Mental health

Emergencies
Mental Status
Assessment
Prepared by: Hayat Ahmed Ismail
Senior charge nurse /BSI

28/06/2019
28/06/2019 1 1
 Learning Objectives
By the end of this presentation ; participants will be able to :
1. Define and Differentiate between Mental Health, Mental
Status, and Mental Disorders.

2. Distinguish the difference between Practical and Theoretical

way of Mental Health Assessment.

3. Identify the reason and the importance why there is a need

to do Mental Health Assessment.

4. Demonstrate Mental Health Assessment according to 4

categories
Mental Health
Mental status definition: A person’s emotional and cognitive function.
Mental disorder definition: “A significant behavioral or psychological
pattern associated with distress or disability and has a significant risk of
pain, disability, or death, or a loss of freedom” (APA, 1994)

•You must believe what your pt. tells you, You don’t know, that’s why
must take them seriously if they say they we assess mental health
want to kill themselves.
•Suicide precautions may be
implemented by having a sitter or
restraints.
Assessing Mental Health

1. Appearance
2. Behavior
3. Cognitive function
4. Thought process and perceptions
Assessing mental health
Appearance
• Posture
• Anxiety – sitting on edge of bed, tense muscles, frowning, restless,
pacing (Hyperthyroidism?)
• Depression – sitting slumped in a chair, slow walk, dragging feet
• Body movements
• Normal – voluntary, deliberate, coordinated, smooth and even
• Anxiety – restless, fidgety
• Depression – apathy, slow movements
• Schizophrenia – bizarre gestures, facial grimaces
• Dress
• Eccentric dress occurs with schizophrenia or manic syndrome
• Hygiene
• Note change from previously well-groomed appearance to one
that is disheveled - depression
• Obsessive compulsive disorder – meticulously dressed and
groomed
Assessing Mental Health
Behavior
• Consciousness (LOC)
• Facial expression
• Look is appropriate for the situation
• Flat, masklike expression in Parkinson’s and depression
• Language – physical ability to speak, word choice
• Mood and affect
• Mood – more temporary expression of emotions
• Affect – more permanent display of feelings
Assessing Mental Health
Cognitive Function
• Orientation – person, place, time (A&O x 3)
• Disorientation occurs with dementia, delirium
• Attention – give orderly instructions and ask pt. to perform
• Memory – short and long term
• Abstract reasoning
• Problem solving and reasoning abilities
• Must keep in mind patient’s education level
Assessing Mental Health
Thought Processes and Perceptions
• Thought process – Logic. How a person thinks.
• Thought content – What a person thinks.
• Perceptions
• How do people treat you? What do people say when they talk about
you?
Assessing Mental Health
• Suicide precautions
• Risk factors
• Prior suicide attempts
• Depression
• Verbal messages to kill self
• Death themes in talk, jokes
• Giving away possessions
• Assessing
• “Have you ever thought about hurting yourself?”
• “Do you plan to hurt yourself now?”
• “Have you ever hurt yourself in the past?
Mental State Examination
• Refer to Malaffi

http://portal.seha.ae/SiteAssets/Malaffi-
icon.png
Speech Disorders
• Dysphonia – difficulty or discomfort
using voice to talk
• Dysarthria – disorder of articulation in
which the speech sounds are distorted.
• Aphasia – language defect in processing
• Global aphasia – little or no speech and
comprehension
• Broca’s aphasia – can understand language,
but difficulty speaking. Grammar problems.
• Wernicke’s aphasia – problem
comprehending words. Can still articulate
well.
Mood and Affect Abnormalities
• Flat affect – no emotional response
• Inappropriate affect – wrong emotion for the situation
• Depression – sadness
• Depersonalization – loss of identity. “I don’t feel real”
• Elation – joy and optimism, overconfidence
• Euphoria – inappropriate elation
• Anxiety – worried, uneasy, nervous
• Fear – worried, uneasy, apprehensive
• Irritability – annoyed, easily provoked
• Rage – furious, loss of control
• Lability – rapid shift of emotions
Thought abnormalities
Process Content
Phobia – irrational fear of an
• Confabulation – make object
up events
Hypochondrias – phobia of
• Loose associations – having diseases.
shifting between Obsession – unwanted and
unrelated ideas
persistent thoughts
• Flight of ideas – Compulsion – unwanted and
unrelated ideas but persistent actions.
connected usually by a
play on words Delusions – False beliefs, often
of persecution or grandiose
• Word salad –
incoherent mixture of
words
Abnormalities of Perception
• Hallucination – Sensory perception for which there
are no external stimuli. May be visual, auditory,
tactile, olfactory, gustatory.
• Delusion – Misperception of an actual existing
stimulus, by any sense.

SCHIZOPHRENIA
Delirium, Dementia, and Amnesia
• Delirium
• Consciousness change – reduced awareness of environment with reduced
ability to focus, sustain, or shift attention
• Cognition change
• Develops over a short period of time (hours to days)
• Dementia
• Memory impairment
• One or more of the following:
• Aphasia – language disturbance
• Apraxia – impaired ability to carry out motor activities despite intact motor
function
• Agnosia – impaired ability to recognize or identify objects despite intact sensory
function
• Executive functioning disturbance – planning, organizing, sequencing,
abstracting
• Alzheimer’s, Parkinson’s, HIV, cerebrovascular disease
• Amnesia
• Memory impairment without other disorders
• May be caused by trauma or substance induced
Substance Use Disorders
Substance: agents taken non medically to alter mood or behavior

• Intoxication – ingestion of substance produces

maladaptive behavior changes due to effects on
CNS
• Abuse – Daily use needed to function. Inability to
stop. Impaired social and occupational functioning
• Dependence – physiologic dependence on
substance
• Tolerance – requires increased amount of
substance to produce same effect
• Withdrawal – cessation of substance produces
physiologic symptoms
Effects of Common Substances
• Alcohol, sedatives, and hypnotics (CNS depressants)
• Symptoms – unsteady gait, incoordination, impaired judgement
• Withdrawal – tremor of hands, eyelids. Tachycardia, elevated BP,
sweating, headache, insomnia, anxiety, N&V, hallucinations,
delusions
• Nicotine (mild stimulant)
• Symptoms – increased systolic BP, increase HR, vasoconstriction,
loss of appetite, dizziness
• Withdrawal – vasodilation, headaches, irritability, anxiety,
nervousness
• Marijuana
• Symptoms – reddened conjunctivae, tachycardia, dry mouth,
increased appetite, euphoria, anxiety, slowed time perception
• Withdrawal – ? restlessness, decreased appetite
Effects of Common Substances
• Cocaine and Amphetamines (psychostimulants)
• Symptoms – Pupillary dilation, tachycardia or bradycardia,
elevated or decreased BP, N&V, weight loss, euphoria,
agitation, aggressiveness
• Withdrawal – Anxiety, depression, irritability, fatigue
• Opiates (morphine, heroin)
• Symptoms – pinpoint pupils, decreased BP, pulse,
respirations, and temperature, lethargy, psychomotor
retardation, inattention, impaired memory
• Withdrawal – Dilated pupils, lacrimation, tachycardia,
elevated BP, sweating, diarrhea, irritability, depression
 Anxiety Disorders
• Panic attack
• Intense fear or discomfort develops within 10 minutes
• Symptoms
• Palpitations, sweating, trembling, SOB, feeling of choking, chest pain, nausea,
dizziness
• Agoraphobia
• Anxiety about being in a place or situation where escape might be difficult or where
help might not be available
• Being outside of home, in a crowd, on a bridge, in a car, bus, or train
• Specific phobias
• Phobias of specific objects provokes an anxiety response
• OCD (Obsessive-Compulsive)
• PSD (Posttraumatic Stress Disorder)
• Experience or witness of actual or threatened death or serious injury of self or others
• Recurrent recollections of event followed by distress
• Generalized Anxiety Disorder
• Persistent general anxiety
Mood Disorders
Depression
• 5 or more present during
the same 2 week period
• Depressed mood
• Diminished interest
• Weight loss
• Insomnia
• Psychomotor agitation
• Fatigue
• Feelings of worthlessness
• Diminished ability to
think
• Thoughts of death
Mania
Persistently elevated or
irritable mood lasting 1
week or more with:
Grandiosity
Decreased sleep
Talkativeness
Flight of ideas
Distractibility
Agitation
Pleasurable activities
Isn’t everyone suffering
from a mental
disorder???
References
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Thank you