Chapter 5: Mental Status Assessment

Mental Status*a person's emotional (feeling) and cognitive (knowing) function.* is relative and ongoing, strikes a balance.       -traumatic life event tips balance, causing transient dysfunction (expected)*mental status assessment documents a dysfunction and determines how that dysfunction affects self-care in everyday life.     -cannot be scrutinized, its functioning is inferred through assessment of behaviors.*consciousness is the most elementary of mental status function.

Mental Disorder*is apparent when a person's response is much greater than the expected reaction to a traumatic life event.*is defined as a significant behavioral or psychological pattern associated with distress (a painful symptom) or disability (impaired functioning) and has a significant risk  of pain, disability, or death or a loss of freedom.*Includes:  -organic disorders: due to brain disease of known specific organic cause.  -psychiatric mental illness: in which an organic etiology has not been established..anxiety and schizophrenia. 

Components of the Mental Status Examination *is a systematic check of emotional and cognitive functioning.*rarely needs to be taken in their entirety     -Appearance, Behavior, Cognition, Thought Process            (ABCT)*may be integrated into the health history interview.*It is necessary to perform a full mental status examination when you discover any abnormality in affect or behavior.************************************************sequence of steps forms a hierarchy in which the most basic functions are assessed: language, consciousness.

      Objective Data**************************

Structure and Function*************************

Appearance*Posture: erect, relaxed, tense, sitting at edge of chair?*Body movements: voluntary, involuntary, smooth, even, restless?*Dress: appropriate for setting, season, age, gender?*Grooming: clean, hair neat? May reflect person's economic status or fashion trend. 

Behavior*Level of Consciousness: awake, alert, aware, lethargic?*Facial Expression: appropriate, comfortable?*Speech: clear, understandable, fluent?*Mood and Affect: judge by body language and facial expression and by asking "how do you feel today," to "how do you usually feel?" Mood should be appropriate and willing to cooperate. 

Cognitive Functions*Orientation X3:  Person, place, time. *Attention span*Recent Memory: 24 hour diet recall*Remote Memory: verifiable past events  *New-Learning: 4 Unrelated words test: test at 5, 10, 30 minutes.*Aphasia:  test patients in the following:    -word comprehension: parts of body, objects in room   -reading:  ask person to read text.   -writing: ask the person to make up and write a sentence.*Judgement: when he/she can compare and evaluate the alternatives in a situation and reach an appropriate course of action, about daily of long-term life goals. Realistic?

Thought Processes and Perceptions*Though Processes: does the person make sense? Should be goal directed, coherent, and relevant. Should complete a thought.*Thought Content: what the person says should be consistent and logical. *Perceptions: should be aware of reality. how do people treat you? do other people talk about you?*Screen for anxiety disorders: anxiety and depression are the two most common mental health problems.      -GAD-7*Screen for depression: ask if they have felt down, depressed, or hopeless, and id they felt little interest or pleasure in doing things.*Screen for suicidal thought: begin with general questions, then probe.

Supplemental Mental Status Examination (MMSE)* concentrates on cognitive functions.*11 questions.*is a valid detector of organic disease, so it is good for dementia and delirium *max score is 30m people with normal mental status average 27. Scores between 24-30 indicate no cognitive impairment. 

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