Mental Status Examination Quiz

Psychiatric Mental Status Examination

• The Psychiatric Mental Status Examination (MSE) is analogous to the physical examination, used to evaluate a person's current cognitive, affective, and behavioral functioning. (Varcarolis, 2014)
• Mental status refers to emotional and cognitive functioning. It's inferred through behavior.
• The nurse assesses mental health using various methods beyond a standard physical exam. These assessments include performing a mental status examination, completing a psychosocial assessment, reviewing psychotropic medication use (and side effects), checking for suicidal ideation/trauma/substance misuse, incorporating spiritual assessment, and considering lifespan, developmental, and cultural factors. The nurse reviews any relevant laboratory results.
• MSEs are done when family members express concern about a person's behavior, when brain lesions are suspected/confirmed, in cases of aphasia, or when psychiatric illness or substance abuse is suspected.
• MSEs provide information about cerebral cortex function, and can help determine the validity of a person's self-reported information if there are concerns about distorted thought processes or impaired memory.

Objectives

• Discuss history taking in mental health
• Describe the Mental Status Examination (MSE).

Mental Status Assessment

• When is it done? Comprehensive if needed; Focused if addressing specific issues like memory loss or confusion.
• How is it done? Through observation, special tests (e.g., MMSE, MOCA, Mini-Cog). Nurses assess, interpret, report, and document findings.

Defining Mental Status

• Mental status encompasses emotional and cognitive functioning.
• It's inferred by observing individual behaviors.

Assessing Mental Health

• Multiple assessments are needed, supplementing the physical examination.
• Assessments may include mental status examinations, psychosocial assessments, psychotropic medication review, screening for suicidal ideation, substance misuse, trauma, and incorporating a spiritual assessment.
• Consider lifespan, developmental, and cultural factors. Reviewing related lab results is also important.

When is a Mental Status Assessment Done?

• Family members express concern about behavioral changes.
• Suspected or confirmed brain lesions.
• Aphasia is present.
• Symptoms of psychiatric illness are present.
• Suspected substance abuse.

Mental Status Examinations

• Provide details about cerebral cortex function.
• Cerebral abnormalities affect intellectual ability, communication, and emotional behaviors.
• Important in assessing the validity of patient-reported information, especially if thought processes or memory are impaired, and other sources of information are needed.

Factors Affecting Mental Status Assessment

• Known illnesses or health problems (e.g., alcoholism, chronic renal disease).
• Current medications and their potential side effects (e.g., confusion or depression).
• Usual educational and behavioral levels to prevent unrealistic expectations based on these.
• Responses to personal history questions assessing stress, social interactions, sleep, and substance use.

Developmental Considerations: Infants and Children

• Varying developmental stages significantly affect aspects of a mental status exam.
• Factors like consciousness, language ability, attention span, and abstract thinking are developmental and should be considered appropriately.

Developmental Considerations: Aging Adult

• The aging process typically doesn't severely impact mental status, but response time may slow down, affecting learning.
• Age-related physical changes (vision/hearing) affect mental status.
• Potential losses (spouse, job, income) can increase risk for grief, despair, disorientation, disability, or depression.

Mental Status Examination: Appearance and Behavior

• Self-care: Neglected or not.
• Facial expression.
• Movement (shoulders/head/gaze).
• Eye contact.
• Speech.
• Speed, pauses, spontaneity, volume.
• Mood/affect.
• Current mood (low mood/misery).
• Future perception (pessimistic).
• Past reflection (guilt).
• Suicidal ideation.
• Overall well-being.
• Dysphoric feelings.

Mental Status Assessment (ABCT)

• Appearance; Behavior; Cognition; Thought processes.

Assessing Appearance

• Posture and position.
• Erect? Relaxed?
• Body movements; voluntary? Deliberate? Co-ordinated? Smooth & even?
• Dress; setting appropriate for season, age, and gender? Proper fit? Put on properly?
• Grooming and hygiene. Clean and well groomed?

Assessing Behavior

• LOC: Awake, alert, aware of environment.
• Facial expression, appropriate to situation.
• Speech: Appropriate volume, pace, articulation, and word choice.
• Mood/affect: Observe body language and, if needed, ask directly.

Level of Consciousness

• Alert: Awake, easily aroused, oriented, communicates appropriately.
• Lethargic (Somnolent): Not fully alert, opens eyes to stimuli, may fall back asleep quickly.
• Obtunded: Transitional state between lethargy and stupor. Difficulty staying awake but responds to stimuli; may be confused.
• Stupor/Semi-coma: Awakens only to vigorous/painful stimuli. May have some reflex activity, but motor responses are usually slow.
• Coma: Unresponsive to stimuli; eyes usually closed. No purposeful movement.

Cognitive Assessment

• Orientation: To time, place, person.
• Attention span: Assessing concentration/focus.
• Recent memory.
• Remote memory.
• New learning: 4 unrelated words (or another test).
• Additional aphasia testing (word comprehension, reading, writing).
• Insight & Judgment: Assessing daily/long-term goals. Realistic in the context of current health.

Additional Cognitive Assessment

• Attention (asking the patient to repeat increasingly long lists of numbers or performing serial 7's or 3's subtraction).
• Memory (recent memory with 3 or 4 unrelated words; remote memory with information like the patient's maiden name, spouse’s name, or birthday).
• Judgment (asking the patient to make decisions in hypothetical situations; assessing sound reasoning).
• Mini-Mental State Exam (MMSE) (Quick 10–15-minute cognitive screening test). Maximum score is 30; average is 27; No cognitive impairment scores between 24-30; Mild cognitive impairment scores 18-23; Severe cognitive impairment scores 0-17.
• Montreal Cognitive Assessment (MoCA) (Standardized set of questions). Maximum score is 30; no impairment above 26; mild cognitive impairment scores 18–26; moderate scores 10–17; severe cognitive impairment scores <10.

Assessing Thought Processes

• Thought content: Logical and consistent?
• Perceptions: Aware of reality? (No hallucinations)
• Screen for suicidal thoughts (with specific questions).

Suicide Ideation

• Incidence: All ages, different social classes and cultures. Attempts are much more common than completed suicides.
• Canadian Statistics: A significant issue, leading cause of death in certain age groups, females less likely to complete than males.
• Factors associated with suicide risk (SAD PERSONAS): Sex, Age, Depression, Previous attempt, Ethanol abuse, Rational thought loss, Social supports, Organized plan, No spouse, Access to lethal means, Sickness.
• Important to remember assessment is a snapshot in time. Risk can change quickly.

Risk of Self-Harm

• Self-harm involves intentional damage to one's body, without the intent to die.
• Assessment factors include low mood, sense of abandonment, history of self-harm, and alcohol use.
• Management of increased risk: The approach should be calm and supportive; remove harmful objects and encourage sharing; remain available for support; and explore alternative coping methods to support future episodes and plan.

Risk of Violence

• Violence is a physical attack to cause harm to a person or object.
• Aggression can range from physical acts (kicks, punches) to verbal abuse.
• Risk factors include young males' higher involvement, and past violence incidents.
• Risk assessment includes considering internal factors (mental health, age, gender, past history) and external factors (environment, treatment setting, situational factors).
• Observable behaviors in violent situations (STAMP). Staring, Tone, Anxiety, Mumbling, Pacing

De-escalation Strategies

• Calm demeanor.
• Choices.
• Change of subject to positive topics.
• Collaboration to calm activities
• Space, allow for time/re-think
• Listen and Repeat

Delirium vs. Dementia

• Delirium: Disturbed consciousness; ↓ awareness of environment & ↓ ability to sustain attention; fluctuations in cognition, memory impairment, disorientation, language disturbances and perception.
• Dementia: Persistent reduced cognitive functioning (memory impairment); various cognitive disturbances present, and they progressively worsen.

Depression

• Criteria for a major depressive episode involve five or more symptoms for at least two weeks, indicating a change from previous functional levels. Symptoms include depressed mood, diminished interest/pleasure, significant unplanned weight change, sleep disturbances, psychomotor changes (agitation/retardation), fatigue, feelings of worthlessness, diminished concentration, indecisiveness, and recurring thoughts of death.

Mental Status: Normal Findings

• Posture erect, gait & symmetrical body movements. Clean/well-groomed/appropriate clothing to setting/weather. Facial expressions that fit conversation content.

Documenting Mental Status

• Appearance; posture, movements, dress, grooming.
• Behavior; alertness, speech, facial expressions, affect/emotional responses.
• Cognitive function; orientation (time,place, person), attention span, memory (recent & remote), new learning. Insight/judgment assessed.
• Any particular ongoing issues, plans, or adjustments to treatment or medication.

Test your knowledge on the Mental Status Examination (MSE) and its various components. This quiz covers when the assessment should be performed, factors affecting it, and key characteristics related to cognition and affect. Perfect for students in psychology or mental health fields.