Mental 1

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

Mental Status Assessment

Chapter 7


Chapter 7


Slide 7-1

Defining Mental Status

Mental status—emotional and cognitive functioning

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


Chapter 7


Slide 7-2

Mental Status

Mental status is inferred through individual’s behaviors– Consciousness– Language– Mood and affect– Orientation – Attention

– Memory– Abstract reasoning– Thought process– Thought content– Perceptions


Chapter 7


Slide 7-3

When to Perform a Full Mental Status Examination

Behavior changes

Brain lesions (trauma, tumor, brain attack)

Aphasia (secondary to brain damage)

Symptoms of psychiatric mental illness


Chapter 7


Slide 7-4

Objective Data

Main components of a mental status examinationA—Appearance

B—Behavior

C—Cognition

T—Thought processes


Objective Data, cont.

Appearance– Posture– Body movements– Dress– Grooming and hygiene

Chapter 7


Slide 7-5

Behavior– Level of consciousness– Facial expression– Speech– Mood and affect



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



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

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


Chapter 7


Slide 7-6


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


Chapter 7


Slide 7-7


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?


Objective Data, cont

Screen for suicidal thoughts– 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


Chapter 7


Slide 7-8

Supplemental Mental Status Examination

MiniMental State– Orientation– Registration– Attention and calculation– Recall– Language


Maximum score: 30Normal mental status: 27No cognitive impairment: 24-30

Dementia and delirium18-23= mild cognitive impairment0-7= severe cognitive impairment

p. 111, chapter 7, Jarvis


Chapter 7


Slide 7-9

Abnormal FindingsLevels of Consciousness

Alert

Lethargic (somnolent)

Obtunded

Stupor or semi-coma

Coma

Acute confusional state (delirium)


Chapter 7


Slide 7-10

Abnormal FindingsAbnormalities of Mood and Affect

Flat affect (blunted affect)

Depression

Depersonalization (lack of ego boundaries)

Elation– Joy and optimism,

overconfidence

Euphoria– Excessive well being

Anxiety

Fear

Irritation

Rage – furious, loss of control

Ambivalence– The existence of

opposing emotions

Lability– Rapid shift of emotions

Inappropriate affect

Mental 1

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