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Here is some information about the Mental Status Exam, Pollard's Physical Functioning, and primary, secondary, and tertiary terminology in relation to mental illness, based on the sources:
Mental Status Exam (MSE)
● The weekly learning objectives for the nursing course include examining components of the Mental Status Exam. ● DsM-5 and the Mental Status Exam are related to the concept of evidence. ● The MSE assesses psychological, emotional, social, and neurological functioning and is standard across clinical settings. ● MSE findings are subjective and rely on the clinician's skills, knowledge, communication, interpretation, and judgment. ● Parts of the MSE are completed through simple observation, while others require specific questions. ● The MSE evaluates a patient's current state and does not reflect their past or future. It is not the Mini Mental Status Exam (MMSE). The findings of the MSE can change and are a record of observations during a particular assessment. The MSE represents a cross-section of the patient’s psychological life and the sum total of the nurse’s observations and impressions at the moment. ● When conducting an MSE, the nurse should attend to the patient's communication process and content. Content refers to overtly communicated information. Process refers to how communication occurs and includes feelings, intuition, and behaviors accompanying speech and thought. ● The MSE includes assessment of many parameters: ○ Appearance Gender, cultural background, apparent age, attire, grooming and hygiene, body habitus, physical abnormalities, jewelry, cosmetics, and tattoos should be noted in the patient's appearance to provide an accurate image of the patient in general. ○ Behavior includes observations of: Agitation, Hyperactivity, Psychomotor Retardation, Akathisia, Automatisms, Catatonia, Choreoathetoid Movements, Compulsions, Dystonias, Extrapyramidal Symptoms, Tardive Dyskinesia, Tics, Tremors, and Negative Symptoms. ■ Movement abnormalities include: Akathisia, Automatisms, and Catatonia. ■ Akathisia is a state of inner tension that causes the need to keep moving due to side effects of antipsychotic medication. ■ Automatisms are "automatic" involuntary movements that range from simple to complex behaviors, lip-smacking or uttering words, fumbling with clothing, eye blinking or staring that occur in altered states of consciousness, and seizures. ■ Catatonia includes postural and movement disturbances, with increased and decreased levels of activity. The mnemonic WRENCHES can be used to remember the core features of catatonia: Waxy flexibility, Rigidity, Echopraxia, Negativism,
Catalepsy, High level of motor activity, Echolalia, Stupor, and Stereotypy. ■ Additional movement abnormalities include: Choreoathetoid Movements, Compulsions, and Dystonia/Extrapyramidal Symptoms. ■ Choreoathetosis is the occurrence of involuntary movements in a combination of chorea (irregular migrating contractions) and athetosis (twisting and writhing). ■ Compulsions are repetitive behaviors that the person feels driven to perform, usually preceded by obsessions, aimed at preventing or reducing distress or preventing some dreaded event or situation. ■ Dystonia/Extrapyramidal Symptoms are a neurological movement disorder characterized by involuntary muscle contractions that cause slow, repetitive movements or abnormal postures that can sometimes be painful. Common dystonias include: Oculogyric crisis, torticollis, blepharospasm, opisthotonos, and laryngospasms. Other extrapyramidal symptoms (EPS) include: Tardive dyskinesia, rabbit syndrome, parkinsonism, and Pisa syndrome. ■ Additional movement abnormalities include: Tics, Tremors, and Negative Symptoms. ■ Tics are Involuntary, sudden, rapid, recurrent, non-rhythmic, stereotyped, irresistible movements or vocalizations - coprolalia (saying or shouting obscenities); palilalia (repeating one's own phrases). ■ Tremors are involuntary moments with regular rhythmic oscillations of some part of the body - seen in arms, hands, head, neck, lips, mouth or tongue, legs, voice or trunk. ■ Negative Symptoms are a lessening or absence of normal behaviors and functions related to motivation and interest or verbal/emotional expression. The mnemonic "NEGATIVE TRACK" can be used to remember negative symptoms: Negligible response to conventional antipsychotics, Eye contact is decreased, Grooming and hygiene decline, Affective responses become flat, Thought blocking, Inattentiveness, Volition diminished, Expressive gestures decrease, Time - increases the number of symptoms, Recreational interests/relationships diminish, A's - Apathy, alogia, affective flattening, anhedonia, attentional deficits, Content of speech diminishes, and Knowledge
- cognitive deficits increase. ○ Cooperation and Reliability Best gauged by the responses the patient gives to open-ended questions. Most patients participate in the MSE interview. Observations include: eye contact, attitude/demeanor, attentiveness to the interview, level of consciousness, affect, and secondary gain.
Situational type, People (social phobia), Blood/Injection, Other, Agoraphobia, and Surroundings. ■ Thoughts of Harm (Self or Others) Key risk factors to consider in assessing suicidal risk are: “SOS MADE PLAIN FOR A DR.". The mnemonic “SOS MADE PLAIN FOR A DR.” can be used to assess suicidal risk: Sex (gender), Occupational status, Stress level, Mental illness, Age, Drug abuse (substance misuse), Effects of medications (side effects), Precipitants, Lethality of method, Isolation, Note written (a will/testament recently changed), Family history, Organic conditions (medical illness), Relationship difficulties, Akathisia, Date (anniversary reactions), and Repeated attempts. ○ Affect and Mood Affect is a visible, external or objective manifestation of an emotional state. Mood is an internal feeling state described by the patient. Aspects of affect include: type/quality, range/variability, degree/intensity, stability, reactivity, appropriateness, and congruence. Aspects of mood include: type/quality, reactivity, intensity, and stability/duration. ○ Perception is the process of experiencing the environment and recognizing or making sense of the stimuli received. Aspects of perception include: Hallucinations, Illusions, Disturbances of Self and Environment, Disturbances of Quality or Size, Disturbances in the Intensity of Perception, and Disturbances of Experience. ■ Hallucinations are perceptions that occur when there is no actual stimulus present. Types of hallucinations include: visual, auditory, olfactory, gustatory, and somatic/haptic. Aspects of hallucinations: Elementary hallucinations, Command hallucinations, and Extracampine hallucinations. ■ Disturbances of Self and Environment include depersonalization and derealization. ■ Disturbances of quality or size include: Micropsia, macropsia, and dysmegalopsia. ■ Disturbances of experiences include: Deja vu, jamais vu, anosognosia, and prosopagnosia. ○ Insight and Judgement Insight includes having an awareness of one's illness. Judgment is a process that involves the transformation of uncertainty into a preference, involves cognitive awareness (decision) and an action (behavior). A description of insight includes: Full insight, partial insight, or impaired/no insight. ○ Cognitive Functions include orientation, attention and concentration, memory, intelligence estimation, knowledge base/fund of information, capacity to read and write, abstraction/concrete thinking, and visuospatial ability.
Pollard's Physical Functioning
● The weekly learning objectives include examining components of Pollard’s Physical Functioning.
● Alterations in physical functioning can affect many other areas of the mental status exam. People with psychiatric disorders have high rates of physical health problems, such as diabetes, cancer, and hypertension. ● There are correlations between medical conditions and the experience of psychiatric symptoms. ● Many diseases have cognitive, emotional, and behavioral symptoms. Any condition that can potentially affect the client's mental state should be recorded. ● Questions to explore a person's physical functioning include: ○ How have you been sleeping? ○ Have there been any recent changes to your appetite or weight? ○ Have you purged or vomited? ○ Do you have any concerns about going to the bathroom? ○ Have you had any recent concerns about your heart or breathing? ○ Have you noticed any recent changes to your hair or skin? ○ Do you have any concerns about your sexual functioning? ○ How often do you get a cold or infection? ○ Do you have any aches and pains? ● When documenting the session, clinicians should note any changes in the client's weight and approximate amount of weight lost or gained. Changes in sleeping patterns should also be recorded.
Primary, Secondary, and Tertiary Terminology
● The weekly learning objectives for the nursing course include identifying the significance of primary, secondary, and tertiary terminology in relation to the client with mental illness. ● Primary-level activities are delivered to healthy populations and include providing information and teaching coping skills to reduce stress to avoid mental illness. ● Secondary-level services involve the early detection and treatment of psychiatric symptoms, with the goal of minimizing impairment. ● Tertiary-level services involve treating psychiatric symptoms and addressing residual impairments in psychiatric patients to promote the highest level of community functioning. ● Primary gain is the deliberate production of symptoms so patients present as being genuinely ill. ● Secondary gain is the actual or real-world advantage derived from being ill. ● Tertiary gain is an advantage others receive from the patient's illness, such as disability income supporting an entire family.
