Mental status

Question 1

What do we assess during mental status screening?

Answer 1

1. Take a thorough history
2. Observe physical appearance and behavior
3. Investigate cognitive functioning
4. Observe speech and language
5. Evaluate emotional stability

Question 2

Why do PTs assess mental status?

Answer 2

1. Design best plan of care
2. Safety
3. Assist in writing proper goals
4. Pt may need to be referred

Question 3

When is mental status assessed?

Answer 3

1. When the patient enters the office
2. During physical examination
3. During interventions/treatment

Question 4

Area responsible for: Motor cortex (speech formation, Broca’s area [expressive aphasia]), Decision making, Problem solving, Ability to concentrate, Short term memory, Awareness of self
Goal-oriented behaviors and drive, Emotions and affect

Answer 4

Frontal lobe of cerebrum

Question 5

Area responsible for Receiving and processing sensory information

Answer 5

parietal lobe

Question 6

Area responsible for: Perception and interpretation of sounds, Comprehension of spoken and written language (Wernicke’s area [receptive aphasia]), Integration of behavior, emotion, and personality, Long-term memory

Answer 6

Temorpal lobe

Question 7

Mediates patterns of behavior for survival:

• Mating
• Fear
• Aggression
• Affection

Answer 7

Limbic system

Question 8

Area responsible for: Reticular activating system - Important for consciousness

Answer 8

Brainstem

Question 9

What does the NS look like in infants and children?

Answer 9

1. All neurons present, but not all connections made
2. Full myelination takes several years
3. Nervous system sensitive to insults: Infections, Trauma (shaken baby syndrome), Chemical imbalance

Question 10

What does the NS look like in adolescents?

Answer 10

1. Continued intellectual maturation
2. Abstract thinking develops
3. Judgment begins to develop with education, intelligence, and experience
4. Develop set of values

Question 11

What age should we not see decline in cognitive function before?

Answer 11

60

- decline before this age indicates a systemic or neurological disorder

Question 12

Where do you seen declines in older adults? what tends to remain intact?

Answer 12

Declines:

1. Problem-solving ability
2. Short term memory
3. Information processing or new concepts

Intact:

1. Verbal skills
2. Inventories of available information
3. Long term memory

Question 13

Level of consciousness where pt is aware of surroundings, oriented x 3 (person, place, year), and cooperative

Answer 13

Conscious

Question 14

Level of consciousness where pt has inappropriate responses to questions, and decreased attention span and memory

Answer 14

Confusion

Question 15

Level of consciousness where pt who is Drowsy, fall asleep easily, but once aroused, responds appropriately

Answer 15

Lethargy

Question 16

Level of consciousness where pt is near-unconsciousness

but arousable to verbal, visual, or painful stimuli for short periods; Slowed motor or moaning responses to stimuli

Answer 16

Stupor

Question 17

Level of consciousness where pt is not awake, not aware, “unarousable unresponsiveness”, and has decorticate or decerebrate posturing

Answer 17

Coma

• decerebrate = worst prognosis, indicates brainstem injury
• decorticate = cortical pathways disturbed

Question 18

Acute confusional state that fluctuates; Marked anxiety; Impaired memory and attentiveness; Rambling and irrelevant conversation; Misperceptions, illusions, hallucinations, delusions; Rapid mood swings, fearful, suspicious; Is reversible

Answer 18

Delirium

- may be due to medication, alcohol/drug withdrawal, severe infection, electrolyte/metabolic disorder, brain injury

Question 19

Used to quantify consciousness; Evaluates function of cerebrum and brainstem; Can be repeated to assess improvement or deterioration

Answer 19

Glasgow coma scale

-eye opening, verbal response, motor response

Question 20

What glasgow coma scale score is a severe head injury? moderate? mild?

Answer 20

Severe = 3-8
Moderate = 9-12
Mild = 13-15

Question 21

Temporary alteration in mental status due to head trauma; Symptoms may disappear quickly or take several weeks; An athlete should not return to activity until all signs and symptoms have resolved

Answer 21

Concussion

Question 22

What are two big screening questions for depression? yes to both questions indicates referral

Answer 22

1. Over the past 2 weeks have you felt down, depressed, or hopeless?
2. Over the past 2 weeks have you felt little interest or pleasure in doing things?

Question 23

In the geriatric depression scale, what score indicates depression?

Answer 23

5

Question 24

Biochemical imbalance in brain; Elevated and euphoric or irritable and agitated mood that lasts longer than one week

Answer 24

Mania

Question 25

Marked anxiety or fear that interferes with personal, social, and occupational functioning; Most common psychiatric disorder

Answer 25

Anxiety disorder | - many people recognize that the anxiety is unreasonable

Question 26

Adolescent or early adult onset; Severe, persistent, psychotic syndrome that results in an impaired reality

Answer 26

Schizophrenia

Question 27

Significant sub-average general intellectual functioning; Delayed developmental milestones – motor and speech Deficits in adaptive behavior and academic performance

Answer 27

Intellectual disability

Question 28

Behavioral disorder; Increased motor activity, difficulty sustaining attention and organizing tasks, disruptive behavior, poor impulse control, poor school performance, low self-esteem; Not related to low intelligence; Onset before age 7, more common in boys

Answer 28

Attention Deficit Hyperactivity Disorder (ADHD)

Question 29

Impaired social interactions, impaired language, lack of awareness of others, poor eye contact, aversion to being held/touched, odd and repetitive behaviors; Developmental disorder; Unknown etiology; Identified prior to age 3; More boys than girls; Great deal of current research

Answer 29

Autism Spectrum Disorder

Question 30

``` Dementia of Alzheimer type – ___ Vascular dementia (recurrent ischemic strokes) – ___ Other dementias – ___ ```

Answer 30

70% 20% 10%

Question 31

What 4 categories of history do we take?

Answer 31

1. History of present illness (Disorientation, confusion, depression, anxiety) 2. Past medical history (Neurologic disorder, psychiatric disorder, brain surgery, brain injury, chronic disease, progressive disease) 3. Family history (Psychiatric disorders, mental illness, Alzheimer’s, intellectual disability, autism, alcoholism) 4. Personal and social history (Emotional status, social or family problems, ability to cope, education/intellectual level, use of alcohol/drugs, sleeping and eating patterns)

Question 32

What aspects of physical appearance and behavior do we need to pay attention to when assessing mental status?

Answer 32

1. Grooming and hygiene 2. Emotional status 3. Nonverbal communication (body language)

Question 33

What tools are used to screen for cognitive function?

Answer 33

1. Mini-Cog (give 3 words, draw clock, then ask to recall words; abnormal clock or inability to recall = impaired) 2. 6CIT – 6 item Cognitive Impairment Test 3. MMSE - Mini Mental State Examination 4. SLUMS – St. Louis University Mental Status Examination 5. Montreal Cognitive Assessment

Question 34

What speech and languages skills are observed in assessing mental status?

Answer 34

1. Voice quality (Volume, quality, pitch) 2. Articulation (Dysarthria) 3. Comprehension (Receptive aphasia (Wernicke’s area)) 4. Coherence (Expressive aphasia (Broca’s area))

Question 35

Impaired speech, a lot of effort to speak, know what they want to say but can’t articulate, speech mostly nouns and verbs

Answer 35

expressive aphasia | - unable to write, but can read

Question 36

Fluent speech but uses words inappropriately, speech may be incomprehensible, can hear words but can’t comprehend the meaning

Answer 36

receptive aphasia | - unable to read and write

Question 37

What aspects of emotional status are observed in assessing mental status?

Answer 37

1. Mood and feelings (Do they correspond to the current situation?) 2. Thought process (Is it logical and easy to follow?)