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The 3 Methods to Assess Mental Status |
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Observation, Conversation, Exploration |
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Appearance, Consciousness, Psycho-motor behavior, affect. *first 5 mins. ANY disturbances you observe are called "SIGNS" |
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Attention and concentration Speech and thinking Orientation Memory Affect |
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Mood, Energy level, perception, content of thinking, medically unexplained somatic symptoms, conversation, dissociation, Paroxysmal attacks ("Spells"), executive functioning, insight, judgement |
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Any disturbances that you observe |
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Undirected, casual conversation.Good to observe now bc ct is "off guard" |
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tapping into the patients internal experiences that are not on display (mood/perceptions) |
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What to look for under appearance |
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Sex, age, race, body type, hygiene, dress, eye contact, level of consciousness |
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Aberrant Eye contact(wandering eyes) |
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revel distractibility, visual hallucinations, mania, cog. impairment |
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May express hostility, shyness, or anxiety |
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Nonverbals that give clues to alertness, affect, energy level, agitation. Note patients posture, movements (expressive/reactive) and gestures |
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movements can be grouped into 4 categories |
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1. Posture 2. Psychomotor Movements 3. movements that express 4. Abnormal complex movements |
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muscle tone and change in posture Muscle tone reflects a persons energy level and tension. High muscle tone= agitated person. Low muscle tone= calm person |
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Important to distinguish between goal-directed movements, expressive and illustrative gestures, and symbolic gestures. |
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movements that reach a goal |
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expressive and illustrative gestures |
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hand gesture while talking. Do not duplicate the verbal message, but compliment it. |
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make "Ok" sign instead of words |
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What to look for in Speech |
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Speed and flow slurring Using wrong words (paraphasic) |
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Continuous, senseless word fluency |
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The correct word is substituted for another correct word but inappropriate for the sentence. "I like to drive around in my tent" |
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one letter or syllable is substituted "I wrote the letter with my len" |
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the correct word is substitued by an incorrect word, which has a relationship with the correct word. "I wrote the letter with my writing toy" |
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Newly created words. "i wrote the letter with my zemps." |
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Receptive Paraphasias show: |
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1. povery of verbs and nouns 2. abundance of conjunctions, prepositions, and interjections. 3. random, nonrepetive neologims without fixed meaning 4. isolated sentences- no gram structure |
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The visual and audiable manifestation of the ct's emotional response to external and internal events. ex. voice, facial expressions, grooming
*pay attention to the intensity, range and duration |
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- what brought you here?.... I came in a car. (instead of stating the problem they are experiencing that brought them to counseling.) |
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Opp. of concrete thinking. |
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-affect lasts momentarily (1-2 seconds), mood lasts longer - affect is attached to external/internal stimiuli and changes with them. MOOD, can change spontaneously - Affect is forground, MOOD is the emotional background - affect is observed by you, MOOD is reported |
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1. disgust 2. perplexity (surprise) 3. joy 4. anger 5. fear 6. sadness 7. interest 8. shame 9. content |
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Non-Verbals- gestures and facial expressions. Verbals- Tone of voice, selection of vocabulary |
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4 key symptoms and signs that threaten rapid decline |
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S.O.A.P. (S)uicidal and homicidal tendencies expressing immediate danger (O)rganic conditions (GMC) that contribute to the development of cognitive disorders (A)lcohol and other subs use leads to intoxication, withdraw, ectthat leave long term effects on brain snd other body systems (P)sychosis- hallucinations and delusions that inturupt the ct's relationship to reality and make him a victim to irrational thinking and unrealistic perceptions |
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1. Quality 2. Stability 3. reactivity 4. intensity 5. duration |
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Cannot be determined by observed affect- IT MUST BE ASKED! "How do you feel most of the day?" "How do you feel now?" |
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Stable vs. Unstable vs. diurnal variation (mood disorder) Ask: "Compare your mood in the morning to your mood in the evening. Are there any differences?" |
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Can things cheer you up or not... |
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High vs low
A depressed mood can be intense despite their flat affect |
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Duration gives mood its diagnostic value. |
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Ask: how long it takes them to carry out activities - motivated or not -new tasks? -daily routines |
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medically unexplained neurological symptoms ie. blindness, deafness |
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a disruption in the usually integrated functions of conscious memory, identity, or perception
Ask: do you switch to any other personality? do you have periods of memory loss |
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Paroxysmal Attacks "spells" |
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Losing consciousness , falling asleep during the day.. dizzy, fainting |
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1. planning 2. organizing 3. sequencing 4. abstracting |
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the ct's insight of their own symptoms
Ask: do you consider this normal for you? what are your strengths |
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ability to choice appropriate goals and to choice socially appropriate ways to reach them. "how does your future look to you?" |
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Terms to describe consciousness |
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alert lethargy sleepiness stupor coma |
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