HA LEC MIDTERMS

• Mental status


  Client's level of cognitive functioning (T, K, PS) and emotional functioning (F, M, B, S)
• Mental status includes descriptions of the patient's appearance and general behavior, level of consciousness and attentiveness, motor and speech activity, mood and affect, thought and perception, attitude and insight, the reaction evoked in the examiner, and, finally, higher cognitive abilities
• One cannot be totally healthy without "mental health"
• Mental health (WHO definition)


  A state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community
• Factors affecting mental health

  • Individual psychological and biological factors (emotional skills, substance use, genetics)
  • Exposure to unfavourable social, economic, geopolitical and environmental circumstances (poverty, violence, inequality, environmental deprivation)
  • Risks that occur during developmentally sensitive periods, especially early childhood (harsh parenting, physical punishment, bullying)
  • Protective factors (individual social and emotional skills, positive social interactions, quality education, decent work, safe neighbourhoods, community cohesion)
• Mental health risks and protective factors can be found in society at different scales (local threats heighten risk for individuals, families and communities; global threats heighten risk for whole populations)
• Each single risk and protective factor has only limited predictive strength. Most people do not develop a mental health condition despite exposure to a risk factor and many people with no known risk factor still develop a mental health condition. Nonetheless, the interacting determinants of mental health serve to enhance or undermine mental health.
• Clinical interview skills


  • Active listening
  • Reflection
  • Paraphrasing
  • Summarizing
  • Clarification
  • Confrontation
  • Probing
  • Rapport
• Components of mental status examination

  • General appearance and behavior
  • Speech
  • Mood and affect
  • Thought
  • Perception
  • Cognition (higher mental functions)
  • Judgement
  • Insight
• Mental health assessment


  An assessment tool of the brain functions that helps mental health professionals to reach a tentative psychiatric diagnosis
• An experienced nurse can complete all the components of mental status examination
• General appearance and behavior

  • Dress, grooming, hygiene (self-care)
  • Facial expression
  • Eye contact
  • Nutritional status
  • Psychomotor behavior (hyperactivity, hypoactivity)
  • Posture
  • Stereotypy
  • Bizarre behavior
  • Mannerism
  • Attitude (cooperative, resistive, aggressive)
• Disorders of speech


  • Aphonia
  • Slow speech
  • Fast speech
  • Pressure of speech
  • Poverty of speech
  • Poverty of content of speech
  • Echolalia
  • Palilalia
• Mood variations


  • Euthymic
  • Dysphoric
  • Depressed
  • Irritable
  • Euphoric
  • Anxious
  • Mood swings
  • Anhedonia
• Affect


  External expression of feelings as observed by others
• Types of affect


  • Appropriate
  • Inappropriate
  • Flat
  • Blunted
  • Labile
• Types of perception disturbances

  • Hallucination (auditory, visual, olfactory, gustatory, tactile, general somatic)
  • Illusion
  • Depersonalization
  • Derealization
• Disturbances in the form of thought


  • Neologism
  • Word salad
  • Perseveration
  • Loosing of association
• Olfactory hallucination - client perceives a smell that is not present
• Gustatory hallucination - client tastes something that is not present
• Tactile hallucination - client senses that he is being touched when he is not. One of the most common complaints is the sensation of bugs crawling over the skin and phantom sign after amputation of limb
• General somatic hallucination - client experiences a feeling of their body being seriously hurt through mutilation such as snakes crawling into their stomach
• Illusions


  Misperception or misinterpretation of real external stimuli
• Depersonalization


  Subjective sense of being unreal, strange, or unfamiliar to oneself as in panic disorder
• Derealization


  Subjective sense that the environment is changed or unreal as in panic disorder
• Disturbance in the form of thought

  • Neologism - new word created by the client as in schizophrenia
  • Word salad - incoherent mixture of words, extreme neologism as in schizophrenia
  • Perseveration - repetition of the same word or idea in response to different question as in dementia
  • Loosing of association - ideas shift from one subject to another in unrelated way as in schizophrenia
  • Flight of ideas - rapid constant shifting from one idea to another, ideas tend to be connected, some followed by a listener as in mania
  • Clang association - association of words similar in sound not meaning as in mania
  • Blocking - abrupt interruption of thinking before finishing the idea as in depression and schizophrenia
• Disturbance in content of thought

  • Delusion - false fixed belief, not consistent with client intelligence or cultural background
  • Obsession - pathological persistent of an irresistible thought cannot eliminated from consciousness by logical effort
  • Hypochondriasis - exaggerated health concern based on false interpretation of physical signs and not supported by realistic pathology
  • Phobia - persistent, irrational, and exaggerated pathological dread of stimulus lead to a pressing desire to avoid it
• Abstract thinking


  Ability to deal with concepts. Ability to explain similarity between orange and apple are fruit
• Concrete thinking


  Client says both orange and apple are round as in schizophrenia and organic brain disease
• Disturbance of orientation


  • Disorientation to time, place, person
• Disturbance in consciousness


  • Somnolence - abnormal drowsiness
  • Stupor - lack of reaction and awareness to the surroundings
  • Coma - profound degree of unconsciousness
• Attention


  • Distractibility - inability to concentrate attention, it is drawn to unimportant external stimuli as in anxiety and mania
  • Selective inattention - blocking out things generate anxiety as in malinger
  • Hypervigilance - excessive attention as in post traumatic stress disorder and paranoid state
• Memory


  • Immediate memory - recall perceived objects within second
  • Recent (short term) memory - recall events in the past few days
  • Remote (long term) memory - recall events in the distant past
  • Amnesia - partial or total inability to recall past experiences may be organic or emotional as in PTSD
• Intelligence


  • Mild mental retardation - 50-70 IQ, educable in special classes
  • Moderate mental retardation - 40-50 IQ trainable simple crafts
  • Severe mental retardation - 20-40 IQ maintain activity of daily living
  • Profound mental retardation - below 20 IQ dependent and institutionalized
• Judgement


  • Critical judgement - Ability to assess situation and choose decision among different options
  • Automatic judgement - Reflex performance of action as in impulse control disorder
  • Impaired judgement - Diminished ability to understand a situation and act properly as schizophrenia
• Insight


  • Complete insight - Client is aware that he has mental illness, recognize the precipitating and relieving causes, and the importance of treatment program as in neurosis
  • Partial insight - Client realizes that he has mental health problem but explain it as a result of somatic or social cause and not committed to his therapeutic program
  • Loss of insight - Client completely deny that he has mental health problem as in psychosis
• Reliability


  Interviewer impression that the client give information accurately and completely
• Spirituality


  Involves the client's beliefs, values, and religious culture. These beliefs helping or hindering the client
• Sexuality


  May be impotent, hermaphrodite, may have lost a sexual partner, or victim of sexual abuse
• Glasgow Coma Scale


  Used to objectively describe the extent of impaired consciousness in all types of acute medical and trauma patients. Assesses patients according to three aspects of responsiveness: eye-opening, verbal responses and motor (E-V-M)