MENTAL STATUS EXAM After 5 hours of varied learning experiences, the level III students will be able to:

1. define the following terms: 1.1. Mental status examination 1.2. Cognition 1.3. Coma 1.4. Delusion 1.5. Dementia 1.6. Hallucination 1.7. Catatonia 1.8. Illusion 1.9. Obsession 1.10 Assessment 1.11 Speech 1.12 Mood 1.13 Affect 1.14 Appearance 1.15 Behavior 1.16 Perception 2. state the purpose of doing mental status examination 3. give the description of the following categories to be explored during mental status examination 3.1 Appearance 3.2 Behavior 3.3 Affect 3.3.1 Range 3.3.2 Types 3.3.3 Intensity 3.3.4 Appropriateness 3.4 Mood

3.5 Speech 3.5.1 Volume 3.5.2 Productivity 3.5.3 Rate 3.5.4 Goal direction 3.5.5. Tone 3.6 Thought content 3.7 Thought process 3.7.1 Form 3.7.2 Delusions 3.7.3 Disorders of Perception 3.7.4 Phobias 3.8 Intellectual Functions 3.9 Insight 3.10 Judgment 3.11 Cognition 3.12 Consciousness 3.13 Memory

1. Definition of Terms 1.1. Mental status examination - a full psychiatric examination of signs and symptoms, which takes place during a psychiatric interview and should apply only to signs and symptoms elicited at that time; it should not take into account historical information. The examination is usually devided into the following subheadings: appearance and behavior, speech, mood, affect, thought and perception, insight, and orientation. 1.2. Cognition - the mental processes by which knowledge is acquired. These include perception, reasoning, acts of creativity, problem-solving, and possibly intuition. 1.3. Coma - a state of unrousable unconsciousness 1.4. Delusion - unfounded beliefs that are held to be true, even in the face of contradictory evidence. 1.5. Dementia - a chronic and progressive deterioration of behavior and higher intellectual function due to organic brain disease. It is marked by memory disorders, changes in personality, deterioration in personal care, impaired reasoning ability and disorientation. 1.6. Hallucination - a false perception of something that is not really there. It may be visual, audiotory, tactile, gustatory or olfactory. 1.7. Catatonia - a state in which a person become mute or stuporous or adopts bizarre posture. 1.8. Illusion - a false perception due to misinterpretation of the stimuli arising from an object. 1.9. Obsession - a recurrent thought, feeling, or action that is unpleasant and provokes anxiety but cannot be got rid of. The obsession may be a vivid image, a thought, a fear, or an impulse.

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Assessment

- systematic and continuous collection, validation and communication of client data as compared to what is standard/norm.It includes the clients perceived needs, health problems, related experiences, health practices, values and lifestyles. Its purpose is to establish a data base . 1.11 Speech - the communication or expression of thoughts in spoken words 1.12 Mood - a sustained emotion that affects the patients perception of the world 1.13 Affect - the predominant emotion in a persons mental state at a particular moment. 1.14 Appearance - the outward or visible aspect of a person or thing; how a person looks like 1.15 Behavior - the manner of conducting oneself in response to a stimuli 1.16 Perception - the process by which information about the world, as received by the senses, is analyzed and made meaningful.

2. Purpose of mental status examination Mental status examination provides a summary of the patients current functioning. It is essential for the development of an appropriate plan of care. determines whether or not there are abnormalities in thinking and reasoning ability, feelings or behavior of the client evaluates physiologic state of the client

3. Categories to be explored during a mental examination 3.1 Appearance - The patients appearance should be described interms of consistency with his age and situation in life, his manner of dress (conservative, tasteful, meticulous, inappropriate), his personal habits (clean, unkept, disorderly), his characteristic facial expression (alert, vacant, sad, bewildered, hostile, masklike), and his state of health and nutrition. 3.2 Behavior - any overt behaviors such as finger tapping, hair twirling, hand wrining, pacing, posturing, gait and bizarre movements are described . 3.3 Affect - Observations of the range , appropriateness, and intensity of the patients emotional expressions in relation to the circumstances of the interview and the ideas expressed are documented. Does the patient demonstrate variability in the expression of feeling, or does his affectual response appear blunted or restricted in some way? Does he report significant life events without any emotional component? Is the patients affectual response congruent with the content of his speech? 3.3.1 Range it may be described as broad or restricted. 3.3.2 Types - may be described by the use of the following words: Sad, angry, hostile, indifferent, euthymic, dysphoric, detached, elated, euphoric, anxious, animated, irritable. 3.3.3 Intensity - can be described as blunted, flat, or normal intensity. 3.3.4 Appropriateness may be indicated as Appropriate or inappropriate to situation. Congruous / incongruous 3.4 Mood - The pervasive, relatively enduring emotional state of the patient reflects his mood and can influence his perception of his life situation. Does his appearance reflect his mood? Does he look down in the bumps? How would he describe his mood? Does it remain the same or change during the day or from day to day? Asking the patient to rate his mood on a scale of 0 to 10 can be useful for an immediate rating and valuable comparison of changes that occur during treatment. When the clinical picture is highlighted by a continuous intensification or change in the patients mood, an affective disorder is suspected.

3.5 Speech - This part of the interview describes the quality and quantity of the patients speech. The nurse also reports any speech defects such as lisps and stuttering. 3.5.1 Volume may be indicated as loud, soft, ordinary, whispered, yelling, inaudible. 3.5.2 Productivity- may be indicated as: information; scant; mute; verbose, repetitive. Responds only to questions; offers

3.5.3 Rate descriptions may include rapid, slow, ordinary 3.5.4 Goal direction may be indicated as: Hesitant, expansive, rambling, halting, stuttering, lilting, jerky, long pauses, forgetful. 3.5.5. Tone descriptions may include Lively, dull, monotonous, normal, intense, pressured, explosive. 3.6 Thought content - During the interview, the patient is asked about desires, ambitions, and fears. As the patients story unfolds, the nurse is alert to recurring themes such as delusions, hallucination or illusions. These central themes reveal important information about thought content. Disturbances in thought content: Hallucination sensory perceptions without external stimuli. Illusion misinterpretations of real external stimuli Delusion false, fixed beliefs not alterable by logical explanation Obsessions unwanted, distressing recurring thoughts Phobia - irrational fear of a specific situation accompanied by avoidance of the phenomenon feared Depersonalization sense of not being real, sense of being detached from ones body or self Magical thinking thinking about something happening is the same as doing it Grandiosity exaggerated beliefs in own worth and/or abilities Paranoia unwarranted belief that others have harmful intentions to person

3.7 Thought process - In this section of the mental status exam, the nurse observes the characteristics of the patients thought processes rather than the content of his thought. 3.7.1 Form - The nurse also observes the amount for thought and rate of its production. A patient may exhibit unusual rapidity of association, which when extreme is called flight of ideas. Conversely, the patient may exhibit slowness or poverty of ideas. The nurse notes any disturbances in the logical progression of ideas . Normally, individuals demonstrate goaldirected thinking and explain events in cause-effect context. 3.7.2 Delusions - Delusions are recurring false beliefs not congruent with patients culture or background. Tactful questioning halps the patient focus on delusional material. Does he misinterpret what happens to him, giving it special or false meaning? Does he feel that he has been singled out or watched? Does he experience his thoughts or actions as being controlled by an external force? Can people read his mind , or does he have psychic powers? 3.7.3 Disturbances in thought process Circumstantiality a pattern of speech that is indirect and delayed in reaching its goal. Confabulation Fabrication of stories in response to questions about situations or events that the patient does not recall. Blocking a sudden obstruction or interruption in spontaneous flow of thinking or speaking, perceived as an absence or deprivation of thought. Perseveration tendency to emit the same verbal or motor responses again and again to varied stimuli. Tangential replying to a question in an oblique or irrelevant way. Word salad a mixture of words and phrases that lack comprehensive meaning or logical coherence; commonly seen in patients with schizophrenia. Clang association a type of thinking in which a sound of a word, rather than its meaning, gives direction to subsequent associations. Neologisms - a new word or condensed combination of several words coined by the patient to express a highly complex idea not readily understood by others Loose association a disturbance of thinking in which ideas shift from one subject to another in an unrelated matter. Flight of ideas verbal skipping from one idea to another

3.7.4 Phobias - Objects and/or situations irrationally and persistently feared by the patient are identified as phobias . The individual can phobias . The individual can exert great energy avoiding certain situatoins or thinking about the feared object. 3.8 Intellectual Functions - A patients intellectual function is assessed in relation to his educational, occupational and attainment levels. Testing vocabulary, counting and calculating ability , abtract ability and fund of general knowledge provides some information about clients intelligence. Vocabulary can be assessed by asking for word definitions or synonyms. Counting and calculating involve simple arithmetic (9 x 6, 21 + 7). 3.9 Insight - The degree of insight the patient has about the nature of his problem and how it affects his feelings, thoughts and behavior may be assessed iformally as he talks. It is important to determine if he sees the problem as something brought on by external factors or stremming from within himself. Questions that may be helpful are: What does he think about all he has told to the nurse? What does he want to do about it? What does he want others, including the nurse, to do about it?

3.10 Judgment - The patients judgement can be best assessed from an account of past decisions and how they were reached and form from responses in the interview. Judgment involves the ability to understand facts and draw conclusions from relationships. It is useful to determine if the judgement are deliberate, impulsive or inappropriate. Several hypothetical situations can be presented for the patient to evaluate: What would he do if he found a stamped, addressed envelope lying on the ground? What would he do if he entered his house and smelled gas? 3.11 Cognition -Refers to clients ability to acquire higher mental processes such as thinking, language, memory, problem solving, knowing , reasoning, judging and decisionmaking 3.12 Consciousness - a variety of terms can identify the patients level of consciousness. Is he alert and awake and stuporous and sleepy? Is he easily distracted or hyperalert? Can he sustain attention to both external and internal stimuli?

3.13 Memory - Assessment of memory includes asking about and testing recent and remotepast memory as well as immediate recall. The nurse can examine the clients recent memory by asking how he spent the last twenty-four hours or what he last ate. Remote memory can be evaluated by asking the patient about important life events in his life such as childrens birthdates. The nurse may assess retention and recall ability with the digit span test. The patient is asked to repeat 3 digits after the nurse and then to state them in reverse order. This process is repeated with up to seven digits.

NCM105 RLE1 Genogram Mental Status Examination Sensory Stimulation

Members: Alonzo, Althea Jane Andales, Anthony Nino Archival, Moira Kate BSN 3B