AppearanceYes, appearance is justas straightforward as itseems. For examplehow does your patientlook, smell, behave, orspeak .What can you say aboutthis patient?Age GroomingSex DressBuild Activity
AppearanceHow the patient relatesto the interviewer isalso important.Is the patientwithdrawn, cooperative,distant, shy, relaxedcautious, hostile orFRIGHTENED?
Rate and amount Normal (culturally derived)Speech Pressured –rapid speechSpeech patterns can be Slow-difficulty finding wordsassessed for speed.Some illness conditions Impoverished or paucity of speechhave concomitantspeech patterns. One ofthose patterns is acharacteristic rate.
Rhythm StutteringSpeech MonotoneSometimes called Slurredprosody-rhythm alsoalludes to the quality of Mumbledthe voice Poor articulation Clear Coherent
Volume Soft-spokenSpeech LoudThe softness of Poor articulationloudness of voice canindicate sensoryproblems, e.g.,deafness, moodproblems, e.g.,depression or mania; orcognitive problems,e.g., dementia
Spontaneity Animated- excitedSpeech Little detail No speech
Eye contactUsually included in theAppearance section, becautioned to respect thecultural componentof eye contact.No eye contact isconsidered rude insome cultures anddirect eye contact isconsidered rude inother cultures
MoodMood and Euthymic (normal)Affect Euphoric (elated)Mood- the subjective Dysphoric (sad)state of a person or howthe person ―feels‖.
Some other recognized subjective feelings (mood) are:Mood Anxious Calm Irritated Angry
Range The degree of variation in emotionAffect ExpansiveAffect is the outward Normaldisplay of mood andcan be judged on four Restricted – Dull- Bluntedparameters: FlatRangeIntensityLabilityAppropriateness
Intensity High LowIntensityEmotional power beingemitted from thepatient
Labile affect Extreme change in a short period ofLability timeMoodiness or the Laughing and crying at the same time―swing‖ of moodsOutside of highlyemotional events suchas weddings, labileaffect can be noted insome diseaseconditions, e.g. chronicalcoholism, or bipolardisorder 1.
The patient below says, ―I am soAppropriate happy today.‖ His affect isness inappropriate to his mood andAffect- the outwarddisplay of mood – circumstance.should be congruentwith mood andcircumstances.
Failure of orientation usually occurs in the following sequence:OrientationAreas of orientation are TimePersonPlace PlaceTime Person andCircumstance Never document person is oriented times three. Proper documentation is person is oriented to person, place, and time.
Confused is the attribute given to persons who become unaware ofCircumstance the circumstances surroundingNot understanding thatthis presentation is a them.lesson on the mentalstatus exam andthinking it is a group ofcartoons is amisunderstanding ofthe circumstance orCONFUSION
So, a person can be oriented to person, place, and time and stillCONFUSION be confused.Sometimes calleddisorientation tocircumstanceConfusion is quitecommon in high anxietystates or in delirium,dementia, or mooddisordered states
Intellectual Intellectual Capacity is based on:and Cognitive VocabularyFunctioning Ability to understand complex conceptsTwo closely related General fund of informationattributesIntelligence isconsidered to beAverageAbove AverageBelow Average
Level of Abstraction Don’t cry over spilled milk.CognitionCognitive ability isusually examined bytestingLevel of Abstraction Does the patient interpretExecutive Function literally?Memory How are an orange and a banana alike? Both are fruit or both are in the world?
Executive function- How to studyExecutive for an exam in NUR 682functionThe ability to make asequence or plan 1. Order a latte grande 2. Add extra sugar 3. Sit by the library 4. Study for the exam 5. Get a good night’s sleep
Memory Recent -within the relative past shortMemory time e.g. breakfastThe first memory to be Remote – not in the relative past shortlost is recent. time e.g. name of first boyfriend Recall-ability to say one’s SS # Retain- ability to learn and then recall new information, e.g., nurse’s name.
ConfabulationA special case ―I went out on a date with BradConfabulation issometimes used by Pitt last night.‖persons with braindamage or dementia.Confabulation is theconstruction of unrealevents which seem real,even to the person whoconstruct them, yet thee vents are unreal.
Tangentiality– digressing, oftenThought multiple times, during theProcesses relating of an episode or story.The only way toexamine is by analyzing Noted in states of high anxietyspeech:TangentialityCircumstantialityFlight of IdeasBlockingLoose AssociationsPerseveration
Circumstantiality- an unnecessaryThought telling of details when relating anProcesses episode or story.Circumstantiality isnote d with personswho are highly anxious,suffer from Bipolardisorders, or fromDementia
Blocking---train of thought stopsThought in mid sentence.processesBlockng is noted in highanxiety states,depressive states, andin thought disorderedconditions
Flight of IdeasFlight of IdeasMoving quickly fromone idea to another in avery short period oftime. Often noted inpersons with Bipolardisorder
Loose Associations- words spokenThought at random and not in sentencesProcessesLoose associations aremost often noted inpersons suffering fromSchizophrenia
PerseverationThought Now is the time for every goodProcesses man to come to the aid of thePerseveration- the country. Now is the time for everyinability to move on toanother topic or the good man to come to the aid ofcontinual return to the the country. Now is the time forsame topic every good man to come to the aid of the country. Now is the time for every good man to come to the aid of the country. Now is the time for every good man to come to the aid of the country. Now is the time for every good man to come to the aide of the country
Delusions—false beliefsThought --Ideas of referenceContent (People are talking about me)Delusions- false beliefs --Paranoid (People are after me)Life themes-recurrentbeliefs --Grandeur (I am the President of UM)Control-degree of --Nihilisticcontrol over one’sthoughts (My muscles are disappearing)
Life themes-Recurrent beliefs --Loss --Anger --Victimization
Thought ControlThought Thought broadcasting (thinking one’sControl thoughts are being heard by others)These disorders ofthought are often foundin persons who suffer Thought insertion (thinking one’sfrom schizophrenia thoughts are being inserted by someone or something else) Thought withdrawal (thinking one’s thoughts are being stolen)
Hallucinations- the experiencingPerceptual of a perception in the absence of aProblems stimulusAll senses can beinvolved in sensory Auditory (hearing voices)perceptual problems Visual (seeing people of objects)Hallucinations Tactile (feeling things)Illusions Gustatory (tasting things) Olfactory (smelling aromas)
Illusions --the experiencing of a mis-perception Auditory (hearing a sound andIllusions- common in thinking it is a knock on the door)fatigue and delirium Visual (seeing a towel and thinking it is a cat) Tactile (feeling a touch and thinking it is a burn) Gustatory (tasting onions and thinking they are chocolate) Olfactory (smelling fish and thinking it is apple pie)
Final Judgment- stable quality ofcomponents of persons decision makingthe MSEJudgmentInsightImpulse control
Insight- the ability for one to understand his or her condition.
Impulse control-the ability to talkImpulse out rather than act out.control