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Difficulty or discomfort in talking, with abnormal pitch or volume, caused by laryngeal disease. Voice sounds hoarse or whispered, but articulation and language are intact.
Articulation disorder. Distorted speech sounds; speech may sound unintelligible; basic language intact
Language comprehension & production secondary to brain damage disorder. True language disturbance; defect in word choice & grammar or defect in comprehension; defect is in higher integrative language processing
Most common & sever form. Spontaneous speech is absent or reduced to a few stereotyped words or sounds. Comprehension is absent or reduced to only the person's own name & in a few words. Repetition, reading, writing severely impaired. Poor prognosis for language recovery.
Expressive aphasia. Can understand language but can not express self using language. Characterized by nonfluent, dysarthic, & effortfull speech. Speech is mostly nouns & verbs (agrammatic or telegraphic) Auditory and reading comprehension in tact
Receptive aphasia. Opposite of broca. Can hear sounds and words but can not relate them to previous experiences. speech is fluent, effortless, and articulated but has many paraphasias & neologisms. Repetition, reading, writing impaired.
Lack of emotional response; no expression of feelings; voice monotonous and face immobile. ex: topic varies, expression does not.
Loss of identity; feels estranged, perplexed about own identity and meaning of existence. ex: "I don't feel real." "I feel like I'm not really here."
Rapid shift of emotions. ex: person expresses euphoric, tearful, angry feeling in rapid succession
Affect clearly discordant with content of person's speech. ex: laughs while discussing admission for liver biopsy
Sudden interruption in train of thought, unable to complete sentence, seems related to wrong strong emotion
Fabricates events to fill in memory gaps
Coining a new word; invented word has no real meaning except for the person; may condense several words. ex: "I have to turn on my thinkilator."
round-about expression, substituting a phrase when can not think of name of object. ex "the thing you open the door with" instead of "key"
Talks with excessive and unnecessary detail, delays reaching point
shifting from one topic to an unrelated topic; person seems unaware that topics are unrelated.
Flight of ideas
Abrupt change, rapid skipping from topic to topic, practically continuous flow of accelerated speech; topics usually have recognizable associations or are plays on words. ex: take this pill? this pill is blue. i feel blue. She wore blue velvet
persistent repeating of verbal or motor response, even with varied stimuli
Imitation, repeats others words or phrases, often with mumbling, mocking, or mechanical tone
- Word choice based on sound, not meaning, includes nonsense rhymes and puns.
- Clanging refers specifically to behavior that is situationally inappropriate. While a poet rhyming is not evidence of mental illness, disorganized speech that impedes the patient's ability to communicate is a disorder in itself, often seen in schizophrenia
Acute confusional state. Characterized by disorientation, disordered thinking and perceptions, defective memory, agitation and inattention
Chronic progressive loss of cognitive and intellectual functions, although perception and consciousness are intact. Characterized by disorientation, impaired judgment, memory loss.
Incoherent mixture of words, phrases, and sentences; illogical, disconnected, includes neologisms.
Misperception of an actual existing stimulus,by any sense
Sensory perceptions for which there are no external stimuli; may strike any sense: visual, auditory, tactile, olfactory, guslatory
Morbid worrying about his or her own health;feels sick with no actual basis for that assumption
Unwanted repetitive,purposeful act;driven to do it;behavior thought to neutralize or prevent discomfort or some dreaded event
unwanted,persistent thoughts or impulses;logic will not purge them from consciousness;experienced as intrusive and senseless.
Lethargic (or Somnolent)
Not fully alert,drifts off to sleep when not stimulated;can be aroused to name when called in normal voice but looks drowsy; responds appropriately to questions or commands but thinking seems slow and fuzzy;inattentive;loses train of thought;spontaneous movements are decreased
Sleeps most of the time;difficult to arouse needs loud shout of vigorous shake;acts confused when aroused;converses in monody llables; speech may be mumbled and incoherent; requires constant stimulation for even marginal cooperation
Stupor or Semi-Coma
Spontaneously unconscious; responds only to persistent and vigorous shake or pain; has appropriate motor response; other than that can only groan mumble, or move restlessly; reflex activity persists
Completely unconscious; no response to pain or any external/internal stimuli; some comas have light responses to reflex activity but no purposeful movement; deep coma; has no motor response
a defined period of intense fear,anxiety,and dread accompanied by signs of dyspnea, choking, chest pain, increased heart rate, palpitations, nausea, and sweating. Also, a fear of going crazy or dying or impending doom. Sudden onset,last about 10 minutes, then subsides.
An irrational fear of being out in the open or in a place from which escape is difficult (airport or airplane,car or bus, elevator, bridge). Fear of anxiety is so intense that these places are avoided and person is reluctant to leave safe place(home).
A pattern of debilitating fear when faced with a particular object or situation (e.g. dogs, cats, spiders, thunder storms, enclosed spaces, heights, blood). Person knows it is irrational yet studiously avoids the feared object,thus becoming restricted in social or occupational activities.
Pondering a deeper meaning beyond concrete an literal
Organic brain disorder vs psychiatric mental disorder
- Organic: Brain disease with a specific known cause
- Psychiatric: Etiology has not yet been established
Thought Content vs Thought Process
- Thought Content: What a person thinks, Specific ideas, beliefs, and use of words
- Thought Process: The way a person thinks, the logical train of thought
Situations in which it would be necessary to perform a complete mental status examination
- If family member expresses concern
- Presence of brain lesions
- Symptoms of psychiatric illness are noted
Factors that could affect a persons response to the mental status examination but have nothing to do with mental disorders
- Any known illnesses or health problems
- Current medications
- Responses to personal history questions about stress, sleep, etc.
Conventional ways to assess a person's recent memory within the context of initial health history.
- 24 hour diet recall
- Asking what time the person arrived
- Asking questions you can corroborate
Which mental function is the Four Unrelated Words Test intended to test?
New learning; it tests the person's ability to lay down new memories
Questions you could ask a patient to screen for suicide
- Do you feel like hurting yourself now?
- Do you have a plan to hurt yourself?
- How would other people react if you were dead?
- How often do you have thoughts about hurting yourself?
Levels of consciousness
1. Lethargic or somnolent: Not fully alert, drifts off to sleep if not stimulated
2. Obtunded: Sleeps most of the time, difficult to arose
3. Stupor or semicoma: Spontaneously unconscious, responds only to shake
4. Coma: Completely unconscious, no response to pain or stimuli
5. Delirium: Clouding of consciousness, inattentive, incoherent conversations
During an examination, the nurse can assess mental status by
- Observing the patient and inferring health or dysfunction.
- Mental status cannot be directly scrutinized like the characteristics of skin or heart sounds. Its functioning is inferred through an assessment of an individuals behaviors, such as consciousness, language, mood and affect, and other aspects.
All aspects of mental status in children are interdependent
Separating and tracing the development of only one aspect of mental status is difficult. All aspects are interdependent. For example, consciousness is rudimentary at birth because the cerebral cortex is not yet developed. The infant cannot distinguish the self from the mothers body. The other statements are not true
One of the first things that should be assessed before making judgments about their mental status
Sensory-perceptive abilities: Age-related changes in sensory perception can affect mental status. For example, vision loss may result in apathy, social isolation, and depression. Hearing changes are common in older adults, which produces frustration, suspicion, and social isolation and makes the person appear confused.
Full Mental Status Examination
- The full mental status examination is a systematic check of emotional and cognitive functioning. The steps described, however, rarely need to be taken in their entirety. Usually, one can assess mental status through the context of the health history interview.
- Gathering mental status information during the health history interview is usually sufficient.
- Is necessary when any abnormality in affect or behavior is discovered or when family members are concerned about a persons behavioral changes (e.g., memory loss, inappropriate social interaction) or after trauma, such as a head injury.
- The following factors from the health history that could affect the findings should be noted: any known illnesses or health problems, such as alcoholism or chronic renal disease; current medications, the side effects of which may cause confusion or depression; the usual educational and behavioral level, noting this level as the patients normal baseline and not expecting a level of performance on the mental status examination to exceed it; and responses to personal history questions, indicating current stress, social interaction patterns, and sleep habits.