Mental 1

Chapter 7

Mental Status Assessment

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Chapter 7 Mental Status Assessment

Defining Mental Status 

Mental status—emotional and cognitive functioning

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Mental disorder – Organic disorder • Due to brain disease of known specific organic cause • E.g dementia, intoxification, delirium – Psychiatric mental illness • Organic etiology has not yet been established • Anxiety disorder, schizophrenia

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Slide 7-1

Chapter 7 Mental Status Assessment

Mental Status 

Mental status is inferred through individual’s behaviors – – – – –

Consciousness Language Mood and affect Orientation Attention

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

– – – – –

Memory Abstract reasoning Thought process Thought content Perceptions

Slide 7-2

Chapter 7 Mental Status Assessment

When to Perform a Full Mental Status Examination 

Behavior changes

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Brain lesions (trauma, tumor, brain attack)

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Aphasia (secondary to brain damage)

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Symptoms of psychiatric mental illness

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Slide 7-3

Chapter 7 Mental Status Assessment

Objective Data 

Main components of a mental status examination A—Appearance B—Behavior C—Cognition T—Thought processes

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Slide 7-4

Chapter 7 Mental Status Assessment

Objective Data, cont. 

Appearance – – – –

Posture Body movements Dress Grooming and hygiene

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

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Behavior – – – –

Level of consciousness Facial expression Speech Mood and affect

Slide 7-5

Objective Data, cont. 

Level of consciousness – Alert • Awake or readily aroused – Lethargic (or somnolent) • Not fully alert, drifts off to sleep when not stimulated, but can be aroused to name when called in normal voice but drowsy, respond appropriately but slow thinking – Obtunded • Sleeps most of the time, loud shout to arouse – Stupor or semi coma • Apontaneously unconscious, respond only to persistent and vigorous shake or pain – Coma • Completely unconscious, no responds to pain or any external or internal stimuli • Light coma- reflexive reponse • Deep coma- no motor respond

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Objective Data, cont. 

Acute confusional state (Delirium) – Clouding of consciousness (dulled cognition, impaired alertness) – Disorientated, with confusion worse at night when environmental stimuli are decreased – Often agitated and having visual hallucination

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Mood and affect – – – –

Judge by body language and facial expression “How do you feel today”/ “ How do you usually feel” Wild mood swings occur with manic syndrome Bizarre mood is apparent in schizophrenia

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Chapter 7 Mental Status Assessment

Objective Data, cont. 

Cognitive functions – – – – – –

Orientation (time, place and person) Attention span (ability to concentrate) Recent memory (24 hours recall) Remote memory (past event) New learning—the four unrelated words test Judgment- daily or long- term life goal

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Slide 7-6

Chapter 7 Mental Status Assessment

Objective Data, cont. 

Thought processes and perceptions – Thought processes- ? Logical, goal directed, coherent and relevant – Thought content- What the person say should be consistant and logical – Perceptions • How do people treat you? • Do other people talk about you? • Do you feel like you are being watch, followed or controlled? • Have you heard your name when alone?

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Slide 7-7

Objective Data, cont 

Screen for suicidal thoughts – – – – –

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Have you ever felt so blue you thought of hurting yourself? Do you feel like hurting yourself now? Do you have a plan to hurt yourself? What would happen if you were dead? How would other people react if you were dead

Warning signs: – – – – –

Prior suicide attempts Social withdrawl, running away Verbal suicidal messages Saying goodbye (giving away prized possession) Anorexia and /or insomnia

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Chapter 7 Mental Status Assessment

Supplemental Mental Status Examination 

MiniMental State – – – – –

Orientation Registration Attention and calculation Recall Language

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Slide 7-8

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Maximum score: 30 Normal mental status: 27 No cognitive impairment: 24-30 Dementia and delirium 18-23= mild cognitive impairment 0-7= severe cognitive impairment p. 111, chapter 7, Jarvis

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Chapter 7 Mental Status Assessment

Abnormal Findings

Levels of Consciousness 

Alert

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Lethargic (somnolent)

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Obtunded

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Stupor or semi-coma

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Coma

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Acute confusional state (delirium)

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Slide 7-9

Chapter 7 Mental Status Assessment

Abnormal Findings

Abnormalities of Mood and Affect 

Flat affect (blunted affect)

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Fear

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Depression

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Irritation

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Depersonalization (lack of ego boundaries)

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Rage

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Elation – Joy and optimism, overconfidence

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Euphoria – Excessive well being

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Anxiety

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

– furious, loss of control 

Ambivalence – The existence of opposing emotions

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Lability – Rapid shift of emotions

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Inappropriate affect Slide 7-10