Unit 2: Mental Health Assessment

Clinical interview:
Nurses hear the problems in patient’s perspective by
effective in quite place
 Relaxed and unhurried posture
 Eye contact
 Be interested
 Pick up verbal and non verbal
 Allow patient to talk freely
 Deviated guide the patient to bring in track
 Active listening
 Open ended questions
 Do not offer premature conclusions
History taking
It proceeds through different headings as follows:
• Identification and demographic details
• Presenting complaints and duration
• History of present illness
• Past psychiatric history
• Family history
• Personal history
• Premorbid personality
Identification Data
Includes
• Patient’s name
• Age
• Sex
• Religion
• Address
• Socio economic status
• Occupation
• Details of informant
Chief complaints:
• Symptoms are listed in sequential order.
Sometimes the patient may deny the
existence of any symptoms.
• This allows identification of the problems and
specific treatment plan
History of present illness
• Main part of interview to identify the key
elements .
• Record the severity and duration of each
symptoms, how and when it began, what
comes it has taken (precipitating factors).
• Record important life events to complete this
part of the evaluation,helps to establish
rapport with the patient.(eg lack of
anhedonia ,complaining of low mood).
• Regularly taking medicine
Family history
• Family history of psychiatric disorder
indicating genetic and environmental
influences
• Recent events in the family may have been
stressful to the patient.
Personal history
• Pregnancy and birth
• Child development
• Education
• Occupational history
• Marital history
• Sexual history
• Children
• Social circumstances
• Substance use and misuse
Past psychiatric and medical
history
• Previous medical or surgical treatment
should always be asked about and
particularly careful inquires made about
previous psychiatric disorders.
Premorbid personality
• Patient’s manner and description of their
history will be provided
• Relationship
• Use of leisure time
• Predominant mood and emotions
• Character traits
• Attitudes
• Ultimate concern
Mental status examination
• General appearance and behavior
• Speech
• Thought
• Mood and affect
• Perception
• Cognitive functions
• Insight
General Apperance
Speech
• Rate of speech
• Flow of speech
• Content of speech
• Volume
Thought
• Pre occupations and/or worries?
• •Ideas and plans of suicide?
• •Obsessional ideas/impulses/images and
compulsive rituals?
• •Delusions/overvalued ideas?
Mood and Affect
• Anxious
• Depressed
• Elated
• Irritable
• Angry
Perception
• Hallucinations –auditory, visual, olfactory,
gustatory, tactile
• •Illusions
Cognitive functions
• Level of Consciousness
• Orientation in time, place and person
• Attention and concentration
• Memory –short term and long term
• Intelligence
Insight(understands of illness)
Mini mental status examination
• Cognitive test used to screen for the
presence of cognitive impairment.
• Uses of MSE:
• Provides measures of orientation,registration
and short term memory,attention, voluntary
movement.
• To predict dementia.
Scoring:
• Reliable test
• Scores 25-30 = normal
• Scores 18-24 = mild and moderate
• Scores 17 or less = substantial impairment
Components of MMSE:
• Orientation
• Registration
• Attention and Calculation
• Recall
• Language
Orientation (10 points)
• Ask for the year,season, date, day, month,
which is our state? Country, town or city,
hospital, floor).One point for each correct
answer
Registration (3 points)
• Name three objects clearly and slowly.
• After you have said all three, ask the patient
to repeat them.
• Give one point for each correct answer.
Attention and Calculation (5 points)
• Spell “word” backwards give 1 point for each
letter that is in the right place Score the total
number of correct answers.
• Give one point for each correct answer
Recall (3 points)
• Ask for the three objects repeated above( for
e.g. apple, table, pen) Give one point for
each correct object. (3)
Language (9 points)
• Point pencil and ask the person to name this
object ,Do the same thing with wrist watch(2)
• Ask the person to repeat the following (No
ifs, ands, or buts”) (1)
• Give the blank paper and say to follow three
stage command.”Take a paper in your right
hand, fold in half and put it on the floor) (3)
• Write “ CLOSE YOUR EYES” in large letters
and show it to the patient. Ask to read the
message (1)
Cont:
• Ask the individual to write a sentence of their
choice on blank piece of paper
• Show the person a drawing of two
pentagons which intersect to form
quandrangle. Each side should be about 1.5
cm.
NEUROLOGICAL EXAMINATION
• Level of consciousness
• Mental state examination
• Special cerebral functions
• Cranial nerve function
• Motor function
• Sensory function
• Cerebellar function
• Reflexes
Levels of consiousness
a. Alertness
b. Lethargic
c. Stuporous
d. Semi-comatose
e. Comatose
Special cerebral functions
• Assess for agnosia, apraxia and aphasia
Assessment of cerebellar function
• Finger to finger test
• Finger to nose test
• Romberg test
• Tandom walking test
Investigation in psychiatry
• Routine investigations
- Blood test
- Renal functions tests
- Liver function test
- Serum electrolytes
- Blood glucose
- TFT
- ECG
- HIV
- VDRL
EEG:(Electroencephalogram)
EEG:
• Electrical activity recorded through
electrodes on the scalp to measure brain
electrical activity, identifies dysrhythmias and
asymmetries, used in diagnosis of
seizures,dementia,neoplasm,stroke.
Cont:
Cont:
CT and MRI
• Computed tomography
• Magnetic resonance imaging
Role of nurse in Psychological
investigations
• Measuring the extent of the patient’s
problems
• Making an accurate diagnosis
• Tracking patient progress over time
• Documenting the efficacy of treatment
• Thank You..!