1. Mental Status Assessment
Physical Examination and
Health Assessment
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2. Learning Objectives for Mental Health Assessment
Define the behaviors that are considered in an assessment of a person’s mental status
Describe relevant developmental considerations of the mental status exam.
State the purpose of a mental status exam.
List the 4 components of mental status assessment.
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3. Objectives cont. Complete a MiniMental State Examination.
Discuss developmental considerations for infants, children and the aging adult
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4. Introduction Defining mental status
Assessment of an individual’s behavior
Developmental considerations
Components of the mental status exam
Objective data
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5. Introduction Mini-mental state examination
Application and critical thinking
Abnormal findings
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6. What Does Mental Status Mean to You?
Emotional and cognitive functioning
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7. Mental Disorder Definition of Mental Disorder Organic disorders
Psychiatric mental illness
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8. Assessment of an Individual’s Behavior
Consciousness
Language
Mood and affect
Orientation
Attention
Memory
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9. Assessment Cont. Abstract reasoning Thought process Thought content
Perceptions
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10. Developmental Considerations
Infants and children
Aging adult
Infants and children
All aspects mental development are interdependent…..ie: at birth cerebral cortex not developed therefore conscious awareness is not present, the infant does not realize not a part of the Mom’s body. Review expected developmental milestones for children.The omission or lack of achievement of a milestone may be an indication for further exploration
Abstact thinking (hypothetical situations) develops b/w ages 12-15yrs or not at all in some cases.
Aging Adult No decrease in general knowledge or vocabulary
Response time slower than in youth
Longer for brain to process info and respond (not loss of intelligence)
Recent memory-decreases with aging Remote memory –not affected
Age related changes in sensory perception
vision loss
hearing loss
Aging+loss(income,death,energetic body etc. )= potential for grief and despair which affects mental status
Disorientation
Disability
Depression
For the aging adult the set (FACT) test is used to assess mental status.
_Name 10 items in each of 4 categories or sets ie. fruits, animals, colors, or towns Take into consideration sensory status and deficits ( eye glasses, hearing aids)
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11. Components of The Mental Status Exam
A……appearance
B…….Behavior
C…….Cognition
T…….Thought processes
Integrate exam into the health history interview
Assess mental strengths and coping skills
Screen for dysfunction
Full mental status exam indicated if abnormality in affect or behavior detected
Memory loss, inappropriate social skills
Head trauma, tumor, CVA (Brain attack)
Aphasia
Psychiatric mental illness
Note in health history: illnesses(alcohol,kidney),
medications
education and behavioral level
responses to questions…stresses, socialization.sleep habits,drug and alcohol use.
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12. A……for Appearance Posture Body movements Dress Grooming and hygiene
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14. B…….For Behavior Level of consciousness Facial expression Speech
Mood and affect
Awake, alert responds appropriately to stimuli
Expression appropriate to situation with comfortable eye contact (except when against cultural norm)
Conversation, effortless, appropriate, clear and understandable
Body language and facial expression…ask direct questions “How are you feeling” Is the response appropriate?
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16. C…….For Cognitive Function
Orientation
Attention span
Recent memory
Remote memory
New learning
Time, Place, Person ( organic brain disorders…ie delirium and dementia usually lose time, then place but rarely person
?complete thoughts without wondering….easily distracted….inability to follow a series of directions
Use 24 hr diet recall or ask question you can corroborate
Past events…health, job, historical events
The four unrelated words test ( Have 4 unrelated words repeated) In 5 min. ask for recall then in 10min….30min normally under 60yrs accurate 3-4 word recall after 5, 10, 30 min. delay
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17. Cognitive Function Cont.
Persons with aphasia
Word comprehension
Reading
Writing
Higher intellectual function
Judgment
Aphasia- loss of ability to speak or write coherently or understand same
…………..Point to articles in the room, body parts etc. Ask to name them.
……………Read available print
……………Make up and write a sentence
Measure problem solving and reasoning…related to general intelligence, education and culture Little evidence these tests are valid
Note what person says re job plans, family, future…..realistic
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19. T……for Thought Processes and Perceptions
Thought content
Perceptions
Suicidal thoughts
Make sense…follow train of thought…coherent and comple
What is said should be consistent and logical
Example ; Some one just diagnosed with a seizure disorder and still has aspirations of becoming an airline pilot
Aware of reality Ask “How do you feel people treat you?’
“Do others talk about you?”
“Do you hear voices when you are alone?”
Sadness., hopelessness, despair, grief …. Question at first general then direct.
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21. Mini Mental State Examination
Standard set of 11 questions
5 to 10 min. To administer
Cognitive functioning only
Valid detector of organic disease ie ;dementia and delirium and to separate these from psychiatric mental illness
Maximum score = 30
Normal mental status average = 27
Scores b/w = no cognitive impairment
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22. Summary Checklist: Mental Status Assessment
Appearance
Behavior
Cognitive function
Thought processes
Mini -mental state examination
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23. Developmental Considerations
Assessment includes
Behavioral
Cognitive
Psychosocial development
Examines environmental coping mechanisms of child
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24. Cognitive Development Behavioral Development
Utilize A, B, C, T plus assess developmental milestones in the following areas:
Psychosocial:
Erikson’s stages of Ego Development
Erikson’s Theory of Trust vs Mistrust
Cognitive Development
Behavioral Development
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25. Personal Social Skills Imitation
Fine Motor Skills
Language Skills
Personal Social Skills
Imitation
Abnormalities are usually problems of omission.
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26. Application and Critical Thinking
Subjective and objective data collection
Developmental
Age
Socioeconomic
Transcultural considerations
A,B,C, & T
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27. Example of Documentation
Mental Status: Alert, relaxed, and cooperative. Thought process coherent. Orientated x 3.
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28. Critical Thinking Exercises
During lab each team will take a situation and will role play the scenario chosen
Interviewer, interviewee, third student will be the spotter
Complete the mini mental exam as part of the assessment
Movies for viewing
.Rain Man, I Am Sam, Forest Gump, Beautiful Mind
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29. Web Sites of Interest American Federation for Aging Research
American Psychological Association
Association of Child and Adolescent Psychiatric Nursing
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