidents

The mayor

Five large cities

Occupation of a well known person

To assess general knowledge, ask the nurse to name (4)

judgement

Involves making decisions that are constructive and adaptive

judgement

Involves the ability to understand facts and draw conclusions from relationships

insight

The patient’s understanding of the nature of the problem or illness

mini mental state exam

Used when a complete full mental status examination is not practical

11 questions

mini mental state exam consists of how many questions

5-10 mins

how long does a mini mental state exam take