Aphra Mental Status Assessment PDF

# The Mental Status Examination ## Areas to be Assessed - **Appearance** (observed) - **Hygiene** (observed) - **Motor behaviour** (observed) - **Conversation** (observed) - **Speech** (observed) - **Main affect** (observed) - **Mood** (observed) - **Thinking** (enquired) - **Intelligence** (enqui...

# The Mental Status Examination ## Areas to be Assessed - **Appearance** (observed) - **Hygiene** (observed) - **Motor behaviour** (observed) - **Conversation** (observed) - **Speech** (observed) - **Main affect** (observed) - **Mood** (observed) - **Thinking** (enquired) - **Intelligence** (enquired) - **Perception** (enquired) - **Memory** (enquired) - **Concentration** (enquired) - **Judgment** (enquired) - **Insight in the diagnosis** (enquired) - **Rapport with therapist** (observed) - **Sleep** (enquired) - **Appetite** (enquired) - **Motivation** (enquired) - **Energy** (enquired) **Enquired** - Ask the patient **Observed** - Observe the patient ## Aphra OSCE Mental Status Assessment - **First Bell** - Read the scenario (2 min) - **Second Bell** - Enter the patient station and perform (8 min) ### Introductory Phase - Entering to the patient room, checking for scene safety, ensuring that scene is safe to approach. - Ensuring privacy and dignity of patient by closing curtains and door. - Hand rub using seven steps of hand hygiene. - Hello, myself 'name', I am your attending nurse today. - Can I cross check the details with your id tag (3 checks - Full name, Date of birth and Hospital Number) with kardex. - Myself here to do a mental status assessment, is it ok with you? - Are you allergic to any medication? (Usually they will be allergic to something) - What exactly happens when you have that drug? - Can I ask you a few questions? - If yes I will note that and make sure nobody will give that medicine to you, also I can't see any allergic ID band, I am going to bring it straight away. - As I told you I am here to assess the mental status examination. - Can I proceed? - Can I have a few questions, this is a test your memory and understanding. - Is this ok? - Can I start? ### General Appearance - **Observe discretely** - Gait, posture, clothes, grooming. ### Hygiene - **Observe Discretely** - Look for hygiene good or poor (circle appropriate). ### Behaviour - **Observe Discretely** - Observe specific abnormal movements, as well as more general observations of the patient’s general activity and arousal and observations of the patients eye contact and gait. - Un co operative with exam, proper / poor eye contact, proper poor engagement, repetitive movements (OCD) - Calm, restless, agitated, slowed, angry depressive, hyper reactive, very subdued Motor behaviour ### Conversation - **Observe Discretely** - Good Expression, Un communicative, poor eye contact, hesitant, Over assertive, Guarded, Over inclusive ### Speech - **Observe Discretely** - **Quantity** - Possible descriptors: - Talkative, spontaneous, expansive, paucity, poverty. - **Rate** - Possible descriptors: - Fast, slow, normal, pressured. - **Volume (Tone)** - Possible descriptors: - Loud, soft, monotone, weak, strong. - **Fluency and Rhythm** - Possible descriptors: - Slurred, clear, with appropriately placed inflections, hesitant, with good articulation, aphasic. ### Main affect - **Observe Discretely** - Description of Patients apparent emotion conveyed by the persons non verbal behavior ( anxious sad etc... - and also by using the parameters of appropriateness intensity range reactivity and mobility. Neutral, euthymic, dysphoric, euphoric, angry, anxious, apathetic irritable Calm, anxious, fearful, agitated, irritable, depressive, angry ### Mood - **Enquired Discretely** - I have a few questions for you. - "How is your mind?" - "How are you feeling?" - "Have you been discouraged/depressed/low/blue lately?" - "Have you been energized/elated/high/out of control lately?" - "Have you been angry/irritable/edgy lately?" ### Thinking - **Observed/Enquired** - Description of Quantity or tempo (rate of flow and form (or logical coherence) of thought: - Organized, responsive to questions, pre-occupied, rambling, vague, obsessive, racing, disordered, tangential, focuses on dangers, focuses on failures. - Delusional, flight of ideas, blocking, depersonalized - **Thought Content** (Inquired/Observed) - Ask the patient the following questions: - "What do you think about when you are sad/angry?" - "What’s been on your mind lately?" - "Do you find yourself ruminating about things?" - "Are there thoughts or images that you have a really difficult time getting out of your head?" - "Are you worried/scared/frightened about something or other?" - "Do you have personal beliefs that are not shared by others?" (Delusions are fixed, false, unshared beliefs.) - "Do you ever feel detached/removed/changed/different from others around you?" - "Do things seem unnatural/unreal to you?" ### Intelligence - **Enquired** - **Information and Vocabulary** - Suggested patient instructions: - **Ask the patient** - "Name the last 5 presidents." (Clinton, Bush, Reagan, Carter, Ford, Nixon, ...) - "Name 5 of the largest cities in the country." (New York City, Los Angeles, Chicago, Houston, Philadelphia) - "Name the current president, vice president, governor, and mayor.” (Bill Clinton, Al Gore, George Ryan, Richard M. Daley) - **Vocabulary** - Possible descriptors: - Grade school level, high school level, fluent, consistent wit ### Perceptions - **Enquired** - Do you get any hallucination, say some body is talking to you? - Reality oriented, auditory hallucinations, visual hallucinations, tactile Hallucinations, somatises ### Memory - **Enquired** - Ask patient to remember 3 words, I will ask you to repeat it in 5 min. - Three words to remember later, Eg. dog bicycle and tree and repeat after 5 min (give the question and do net two steps and then go back and test memory) ### Concentration - **Enquired** - Ask a brief calculation question: - Brief calculation question - Start from 100 - Subtract serially with 7, probably 5-6 times. - Or world - backwards - Normal, distractible, unable to concentrate ### Judgment - **Enquired** - Ask the following questions: - "What brings you here today?" - "What seems to be the problem?" - “What do you think is causing your problems?" - "How do you understand your problems?" - "How would you describe your role in this situation?" - "Do you think that these thoughts, moods, perceptions, are abnormal?" - "How do you plan to get help for this problem?" - "What will you do when _ occurs?" - "How will you manage if _ happens?" - "If you found a stamped, addressed envelope on the street, what would you do with it?" - "If you were in a movie theater and smelled smoke, what would you do?" ### Insight into Diagnosis - **Enquired** - Ask the following questions: - "What brings you here today?" - "What seems to be the problem?" - "What do you think is causing your problems?" - "How do you understand your problems?" - "How would you describe your role in this situation?” ### Rapport with Therapist - **Observe** - Good relationship, reluctant to engage, reliant on. Argumentative, hostile ### Vegetative ### Sleep - **Enquired** - Ask the patient how is your sleep: - Normal sleep, broken sleep, unable to sleep ### Appetite - **Enquired** - Ask the patient how is your appetite: - Normal, low & loss of weight, over-weight ### Motivation - **Enquired** - Ask the patient do you have any goals in life: - Wants to achieve life goals, low motivation, under-motivated (needs personal support), ### Energy - **Enquired, Observed** - Ask the patient how is your energy level like: - Has energy to achieve goals, lethargic, over-active ## Post Procedure - Thank you - My questions over. - Going to document. - Going to contact psychology team. - Will be coming for review (escalation plan) - Document everything - Hand gel - Call bell - Curtains open - Say thank you