Nursing 212

Health Differences Across the Lifespan 2 Study Guide

Chapter One: Care of Patients with Mental Health Problems 1.1 General Assessment for Psychiatric Disorders

Health History A psychiatric assessment is most commonly carried out for clinical and therapeutic purposes. Psychiatric assessments are also used to establish a diagnosis and formulation of the individual's problems, and to plan the individual's care and treatment. This may be done in a hospital (or in- patient) setting, in an ambulatory (or outpatient) setting, or in a community setting (as done in a home-based assessment). Subjective information is the information that is obtained from the patient’s point of view, such as his/her chief complaints, the history of the present illness, and the reason the patient is seeking health care. If possible, the chief complaints should be a standard part of any psychiatric assessment. The standard psychiatric history consists of biographical data (name, age, marital and family contact details, occupation, and first language), the presenting complaint (an account of the onset, nature, and development of the individual's current difficulties), and personal history (including birth complications, childhood development, parental care in childhood, educational and employment history, relationship and marital history, and criminal background). The history also includes an inquiry about the individual's current social circumstances, family relationships, current and past use of alcohol and illicit drugs, and the individual's past treatment history (current and past diagnoses and use of prescribed medication). The psychiatric history includes an exploration of the individual's culture and ethnicity, as cultural values can influence the way a person (and their family) communicates psychological distress and responds to a diagnosis of mental illness. Certain behaviors and beliefs may be misinterpreted as features of mental illness by a clinician who is from a different cultural background than the individual being assessed. The mental status examination (MSE) is another core part of any psychiatric assessment. The MSE is a structured way of describing a patient's current state of mind under the domains of appearance, attitude, behavior, speech, mood, thought process, thought content, perception, cognition (including orientation, memory, and concentration), insight, and judgment. The data is collected through a combination of direct and indirect means. This includes unstructured observation while obtaining the biographical and social information, focused questions about current symptoms, and formalized psychological tests. The purpose of the MSE is to obtain a comprehensive, cross-sectional description of the patient's mental state, which, when combined with the biographical and historical information of the psychiatric history, allows the clinician to make an accurate diagnosis and formulation, which are required for coherent treatment planning. The MSE is not to be confused with the mini-mental state examination (MMSE), which is a brief neuro- psychological screening test for dementia. The mini-mental state examination (MMSE) is a popular screening tool used to determine cognitive functioning. The MMSE is a reliable measurement containing thirty questions that are used to test basic cognitive functions such as attention, language production, orientation, language comprehension, and immediate memory. The average time it takes to complete the MMSE is five to ten minutes. People with normal cognitive functioning usually score high on the measurement, ranging from 27 to 30. The instrument is accurate in determining

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