Scribd
Upload
9 views36 pages

Lecture 3

Uploaded by

MAHENDRA KUMAR
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
9 views36 pages

Lecture 3

Uploaded by

MAHENDRA KUMAR
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
You are on page 1/ 36

BEHAVIOR & MENTAL

STATUS
MENTAL STATUS

● Level of consciousness (arousal)


●Attention and concentration
●Memory
●Language
●Visuospatial perception
●Praxis
●Calculations
●Executive functioning
●Mood and thought content
INTRODUCTION (1)
▪ Clinicians are uniquely poised to detect clues to mental illness and
harmful behavior through empathic listening and close observation.
Nonetheless, these clues are often missed
▪ Recognizing mental illness is especially important given its
significant prevalence and morbidity, the high likelihood that it is
treatable, the shortage of psychiatrists, and the increasing
importance of primary care clinicians as the rest to encounter the
patient’s distress
▪ Mental health disorders are commonly masked by other clinical
conditions. Look for the interaction of anxiety and depression in
patients with substance abuse, termed “dual diagnosis,” because
both must be treated for the patient to achieve optimal function
▪ Nearly half of those with any single mental disorder meet the
PERSONALITY DISORDERS
▪ Difficult patients may have personality disorders resulting in
problematic office behaviors that escape diagnosis
▪ The DSM-5 characterizes these disorders as “an enduring pattern
of inner experience and behavior that deviates markedly from the
expectations of the individual’s culture, is pervasive and in inflexible,
has an onset in adolescence or early adulthood, is stable over time,
and leads to distress or impairment.”
▪ These patients have dysfunctional interpersonal coping styles that
disrupt and destabilize their relationships, including those with
health care providers
▪ For unexplained conditions lasting beyond 6 weeks, experts
recommend brief screening questions with high sensitivity and
specificity, followed by more detailed investigation when indicated
MENTAL HEALTH SCREENING
▪ Unexplained conditions
lasting more than 6 weeks
are increasingly recognized
as chronic disorders that
should prompt screening
for depression, anxiety, or
both
▪ Because screening all
patients is time consuming
and expensive, experts
recommend a two-tiered
approach: (1) brief
screening questions with
high sensitivity and
specificity for patients at
THE HEALTH HISTORY
▪ Common or Concerning Symptoms
▪ Changes in attention, mood, or speech
▪ Changes in insight, orientation, or memory
▪ Anxiety, panic, ritualistic behavior, and phobias
▪ Delirium or dementia
▪ Your assessment of mental status begins with the patient’s first
words
▪ As you gather the health history, you will quickly observe the
patient’s level of alertness and orientation, mood, attention, and
memory
▪ You will learn about the patient’s insight and judgment, as well as
any recurring or unusual thoughts or perceptions. For some, you will
ATTENTION AND
CONCENTRATION

Attention is the ability to focus and direct cognitive processes and to resist distraction; concentration is
the ability to sustain attention over a period of time.
MEMORY

Immediate and working memory represent components of attention and concentration that are best
measured with digit span forward and backwards

Recent memory reflects the ability to learn new material.

Remote memory retrieval can be tested by asking patients to name presidents of the United States in
reverse order as far back as they can remember or by asking about important historical events, famous
sporting events, and popular television shows
TECHNIQUES OF
EXAMINATION
▪ Observe the patient’s mental status throughout your interaction.
▪ Test specific functions if indicated during the interview or physical
examination
AROUSAL

When starting to examine the patient, it is first important to observe whether the patient is alert,
attentive, sleepy, or unresponsive.
LANGUAGE
Fluency – Spontaneous fluency is assessed by listening to the patient's speech, focusing on its rate, ease of
production, and use of grammar.

Content – Language errors that can emerge during the examination include paraphasic errors (phonemic or
semantic) and neologisms.

Repetition – Patients are asked to repeat phrases of increasing length and complexity.

Naming – Patients are asked to name objects or pictures that are presented to them, beginning with words
that are more frequently used and progressing to those that are less common.

Comprehension – Understanding of both written and oral language is evaluated by giving a sequence of
commands, beginning with one-step, midline commands ("Close your eyes") and progressing to more
complex multistep commands

Reading – Patients are asked to read aloud from a paragraph or a list of single words, including those with
typical and atypical pronunciations.

Writing – Patients are asked to spontaneously generate a written sentence.


Aphasia, dysphonia, dysarthria, changes
with mood disorders
Thank you

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy