Mental Status Assessment and Substance Abuse

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Questions and Answers

What is a common characteristic of schizophrenia as noted in the provided content?

Distorted speech (correct)

Increased physical energy

Positive screening results

Stable mood patterns

Which condition is directly related to significant memory loss as mentioned?

Alzheimer's dementia (correct)

Anxiety

Stroke

Schizophrenia

How is delirium described in comparison to normal aging?

Rational thinking

Complete cognitive clarity

Severe cognitive impairment (correct)

Slight memory loss

What does a score of 22 or more indicate in the context of alcohol use?

Further assessment required Signup and view all the answers

Which of the following symptoms is NOT typically associated with poor self-esteem?

Heightened sense of self-worth Signup and view all the answers

What indicates a person is not fully alert based on the provided descriptions?

Constant stimulation needed Signup and view all the answers

Which drug-related issue is highlighted as a risk factor for poor decision-making?

Withdrawal symptoms Signup and view all the answers

What condition is characterized by a distorted speech that is not coherent or understandable?

Schizophrenia Signup and view all the answers

Which of the following best describes a person who drifts to sleep but can be aroused appropriately?

In and out of consciousness Signup and view all the answers

What is the primary risk level associated with a screening score of 8 to 14?

Hazardous use Signup and view all the answers

Which symptom is often linked to substance abuse and poor decision-making?

Poor delusion making Signup and view all the answers

What condition is characterized by a need for vigorous stimulation to be aroused?

Delirium Signup and view all the answers

What level of alcohol use risk is indicated by a score of 22 or more?

Further assessment needed Signup and view all the answers

What does early depression potentially lead to in terms of psychological conditions?

Anxiety disorders Signup and view all the answers

Study Notes

Chapter 5: Assessing Mental Status Including Risk for Substance Abuse

This chapter focuses on assessing mental status, including the risk for substance abuse.
Objectives include defining behaviors indicative of mental status, describing developmental considerations in mental status exams, stating the purpose of mental status exams, listing the components of a mental status assessment, completing a mini-mental state exam, and discussing developmental care for various age groups.

Mental Disorder

A mental disorder is apparent when a person's response is significantly greater than expected in reaction to a traumatic event. This is often subjective data.
A mental disorder is a clinically significant behavioral, emotional, or cognitive syndrome linked to distress or disability in social, occupational, or critical areas of life.
Over one in five US adults experience mental illness.
Mental illness impacts both physical and emotional well-being.

Factors Affecting Mental Health

Economic and social factors include social norms, financial changes, isolation, and stress.
Unhealthy lifestyle choices like smoking, drug use (including alcohol), and exposure to violence can negatively impact mental health. Also, personality factors like poor decision-making and low self-esteem play a role.
Spiritual factors and cultural factors are also important to consider.
Neurological impairments, such as brain injuries, can also impact mental health.
Psychosocial developmental level and issues also contribute to mental well-being.

WHO Definition of Substance Abuse

Substance abuse is defined as "harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs."
Repeated substance use can lead to dependence syndrome, marked by behavioral, cognitive, and physiological changes.
Individuals experiencing substance abuse often have a strong desire to use the substance, difficulty controlling use, and continue use despite harmful consequences. This can affect their priorities in life, leading to avoidance of responsibilities and physical withdrawal.

Risk Factors for Mental Health Disorders and Substance Abuse

A history of early aggressive behavior can be a risk factor.
Lack of parental supervision is a contributing factor.
A history of substance abuse is a key risk factor.
Drug availability increases the risk of substance abuse.
Poverty is also a risk factor.

Components of the Mental Status Exam

The mental status exam typically includes four main sections: Appearance (A), Behavior (B), Cognition (C), and Thought Processes (T).
These are assessed during the health history interview, considering these core aspects.

Objective Data

Preparing a client for a thorough mental status examination includes preparing them for the questions they may be asked. These can be lengthy, and some may seem silly to the client but are still important.
Necessary equipment for a mental status exam typically includes a pen and paper and screening tools (as needed).

Mental Status Exam - Appearance

Normal findings include erect posture, relaxed position, voluntary, smooth and deliberate movements, appropriate dress for the situation, age, gender, and culture. Proper hygiene is also observed.
Abnormal findings include sitting on the edge of a chair, curled up in bed; facial expressions like frowning or darting eyes; restlessness; pacing; slumped posture; abnormal or bizarre postures; facial grimacing; involuntary tics; and inappropriate or eccentric dress.

Mental Status Exam - Behavior

Normal behaviors include alertness, appropriate responses to stimuli, appropriate facial expressions, comfortable eye contact during conversations, moderate pace, fluent speech with clear articulation, behavior appropriate for the situation, and cooperativeness;
Abnormal behaviors include loss of train of thought; lethargy; flat or mask-like expressions; abnormal volume or slow, monotonous speech; speech impediments (like dysarthria or aphasia), inability to express ideas or be coherent; and inappropriate behavior.

Levels of Consciousness

Alert: awake and easily aroused
Lethargic: not fully alert, drifts to sleep, responds appropriately
Obtunded: often sleeps, difficult to arouse, continuous stimulation needed
Stupor: in and out of consciousness, needs vigorous stimulation
Coma: completely unconscious

Mental Status Exam - Cognitive Functions

Orientation: oriented to person, place, and time, absence of disorientation
Attention span: maintaining attention
Following instructions, absence of distraction, relevant answers to questions;
Recent memory: recalling recent events or information easily
Remote memory: recalling past events, past health, relevant historical events easily
Remote memory: recalling past events
New learning: learning and recalling new information
Impaired cognition might manifest as disorientation, distraction, irrelevant replies, confusion, inability to recall or difficulty with new learning.

Mental Status Exam - Judgment

Judgment involves comparing alternatives and decisions to reach an appropriate course of action.
Assessing judgment involves considering daily/long-term goals, likelihood of acting based on delusions/hallucinations, and capacity to act violently or attempt suicide.
Normal judgement involves realistic job plans, social and family obligations and future plans, as well as actions and decisions.
Abnormal judgment is indicated by impaired judgment, developmental disability, emotional dysfunction, schizophrenia, and organic brain disease.

Mental Status Exam - Thought Processes & Perceptions

Normal thought patterns are logical, goal-oriented, coherent, and relevant.
Thoughts need to be consistent with reality, and the person's perceptions in agreement with others'.
Abnormal thought patterns include illogical, unrealistic thoughts, digressing from the initial thought, and running together of ideas; obsessive-compulsive, phobic, delusional disorders, and hallucinations.
Perceptions congruent with reality.

Mental Status Exam - Screen for Suicidal Thoughts

A significant number of individuals who die by suicide are seen by healthcare providers in the months before their death.
A validated screening tool is crucial, such as the ASQ (Ask Suicide-Screening Questions). This screening tool is quick with four questions.
Positive screening involves assessing denial of suicidal thoughts, and if positive, further assessment and interventions are necessary.

Mental Status Exam - Screen for Anxiety

Anxiety disorders commonly occur and are disabling.
The GAD-7 is a tool for assessing generalized anxiety disorder.
The GAD-2 is a shorter, screened tool for common anxiety symptoms.
Scores above 3 indicate potential generalized anxiety disorder.

Mental Status Exam - Screen for Depression

The PHQ-2 is a brief screening tool that asks 2 questions about depressed mood and anhedonia.
It helps detect a majority of depressed individuals.
For those scoring over 2, the full PHQ-9 should be completed.
The PHQ-9 rates symptoms from minimal to major depression.

Supplemental Mental Status Examination - Mini-Mental State Examination (MMSE)

This exam evaluates cognitive functions such as memory, orientation, naming, reading, copying, visuospatial orientation, writing, and following three-stage commands.
It's a quick method (5-10 minutes), suitable for individuals without visual impairments.
Scoring above 27 indicates typical cognitive function.
Scoring 18-23 indicates possible mild impairment, while 0-17 suggests severe cognitive impairment.

Supplemental Mental Status Examination - Mini-Cog

This is a short, reliable and easily accessible screening tool for cognitive impairment in healthy adults.
It uses a 3-item recall test and a clock drawing test.
These tests take 3-5 minutes to administer and are not influenced by literacy/health knowledge or education level.
Tests executive functionality.

10 Signs & Symptoms of Alzheimer's Disease

Memory loss affecting daily life.
Challenges in planning or problem-solving.
Difficulty with familiar tasks.
Confusion with time or place.
Trouble understanding visual images or spatial relations.
New problems with words/speaking/writing.
Misplacing things and losing the ability to retrace steps.
Impaired judgment.
Withdrawal from social activities.
Changes in mood or personality.

Alcohol Use & Abuse

Nearly 15 million Americans have an alcohol use disorder, with 414,000 being adolescents.
Alcohol-related causes of death are responsible for 100,000 deaths annually, ranking as the third leading cause of preventable death in the US.
Over 10,000 people die annually from alcohol-related driving fatalities.

Alcohol Screening Tools

Brief screening tools (such as AUDIT and CAGE) can identify problem drinking needing further assessment;
AUDIT is a more comprehensive questionnaire
CAGE is a quicker, more targeted questionnaire.

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Description

This quiz covers Chapter 5 on assessing mental status, particularly focusing on the risk of substance abuse. Key objectives include understanding mental status behaviors, conducting mental status exams, and recognizing the impact of mental disorders on individuals. Learn about developmental considerations and the significance of these assessments.