Chapter 6

Assessing mental status

and psychosocial
developmental level

Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Mini-mental state examination tool

Time orientation
Place orientation
Registration of three words
Serial 7s as a test of attention and calculation
Recall of three words
Naming

Copyright 2014 Wolters Kluwer All Rights Reserved

Mini-mental state examination tool

Repetition
Comprehension
Reading
Writing
Drawing

Copyright 2014 Wolters Kluwer All Rights Reserved

Mental status

Level of consciousness
Posture and body movements
Gait
Dress
Hygiene

Copyright 2014 Wolters Kluwer All Rights Reserved

Mental status

Facial expressions
Speech
Behaviours
Thought patterns
Mood, feelings, expressions

Copyright 2014 Wolters Kluwer All Rights Reserved

Question

Is the following statement true or false?

Evaluating level of consciousness is part of a mental

status exam.

Copyright 2014 Wolters Kluwer All Rights Reserved

Answer

True.
Evaluating level of consciousness is part of a mental
status exam.

Copyright 2014 Wolters Kluwer All Rights Reserved

Five levels of consciousness

Alert and awake

Lethargy
Obtunded
Stupor
Coma

Copyright 2014 Wolters Kluwer All Rights Reserved

Question

Which describes a patient who is stuporous?

A.Awakes to vigorous shake or painful stimulus but returns
to unresponsive sleep
B.Remains unresponsive to all stimuli; eyes stay closed
C.Opens eyes to loud voice, responds slowly with
confusion, seems unaware of environment
D.Opens eyes, answers questions and falls back to sleep

Copyright 2014 Wolters Kluwer All Rights Reserved

Answer

A. Awakes to vigorous shake or painful stimulus but

returns to unresponsive sleep.
Stuporous patients awake to vigorous shake or painful
stimulus but returns to unresponsive sleep. Coma
remains unresponsive to all stimuli; eyes stay closed.
Obtunded opens eyes to loud voice, responds slowly
with confusion, seems unaware of environment.
Lethargy opens eyes, answers questions and falls back
to sleep.

Copyright 2014 Wolters Kluwer All Rights Reserved

Glasgow Coma Scale

Eye opening response

Most appropriate verbal response
Most integral motor response (arm)

Copyright 2014 Wolters Kluwer All Rights Reserved

Cognitive ability

Orientation
Concentration
Recent memory
Remote memory

Copyright 2014 Wolters Kluwer All Rights Reserved

Cognitive ability (cont.)

Use of memory to learn new information

Abstract reasoning
Judgement
Visual perceptual and constructional ability

Copyright 2014 Wolters Kluwer All Rights Reserved

Eriksons developmental tasks

Young adult: Intimacy versus isolation

Middle-aged adult: Generativity versus stagnation
Older adult: Integrity versus despair

Copyright 2014 Wolters Kluwer All Rights Reserved

Question

Is the following statement true or false?

The Eriksons developmental task for young adult is
intimacy versus isolation.

Copyright 2014 Wolters Kluwer All Rights Reserved

Answer

True.
The Eriksons developmental task for young adult is
intimacy versus isolation.

Copyright 2014 Wolters Kluwer All Rights Reserved

Psychological developmental level

Mental and emotional health

Self-concept
Role development
Relationships
Coping
Stress patterns
Spiritual beliefs

Copyright 2014 Wolters Kluwer All Rights Reserved

Alzheimers disease

Repeatedly asks the same questions

Becomes lost or disoriented in familiar places
Cannot follow directions
Is disoriented as to the date or time of day
Doesnt recognise and is confused about familiar people
Has difficulty with routine tasks such as paying bills
Neglects personal safety, hygiene and nutrition

Copyright 2014 Wolters Kluwer All Rights Reserved

Depression questionnaire

Falling asleep
Sleep during the night
Waking up too early
Sleeping too much
Feeling sad
Decreased or increased appetite
Decreased or increased weight

Copyright 2014 Wolters Kluwer All Rights Reserved

Depression questionnaire (cont.)

Concentration/decision making
View of oneself
Thoughts of death or suicide
General interest
Energy level
Feeling slowed down
Feeling restless

Copyright 2014 Wolters Kluwer All Rights Reserved