mental assessment.pptx

1. Mental Status Assessment

2. Health is a state of complete physical, mental and social well-being and
not merely the absence of disease or infirmity.(who)
Mental health is “a state of well-being in which every individual
realizes his or her own potential, can cope with normal stresses of life,
can work productively and fruitfully, and is able to make a contribution
to her or his community.(WHO,2013)

3. The stress surrounding a traumatic life event (death of a loved one, serious
illness) tips the balance, causing transient dysfunction. This is an expected
response to a trauma. For example, bereavement may lead to someone
feeling down or depressed, but is an expected emotional.
A mental disorder is apparent when a person’s response is much greater
than the expected reaction to a traumatic life event. It is a clinically
significant behavioral, emotional, or cognitive syndrome that is associated
with significant distress (a painful symptom) or disability (impaired
functioning) involving social, occupational, or key activities.(American
Psychiatric Association)
For example, major depression is characterized by feelings that are
unrelenting or include delusional or suicidal thinking, feelings of low self-
esteem or worthlessness, or loss of ability to function

4. Mental disorders include
1-organic disorders:
Caused by brain disease of known specific organic cause [e.g., delirium,
dementia, alcohol and drug intoxication, and withdrawal]
2-psychiatric mental disorders:
in which an organic etiology has not yet been established [e.g., anxiety
disorder or schizophrenia].

5. Mental status cannot be scrutinized directly like the characteristics of
skin or heart sounds. Its functioning is inferred through assessment of
an individual’s behaviors:
Consciousness: Being aware of one’s own existence, feelings, and
thoughts and of the environment. This is the most elementary of
mental status functions.
Language: Using the voice to communicate one’s thoughts and feelings.
This is a basic tool of humans, and its loss has a heavy social impact on
the individual.

6. Mood and affect: Both of these elements deal with the prevailing feelings.
Affect is a temporary expression of feelings or state of mind, and mood is
more durable, a prolonged display of feelings that color the whole emotional
life.
Orientation: The awareness of the objective world in relation to the self,
including person, place, and time.
Attention: The power of concentration, the ability to focus on one specific
thing without being distracted by many environmental stimuli.
Memory: The ability to lay down and store experiences and perceptions for
later recall. Recent memory evokes day-to-day events; remote memory
brings up years’ worth of experiences.

7. Abstract reasoning: Pondering a deeper meaning beyond the concrete
and literal.
Thought process: The way a person thinks; the logical train of thought.
Thought content: What the person thinks—specific ideas, beliefs, the
use of words.
Perceptions: An awareness of objects through the five senses.

8. Components of the Mental Status Examination
During that time keep in mind the four main headings of mental status
assessments :
A B C T
A:Appearance.
B:Behavior.
C:Cognition.
T:Thought processes.

9. It is necessary to perform a full mental status examination when you
discover any abnormality in affect or behavior and in the following
situations:
1-Patients whose initial brief screening suggests an anxiety
disorder or depression.
2-Family members concerned about a person's behavioral changes
such as memory loss or inappropriate social interaction.
3-Report of relevant organic behavioral symptoms, including
bizarre behavior (e.g., nocturnal wandering), concentration
problems, trouble with simple activities such as using the
television remote, inappropriate judgment, or linguistic difficulty.

10. 4-Brain lesions (trauma, tumor, stroke). A mental status
assessment documents any emotional or cognitive change
associated with the lesion.
5-Aphasia (the impairment of language ability secondary to brain
damage).
6-Symptoms of psychiatric mental illness, especially with acute
onset.(Sleep or appetite changes)

11. In every mental status examination, note these factors from the health
history that could affect your interpretation of the findings:
1-Any known illnesses or health problems such as alcohol use
disorders or chronic renal disease.
2-Current medications with side effects that may cause confusion
or depression.
Drugs that may lead to depressive, anxious, or psychotic syndromes
include corticosteroids, isotretinoin

12. 3-The usual educational and behavioral level—note that factor as
the normal baseline, and do not expect performance on the mental
status examination to exceed it.
4-Responses to personal history questions indicating current
stress, social interaction patterns, sleep habits, drug and alcohol
use.

13. In the following examination the sequence of steps
forms a Maslow’s Hierarchy of Needs

14. Objective Data
Equipment Needed:
1-Pencil.
2-paper.
3-reading material.

15. Appearance
1-Posture:
Posture is erect, and position is relaxed.
Anxiety and hyperthyroidism patients Sitting on edge of chair or curled
in bed, tense muscles, frowning, darting and watchful eyes, and restless
Depression patients Sitting slumped in chair, slow walk, dragging feet

17. 2-Body Movements.
Body movements are voluntary, deliberate, coordinated, smooth, and
even.
Anxiety patients Restless, hyperkinetic appearance.
Depression and dementia patients Apathy and psychomotor slowing.
Schizophrenia patients abnormal posturing and bizarre gestures.
Patients with pain Facial grimaces.
Neurologic disorders (e.g., Tourette syndrome) Involuntary tics can
occur

18. 3-Dress.
Dress is appropriate for setting, season, age, gender, and social group.
Clothing fits and is worn appropriately.
Inappropriate dress can occur with organic brain syndrome.
Eccentric dress combination and bizarre makeup occur with
schizophrenia or manic syndrome.

19. 4-Grooming and Hygiene.
The person is clean and well groomed; hair is neat and clean; women
have moderate or no makeup; men are shaved, or beard or mustache is
well groomed. Nails are clean (although some jobs leave nails
chronically dirty).
Note congruence between dress/grooming and age.
NOTE: A disheveled appearance in a previously wellgroomed person is
significant. Use care in interpreting clothing that is disheveled, bizarre,
or in poor repair;piercings; and tattoos because these sometimes
reflect the person's economic status or a deliberate fashion trend
(especially among adolescents).

20. Unilateral neglect (total inattention to one side of body) occurs
following some strokes.
Inappropriate dress, poor hygiene, and lack of concern with
appearance occur with depression and severe Alzheimer disease.
Meticulously dressed and groomed appearance and fastidious manner
may occur with obsessive compulsive disorders.

21. 5-Pupils.
Note pupil size and reaction to light.
Dilated or constricted pupils may be a sign of recent drug use.
Recent anisocoric (unequal pupil size) can be the result of a brain
tumor.

22. Behavior
1-Level of Consciousness.
The person is awake, alert, and aware of stimuli from the environment
and within the self and responds appropriately and reasonably soon to
stimuli.
Loses track of conversation, falls asleep. Lethargic (drowsy), obtunded
(confused)

24. 2-Facial Expression.
The look is appropriate to the situation and changes appropriately with
the topic. There is comfortable eyecontact unless precluded by cultural
norm.
Flat, mask like expression occurs with parkinson’s and depression.

25. 3-Speech.
Judge the quality of speech by noting that the person makes laryngeal
sounds effortlessly and shares conversation appropriately.
The pace of the conversation is moderate, and stream of talking is
fluent.
Articulation (ability to form words) is clear and understandable.
Word choice is effortless and appropriate to educational level. The
person completes sentences, occasionally pausing to think.

27. 4-Mood and Affect.
Judge this by body language and facial expression and by asking
directly, “How do you feel today?” or “How do you usually feel?” The
mood should be appropriate to the person's place and condition and
change appropriately with topics. The person is willing to cooperate
with you.

29. Cognitive Functions
1-Orientation.
You can discern orientation through the course of the interview by asking
about the person's address, phone number, and health history. Or ask for it
directly, using tact, by saying, “Some people have trouble keeping up with
the dates while in the hospital. Do you know today's date?” Assess:
Time: Day of week, date, year, season
Place: Where person lives, present location, type of building, name of city
and state
Person: Own name, age, who examiner is Many hospitalized people normally
have trouble with the exact date but know the year and are fully oriented on
the remaining items.
Disorientation occurs with delirium and dementia. Orientation is usually lost
in this order: first to time, then to place, and rarely to person

30. 2-Attention Span.
Check the person’s ability to concentrate by noting whether he or she
completes a thought without wandering.
Note any distractibility or difficulty attending to you. Or give a series of
directions to follow and note the correct
sequence of behaviors, such as, “Please take this glass of water with
your left hand, drink from it, shift it to your right hand, and set it on
the table.” Note that attention span commonly is impaired in people
who are anxious, fatigued, or drug intoxicated.
Digression from initial thought. Irrelevant replies to questions. Easily
distracted; “stimulus bound” (i.e., any new stimulus quickly draws
attention). Confusion, negativism.

31. 3-Recent Memory.
Assess recent memory in the context of the interview by the 24-hour
diet recall or by asking the time the person arrived at the agency. Ask
questions you can corroborate.
This screens for the occasional person who confabulates or makes up
answers to fill in the gaps of memory loss.
Recent memory deficit occurs with delirium, dementia, amnestic
syndrome, or Korsakoff syndrome in chronic alcoholism

32. 4-Remote Memory.
In the context of the interview, ask the person verifiable past events
(e.g., ask to describe past health, the first job,birthday and anniversary
dates, and historical events that are relevant for that person).
Remote memory is lost when the cortical storage area for that memory
is damaged (e.g., Alzheimer dementia or any disease that damages the
cerebral cortex)

33. The Four Unrelated Words Test
This tests the person’s ability to lay down new memories. It is a highly sensitive and
valid memory test. It requires more effort than does the recall of personal or
historic events. It also avoids the danger of unverifiable material.
Say to the person: “I am going to say four words. I want you to remember them.
In a few minutes I will ask you to recall them.” To be sure the person has
understood, have the person repeat the words. Pick four words with semantic and
phonetic diversity:
1. Brown 1. Fun
2. Honesty 2. Carrot
3. Tulip 3. ankle
4. Eyedropper 4. loyalty

34. After 5 minutes, ask for the recall of the four words. To test the
duration of memory, ask for a recall at 10 minutes and at 30 minutes.
The normal response for people younger than 60 years is an accurate
three- or four-word recall after a 5-, 10-, and 30-minute delay.
People with Alzheimer dementia score a zero- or oneword recall
Impaired new learning ability also occurs with anxiety (because of
inattention and distractibility) and depression (because of lack of effort
mobilized to remember).

35. Additional Testing for Persons With Aphasia
Aphasia is the loss of the ability to speak or write coherently or to
understand speech or writing as a result of a stroke or brain damage.
1-Word Comprehension.
Point to articles in the room, parts of the body, or articles from pockets and
ask the person to name them.
2-Reading.
Ask the person to read available print. Be aware that reading is related to
educational level. Use caution that you are not testing literacy. Ensure that
the person has reading glasses if needed, and use a large-print item if
possible.

36. 3-Writing.Ask the person to make up and write a sentence describing
the weather or their job. Note coherence, spelling, and parts of speech
(the sentence should have a subject and a verb).
Agraphia (inability to communicate through writing) often occurs in
patients with aphasia.

38. Thought Processes and Perceptions
1-Thought Processes.
Ask yourself, “Does this person make sense? Can I follow what the
person is saying?” The way a person thinks should be logical, goal
directed, coherent, and relevant. The person should complete a
thought.
Illogical, unrealistic thought processes. Digression from initial thought.
Ideas run together. Evidence of blocking (person stops in middle of
thought).

40. 2-Thought Content.
What the person says should be consistent and logical.
3-Perceptions.
The person should be consistently aware of reality. The perceptions should be
congruent with yours. Ask the following questions
• How do people treat you?
• Do other people talk about you?
• Do you feel as if you are being watched, followed, or controlled?
• Is your imagination very active?
• Have you heard your name when alone?
Auditory and visual hallucinations occur with psychiatric and organic brain disease
and psychedelic drugs. Tactile hallucinations occur with alcohol withdrawa

42. Screen for Anxiety Disorders
You can screen for core anxiety symptoms by administering the first 2
questions (GAD-2) from the 7-item generalized anxiety disorder scale
(GAD-7)Scores on the GAD-2 range from 0 to 6; a score of 0 suggests
that no anxiety disorder is present, whereas a score ≥3 is suggestive of
GAD.
The four most common anxiety disorders are GAD, panic disorder,
social anxiety disorder, posttraumatic stress disorder (PTSD) A score of
10 on the GAD-7 identifies GAD; scores of 5, 10, and 15 represent mild,
moderate, and severe levels of anxiety. More recently, research
suggests that a score ≥8 on the GAD-7 may better identify patients with
GA.

43. (Kroenke, 2007.)
The GAD-2 was based on the GAD-7,
which was developed by Drs. Robert
L. Spitzer, Janet B.W. Williams, Kurt
Kroenke and colleagues, with an
educational grant from Pfizer Inc. No
permission required to reproduce,
translate, display or distribute.

45. Screen for Depression
Many formal screening tools are available. However, a shorter
screening method is the Patient Health Questionnaire-2 (PHQ-2), which
entails asking two questions about depressed mood and anhedonia
(little interest or pleasure in doing things) that will detect a majority of
depressed patients.
Thus you can ask: “Over the past 2 weeks have you felt down,
depressed, or hopeless?” and “Over the past 2 weeks, have you felt
little interest or pleasure in doing things?”
Finding positive answers to these questions then requires further
diagnostic tools to assess specific depressive disorders

46. (Developed by Spitzer, R. L., Williams,
J. B. W, Kroenke, K., et al. 1999.)
Add the totals for each of the three
columns together to obtain the
severity score. If question 10 is
answered “somewhat difficult” or
greater, it indicates functional
impairment.
A PHQ-9 score of 5 to 9 = minimal
symptoms; 10 to 14 =minor
depression; 15 to 19 = major
depression, moderately severe; ≥20 =
major depression, severe.

48. Screen for Suicidal Thoughts
When a person expresses feelings of sadness, hopelessness, despair, or grief, it is
important to assess for any possible risk of physical harm to himself or herself.
Begin with more general questions. If you hear affirmative answers, continue with
more specific questions:
1-Have you ever felt that life is not worth living?
2-Have you ever thought of hurting yourself? If so, how often?
3-Do you feel like hurting yourself now?
4-Do you have a plan to hurt yourself?
5-How would you do it?
6-What would happen if you were dead?
7-How would other people react if you were dead?
8-Whom could you tell if you felt like killing yourself?

49. It is very difficult, especially for beginning examiners, to question
people about possible suicidal wishes.
You may be the only health professional to pick up clues of suicide risk.
You are responsible for encouraging the person to talk about suicidal
thoughts.
Another recommendation is to have the person sign a contract that
contains a plan not to act on suicidal thoughts if they happen again.
The plan should contain the names and numbers of people the patient
can call if suicidal ideations occur.

50. Depression is painful and debilitating, and sometimes a depressed
person really wishes to kill himself or herself.
Asking about suicidal thoughts does not increase suicidal behavior.
Promptly share any concerns you have about a person’s suicide ideation
with a mental health professional.
Suicide is preventable, but it is the 10th leading cause of death in the
United States and the 2nd leading cause among those ages 15 to 34 years.
Between 20% and 33% of suicide victims test positive for alcohol,
antidepressants.

51. Although females are more likely to have suicidal thoughts, males are 4 times
more likely to commit suicide (most often by firearms).
Important clues and warning signs of suicide: Prior suicide attempts
Depression, hopelessness Firearms in the home Family history of suicide
Incarceration Family violence, including physical or sexual abuse Self-
mutilation Anorexia Verbal suicide messages (defeat, failure, worthlessness,
loss, giving up, desire to kill self)
Data from the Jordanian Department of Statistics showed an increase in the
number of suicides in Jordan last year to 186, by 10% compared to 2020,
when 169 cases were recorded. According to the data, the number of
suicides recorded last year was the highest since 2017, reaching 130 cases,
and in 2018 about 142 cases, according to what was reported by the semi-
governmental Al-Mamlaka TV.

52. Judgment
To assess judgment in the context of the interview, note what the
person says about job plans, social or family obligations, and plans for
the future. Job and future plans should be realistic, considering the
person’s health situation.
Impaired judgment (unrealistic or impulsive decisions, wish fulfillment)
occurs with developmental disability, emotional dysfunction,
schizophrenia, and organic brain disease.

53. The Mini-Mental State Examination (MMSE)
Test of the cognitive functions of the mental status examination
(memory, orientation to time and place, naming, reading, copying or
visuospatial orientation, writing, and the ability to follow a three-stage
command). It requires paper and pencil; the person must be able to
write and have no vision impairment. The MMSE is copyrighted and
available for purchase from Psychological Assessment Resources, Inc.

54. Includes a standard set of only 11
questions, and requires only 5 to 10
minutes to administer
The maximum score on the test is 30;
people with normal mental status
average 27. Scores between 24 and
30 indicate no cognitive impairment
Scores that occur with dementia and
delirium are classified
as follows: 18-23 =mild cognitive
impairment; 0-17 =severe cognitive
impairment.
An alternate assessment tool, the
Montreal Cognitive Assessment
(MoCA), is available to assess mental
status.

55. The Mini-Cog
The Mini-Cog is a reliable, quick, and easily available instrument to
screen for cognitive impairment in otherwise healthy older adults It can
be used with various cultural groups and literacy levels and takes only 3
to 5 minutes to administer. The Mini-Cog is not influenced by
educational level or health literacy of the patient and can be used in a
variety of settings, including the hospital.

58. Abnormal funding

61. Case study

62. M. Is a 64-year-old married man with chronic hypertension and
Diabetes Completes Self loss of interest in work .
Sadness of mood.
Minimal communication.
Disturbed sleep (Excess for few weeks & decreased for few weeks)
Irritability

63. Symptoms started gradually without any stressor and progressed over period
of time.
He started saying that he has lost interest in work.
He was planning to take VRS and sit at home.
Sleep was becoming irregular and appetite was increased.
There was occasional forgetfulness.
He was feeling that people were talking about him.

64. No h/o Hearing of voices, loss of self care.
No h/o Elated mood or big talk.
No h/o Suicidal attempt.
No h/o Seizure or any neurological disorder.
No h/o Cognitive decline.
No h/o Repeated checking or hand washing.
Pt has h/o occasional social drinking of alcohol in past. But no consumption since
last 8 yrs.

65. Physical examination
General Appearance
Conscious, cooperative but had limited communication.
He was restless.
Sadness was present.
His dressing and grooming was proper.
Eye to eye
contactInitiated but could not be maintained.
Rapport
Established & maintained.

66. Attention
Arousable & sustained.
Mood
Sad & anxious
Affect
Appropriate to mood.
Speech
Continuous, coherent & relevant.
Speech decreased in amount.

67. Thought
Patient had ideas of hopelessness, helplessness & worthlessness. He was
feeling that life is not worth.
Delusions were absent.
Concepts
Both simple and abstract thinking were intact.
Perception
No perceptual abnormality was present.
Memory
Registration 3/3
Recall 1/3
Recent & remote memory intact.

68. Orientation
To time, place and person was present.
Judgment
Both social & test judgment intact.
Diagnosis
Depression