Psychiatric Semiology: Mental Disorder Assessment

Unidad 3: Trastorno Mental - Tema 12: Semiología Psiquiátrica I

• Focuses on psychiatric semiology including appearance, conduct, posture, attitude, and consciousness.
• Highlights the domains of role/relations, growth/development, security, and protection.
• Important for the integral evaluation of a patient.
• Aids in the early detection of psychiatric disorders.
• Forms the basis for diagnosis and treatment.
• Helps develop clinical skills.
• Enhances therapeutic relationships.

Objectives of Psychiatric Semiology Training

• To correctly evaluate and describe a patient's appearance, conduct, posture, attitude, and level of consciousness.
• To evaluate the patient while applying the principles of psychiatric semiology.
• To identify relevant signs and symptoms during clinical evaluation for mental health assessments.

Valoración (Assessment)

• The process of gathering information about a person holistically.
• Goes beyond symptoms of needs or dysfunctions of physical, intellectual, social, cultural, and spiritual aspects.
• More complete assessments increase the likelihood of effective treatment, planning, and nursing interventions.

Symptoms vs. Signs

• Symptoms are subjective and perceived by the patient; emotions, ideations, thoughts, and delusions
• Signs are objective and observed like posture, visual contact, and appearance (e.g., facial expressions of sadness, disorganized association of ideas, and restlessness).

Evaluation Objectives

• Establish a diagnosis.
• Collect information to gain a panoramic view of the case.
• Design an intervention plan.

General Evaluation Components

• Identification
• Reason for consultation
• Current illness
• Personal background
• Family background
• Personal history
• Family history
• Physical examination
• Mental examination
• Diagnosis
• Conduct to follow

Mental Examination

• The following should be examined:
  • General description (attitude, movement, posture)
  • Level of alertness, orientation, attention & sleep status, and affect
  • Thought process, language, and perception
  • Memory
  • Intelligence and other cognitive functions
  • Introspection
  • Judgment of immediate reality

General Description

• Note with whom and how the patient arrives.
• Make note of observable behavior and gestures.
• Visual and verbal contact is important to observe.
• Note verbal expression and facial expression.
• Physical appearance, grooming, and personal hygiene practices should be observed.

Posture and Attitude Assessment

• Evaluating the way a patient presents, assessing their body posture.
• Also assessing their level of cooperation, and emotional disposition toward nursing staff and the environment.
• Evaluate the patient's posture and attitude during interaction with the nurse, noting facial and bodily expressions.
• Note any signs of resistance, openness, mistrust, collaboration, or any attitude that might affect the therapeutic relationship and care process.
• Note the individual's general appearance, including the correspondence of biological age with physical appearance.
• Examine clothing and accessories for appropriateness to the climate and setting along with general presentation, organization, and goal orientation.
• Evaluate posture including whether the patient is erect, hunched, positions of the shoulders, and whether they are seated, or lying down.

Key Points to Emphasize

• Gait
• Posture
• Personal grooming
• Gestures
• Visual contact
• Verbal contact
• Tone of voice
• Verbal and non-verbal communication
• Scars, needle marks, tattoos, or bruises

Attitudes to Notice

• Interest: Smooth gentle body movements with clear facial expressions
• Perplexity: Fixed or lost gaze needing constant attention when speaking
• Distance and lack of communication
• Inhibition includes shyness, excesssiveness, and fear
• Strangeness resulting in clumsy movement patterns as well as irregular emotions.
• Aloofness marked by disparaging remarks toward others and self-deprecation
• Self-confidence involves an expression of well-being, amiability and fast movements
• Intrusiveness which makes subjects unable to appropriately establish boundaries
• Complaining and expressing pain
• Childish with vocalizations and other such expressions.
• Demanding and loud
• Hostile and menacing
• Passive-aggressive and withdrawn
• Seductive verbal and non-verbal communication
• Theatrical display of emotions
• Hallucinating subjects look around seeming surprised
• Hastiness and rapid speaking
• Astenia is when the patient is fatigued and physically weak.
• Discomfort is displayed by subjects who avoid making eye contract and shift to avoid the patient
• Chronicity is common, especially in patients who face similar issues, and typically presents in lentitude with odd expressions.

Assessing Appearance

• A focus on personal hygiene, clothing, and grooming.
• Attention to signs of neglect, poor hygiene.
• Also look for inadequate clothing for the climate, any unusual physical changes, or significant weight loss/gain.
• Assess the patient's facial expressions, looking for signs of distress, sadness, anxiety, or other emotional states.

Key Aspects of Hygiene

• Cleanliness of hair, teeth, skin, and nails.

Assessment of Grooming

• Lack of proper grooming may be indicative or apathy and a lack of self-care.

Expressiveness

• Note emotional expressions and non-verbal communications, which include eye contact, tone of voice and other body movements.

Conduct Assessment

• Observe how the patient behaves during interaction with their surroundings and health personnel.
• Watch for signs of restlessness, agitation, violence, social seclusiveness, hyperactivity or self-regulating behaviors.
• Note sleeping routines, dietary patterns or shifts in routine or health.

Key Areas of Conduct

• Activity and level of energy
• Quality and quantity of sleep
• Look particularly for any changes in levels of activity, as well as energy.
• Also pay attention to their eating patterns and appetite as well.

Sleep Patterns

• Inquire about the quality and amount of sleep, as well as sleep and wake patterns,.
• Inquire about the time spent sleeping, any trouble sleeping through the night and more, as well as daytime sleeping habits.

Changes

• Change in behavior can suggest a major health issue, such as a negative mood, social interactions, as well as self-destructive tendencies.

Conciencia (Awareness)

• Encompasses connection to the surrounding environment; implicit sense of self; temporal continuity.
• Awareness of mental states; recognizing one's own existence; seeing oneself from a third-person perspective.
• Understanding one's alertness and orientation in time, place, and person.
• Allows an individual to be aware of themselves and their environment.
• Includes capacity for comprehension and communication along with vigilance and sleeping patterns.

Level of Alertness

• There is hyperalertness, which is an enhanced state of attention as well as awareness.
• Somnolence as well causes the subject to fall asleep, but they can respond upon waking and return to normal.
• Stupor is a condition in which verbal and motor responses and verbal communication do not exist without external stimulation.
• Coma is a state in which the subject is not capable of identifying stimulus.

Altered Connection to the Environment

• The patient experiences confusion; disorientation; allopsychic alterations (time and space); difficulty understanding stimuli and ideas; poverty of ideas; memory deficits; false recognitions.
  • Obnubilation involves indifference to the surrounding environment
    • A lack of both spontaneity and interest as well
    • Clumsy and slow reactions during interactions
    • Necessitates the speaker to shake or ask multiple times to trigger a response

Delirium

• A state can be characterized as odd, along with disorientation, confusion and incomprehensible thoughts.

Despersonalization

• Occurs when a patient no longer sees themselves in the image in which they're currently standing, as well as a disconnect of the body and the self.

Desrealization

• Happens in patients who see the external world as distant from themselves with a high level of strangeness in their perception.