Mnemonic for Psychiatric Assessment
You have dreamed for this moment to come, and now here you are a day before your first day of duty as a psychiatric nurse. You can’t help but feel both ecstatic and nervous. The long wait has finally ended and it’s time to work on your dream job. However, you feel a bit anxious. Not only is this your first time, but you also fear that you may do something wrong during duty, especially on assessing patients. How does one perform nursing assessment for psychiatric patients? What are the things that the psychiatric nurse must remember? Here’s a tip: Always Send Mail Through the Post Office.
Always Send Mail Through the Post Office
General appearance should be assessed for unspoken clues to underlying conditions since the patients’ appearance can help determine whether they are unable to care for themselves such as in cases when they appear undernourished, disheveled, or dressed inappropriately for the weather or have significant body odor; are unable or unwilling to comply with social norms (eg, they are garbed in socially inappropriate clothing), or have engaged in substance abuse or attempted self-harm (eg, they have an odor of alcohol, scars suggesting IV drug abuse or self-inflicted injury).
This can be assessed by noting spontaneity, syntax, rate, and volume. For example, a patient with depression may speak slowly and softly, while a patient with mania may speak rapidly and loudly. Abnormalities such as dysarthrias and aphasias may indicate a physical cause of mental status changes, such as head injury, stroke, brain tumor, or multiple sclerosis.
Patient’s mood must be assessed such as if they depressed, euphoric, suspicious; and affect if it is restricted, flattened, inappropriate. Mood is described using the patient’s own words, and can also be described in summary terms such as neutral, euthymic, dysphoric, euphoric, angry, anxious or apathetic. Alexithymic individuals may be unable to describe their subjective mood state. An individual who is unable to experience any pleasure may be suffering from anhedonia. Affect is described by labelling the apparent emotion conveyed by the person’s nonverbal behavior (anxious, sad etc.), and also by using the parameters of appropriateness, intensity, range, reactivity and mobility.
Content of thought may include delusions, suicidal thoughts, amount of thought and rate of production, continuity of ideas. Thought process in the MSE refers to the quantity, tempo (rate of flow) and form (or logical coherence) of thought. Thought process cannot be directly observed but can only be described by the patient, or inferred from a patient’s speech. Regarding the tempo of thought, some people may experience flight of ideas, when their thoughts are so rapid that their speech seems incoherent, although a careful observer can discern a chain of poetic associations in the patient’s speech. Alternatively an individual may be described as having retarded or inhibited thinking, in which thoughts seem to progress slowly with few associations.
This may include hallucinations, other perceptual disturbances (derealisation; depersonalisation; heightened/dulled perception). Thinking and perception can be assessed by noticing not only what is communicated but also how it is communicated. Abnormal content may take the form of delusions (false, fixed beliefs), ideas of reference (notions that everyday occurrences have special meaning or significance personally intended for or directed to the patient), or obsessions (persistent ideas, feelings, impulses, preoccupations). The physician can assess whether ideas seem to be linked and goal-directed and whether transitions from one thought to the next are logical. Psychotic or manic patients may have disorganized thoughts or an abrupt flight of ideas.
This may include the patient’s orientation to time, place and person. You may also assess other cognitive functions such as patient’s level of alertness; attentiveness or concentration; memory; abstract reasoning; insight; and judgment. Abnormalities of cognition most often occur with delirium or dementia or with substance abuse or withdrawal but can also occur with depression.