cognition and mental health

define the holistic approach

looking and treating the pt as a whole person rather than just their diagnosis. this includes assessing their mental status and the affect that it has on self care, safety, and adherence to medical tx-care,

define cognition

the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses

what are the 6 domains of cognitive function

1. perceptual motor function

2. language

3. learning and memory

4. social cognition

5. complex attention

6. executive function

define mood

the way a person feels internally

define affect

observable response a person has to his or her own feelings

define euthymia

normal, healthy fluctuations in mood

how do mood spectrum disorders affect a person

it disrupts a person's ability to function normally, and puts them at increased risk for substance abuse and decreased health status

define dysthymia

depression or flat mood

what are some examples of biographical data

age, gender, culture

what is current health history

the health symptoms that caused them to go to the dr

what is past medical history

previous diagnoses, hospitalizations, or treatments

what is family history

conditions and illnesses that a pt's blood relatives have that make them genetically predisposed to getting the same

what is a family history genogram

tree that shows any health history that makes them genetically at risk

what should you ask about when discussing meds that the pt is taking

dosage, frequency, why they take meds, method of administration

what is A&O x4

alert and oriented to person, place, time, situation

what is the PHQ-9 used to screen

depression

how does PHQ-9 scoring work

each question (9 total) is scored 0-3, with 0 being not at all, and 3 being nearly every day. 27 possible points total

what are appropriate actions to take if a pt has a concerning answer on q9 (suicide and self harm)

immediate follow up and escalation

what score makes the pt considered depressed, and what score is considered severe depression

10+ = depressed

20-27 = severe depression

what does the GAD-7 screen for

anxiety

how many questions on the GAD-7

7

score interpretation ranges for GAD-7

0-4: minimal anxiety

5-9: mild anxiety

10-14: moderate anxiety

15-21: severe anxiety

score of 5+ is referral level, and a score of 10 or more is considered clinically significant which requires a follow up

what is the CAGE assessment used for

alcohol use concern assessment

What does CAGE stand for?

C- cut down (have u ever felt that u needed to cut down)

A- annoyed (have ppl annoyed u by criticizing ur drinking)

G- guilty (have u felt guilty about drinking)

E- eye-opener (have u ever needed an eye-opener drink in the morning)

what score is considered necessary for referral on CAGE screening

2 or more "yes" answers

what is the mini mental state exam (MMSE)/mini-cog assessment tool used to screen

cognitive impairment/dementia

what are the 5 main areas in the MMSE assessment

orientation (person, place, time, situation)

registration (immediate recall of words)

attention and calculations (serial 7s - count backwards from 100 in multiples of 7, spell backwards)

recall (short-term memory)

language and visuospatial skills (naming, following commands, drawing)

what are the score ranges for normal cognition, mild cognitive impairment, and severe impairment on MMSE

normal: 24-30

mild impairment: 18-23

severe impairment (REFERRAL LEVEL): 0-17

what are the 3 parts of the mini-cog administration

1. instruct the pt to remember 3 unrelated words, and then repeat them

2. ask the pt to draw a clock, and then ask them to draw the hands interpreting a time

3. ask the pt to repeat the 3 words from step 1

how does mini-cog scoring work

pt given one point for each word recalled after the clock drawing test, and 2 points for a correctly drawn clock/hands (0 for abnormal clock)

0-2 is considered high risk for cognitive impairment, while 3-5 are low risk for dementia but does not rule out cognitive impairment

when administering these assessments, you should also be analyzing the clients based on the ABCT framework. what does that stand for

appearance, behavior, cognitive function, thought process and perceptions

what should u look out for when analyzing a client's appearance during mental assessment

posture

body movements (voluntary, uncoordinated, spastic, etc)

dress (dressed appropriately for setting, season, and age?)

grooming and hygiene (cleanliness v neglect)

what should u examine when assessing a client's behavior during these assessments

level of consciousness: alert, lethargic, stuporous (near unconscious) or comatose

facial expression: appropriate to the situation? eye contact

speech: quality, pace, and articulation

mood and affect

difference btwn mood and affect

mood is how the person states that they feel internally, while affect is how they express that feeling through behaviors and other observable traits

what should u examine when assessing a client's cognitive function during these assessments

orientation

attention span

memory (recent and remote)

new learning (4 unrelated words test)

what are some examples of testing remote and recent memory

remote: historical events

- ask about their first job, or their anniversary date

recent

- ask about what they ate in the last 24 hrs

what should u examine when assessing a client's thought process and perceptions during these assessments

thought process, thought content, perceptions (hallucinations or delusions), suicidal/homicidal ideation

what should u look for when analyzing a person's thought process/content

whether the pt is making sense, and their statements are consistent and based in reality

why is assessing cognition important in infants/childrens

to ensure that they are reaching developmental milestones and behavior

why is assessing cognition important in the aging adult

confusion is not a normal part of aging

what should u do before assuming cognitive loss in an aging adult

check their sensory status (vision/hearing)