Mental Status Assessment

Chapter 5: Mental Status Assessment

Purpose of the Chapter

  • This chapter presents the components of the mental status examination, which includes:

    • Assessing a person’s appearance and behavior.

    • Evaluating cognitive functions such as memory, attention, and language.

    • Analyzing thought processes and perceptions.

    • Understanding the rationale for examination methods.

    • Recording the assessment accurately.

Reading Assignment

  • Primary Text: Jarvis: Physical Examination and Health Assessment, 9th ed., Chapter 5, pp. 59–80.

  • Suggested Reading:

    • Dunlap, J. J., & Filipek, P. A. (2020). "Autism spectrum disorder: The nurse’s role." Am J Nurs, 120(11), 40–50.

    • Fazel, S., & Runeson, B. (2020). "Suicide." N Engl J Med, 382, 266–274.

Glossary of Terms

  • Abstract reasoning:

    • The ability to ponder deeper meanings beyond the concrete and literal.

  • Attention:

    • Concentration; the ability to focus on one specific task.

  • Bereavement:

    • The state of loss, sorrow, and/or grief due to the death of a loved one, decline in health, or end of an important relationship.

  • Consciousness:

    • Being aware of one’s own existence, feelings, thoughts, and the surrounding environment.

  • Delirium:

    • An acute confusional state marked by change or loss of consciousness and perceptual disturbances, often rapid in onset and usually reversible once the underlying cause is treated.

  • Dementia:

    • A gradual and progressive decline in cognitive function while the person is fully conscious, typically irreversible.

  • Executive function:

    • High-level cognitive skills that include organizational and regulatory abilities.

  • Language:

    • The capacity to communicate thoughts and feelings verbally.

  • Memory:

    • The ability to store and recall experiences and perceptions later.

  • Mood:

    • A prolonged display of a person’s emotional state.

  • Orientation:

    • Awareness of the objective world in relation to oneself.

  • Perceptions:

    • Awareness of objects or events through the five senses.

  • Thought content:

    • The specific ideas and beliefs a person has, including the use of words.

  • Thought process:

    • The logical progression and manner in which a person thinks.

  • Visuospatial:

    • The ability to process visual information and understand spatial relationships between objects.

Study Guide Questions

  1. Define the term mental disorder.

    • A mental disorder is a health condition characterized by alterations in thinking, mood, or behavior (or some combination thereof) that results in distress or impairment in functioning.

  2. Differentiate organic brain disorder from psychiatric mental disorder.

    • Organic brain disorders are caused by identifiable physical changes in the brain (e.g., injury, disease). Psychiatric mental disorders are primarily psychological in nature and may not have a clear organic cause.

  3. Situations requiring a complete mental status examination:

    • When a patient presents with altered mental functions.

    • Following a head injury for neurological assessment.

    • In cases of significant behavioral changes.

    • When an individual has a history of psychiatric disorders.

  4. Factors affecting patient response to examination unrelated to mental disorders:

    • Factors such as acute illness, substance use, environmental stressors (e.g., noise), and cultural influences on communication can affect how a patient responds during assessment.

  5. Convenient ways to assess a person’s recent memory:

    • Asking the patient to recount recent events or repeat back specific pieces of information after a short period.

  6. Mental function tested by the Four Unrelated Words Test:

    • This test is intended to assess short-term memory.

  7. Risk factors of suicide:

    • Major depression, previous suicide attempts, chronic illness, and substance abuse.

    Warning signs of suicide:

    • Talking about feeling hopeless, withdrawal from friends, increase in substance abuse, and drastic mood changes.

  8. Levels of consciousness:

    • Lethargic or somnolent: Drowsy and may not be fully engaged but can be aroused.

    • Obtunded: Requires more stimuli to engage and respond appropriately.

    • Stupor or semicoma: Only responds to vigorous stimulation; otherwise unresponsive.

    • Coma: No response to stimuli and unable to be aroused.

    • Delirium: Acute onset of confusion, often fluctuating symptoms.

  9. Primary differences between delirium, dementia, and depression:

    • Delirium: Acute onset, often reversible. Symptoms fluctuate and can include disorientation.

    • Dementia: Gradual decline in cognitive function that is not reversible. Memory and other cognitive abilities deteriorate over time.

    • Depression: Characterized by low mood and loss of interest, but cognitive functioning can remain relatively intact.

  10. Adapting the mental status exam for different age groups:

    • Assessments should be developmentally appropriate, recognizing that children may require playful interactions for engagement, while older adults may need slower and clearer questioning.

Critical Thinking Activities

  • Montreal Cognitive Assessment (MoCA) and Mini-Cog:

    • Use the MoCA to perform cognitive screening on a partner.

    • Use the Mini-Cog with another partner.

    • Compare the tools: Discuss appropriateness in various settings such as outpatient clinics vs. hospitals and comfort levels with instructions and scoring

    • Reflect on experiences with older adults and any necessary adjustments in delivery style based on cognitive impairment.