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Mental Health Nursing – Assessing Mental Health A physical examination is typically included in mental health assessments to rule out any physical conditions. This could involve blood tests or urine tests, as well as brain scans. Psychologists also utilize a range of tools to evaluate mental health. These tools range from paper and pencil test forms, to in-depth interviews or self-completed questionnaires for postal mail. Mood and affect The doctor will first be aware of the patient's mood and emotional state. They are the most accurate indicators of a patient's emotional state. This could vary from joy to sadness or irritability and anger. Affect can be assessed by observing facial expressions and overall demeanour as well as the reactivity to internal or external stimuli (e.g. smiling at an absurd joke or crying over the loss of a loved one). Affect refers to an emotion that is only temporary, whereas mood is a state of constant emotion. It is usually described as euthymic or normal, or dysphoric (meaning depressed). However, psychiatrists should be cautious not to misunderstand the terms since they have different definitions and are influenced by a variety of factors. The MSE can be a useful instrument for diagnosing clinical conditions however it is difficult to interpret based on an individual patient's report. The process of asking patients to share their experiences during the past few weeks can be more beneficial than relying on only physician observations. Recent research revealed that assessment tools were different in their ability to detect a substantial part of symptoms. iampsychiatry included the symptoms that were classified under the same disorder. This could be due to the different emphasis placed on cognitive or emotional symptoms as well as differences between time periods and frequency of reporting symptoms. It is also possible that the MSE relies on self-reports which could be susceptible to bias. A patient who reports both a headache and anxiety is likely to have an lower score than a patient reporting only migraine. Patients tend to minimize negative emotions while exaggerating positive ones. The mood and the affect of a person can have an impact on the content of thought. This can affect decision-making, interpersonal behavior, and physical function. They can be affected by stress, fatigue, social interactions, global events, hormones and even the weather. Positive moods can boost creativity and mental energy. Conversely, a negative mood can reduce concentration and lead to confusion. A thorough and thoughtful mental health evaluation must take into account both the patient's mood and affect as well as the fundamental factors. Thought content Assessing how the patient thinks is one the most important aspects of a mental health exam. Specifically, evaluating thought process and thoughts. The term “thought process” refers to the coherence, logic, and organization of a patient's thought processes. Normal thought processes are focused and logic-based. Thought processing can be altered when a person suffers from mental health issues. Examples include hallucinations, delusions and loose associations. A mental state examination also examines judgment and insight. Insight is the ability to see the presence of a problem, and judgement is the ability to make a rational decision when presented with information. Both are affected by various mental health conditions like depression and schizophrenia. A person who isn't able to see or judgment is more likely to hurt themselves or others. For example, if they are at risk of burning their house down, sensible judgement would tell that they should leave the premises immediately. However, a person with impaired judgment might suggest staying in the building and trying to put out the fire. Thought content is the subject matter, themes and beliefs that a patient has. Typically, examiners discuss the clarity, relevance and content of a patient's thoughts. They will take note of any thoughts that are circumstantial or tangential and also whether the patient is prone to having a flurry of thoughts (digressions from the conversation subject). They will also comment on the speed of a person's thoughts, including whether they appear fast or slow. It is also crucial to determine if the patient's mood matches the environment in which they live. A person suffering from depression could be able to hear angry voices, whereas a person suffering from schizophrenia might experience a hallucination that a soothing voice is speaking. The patient should be asked about any suicidal or homicidal ideation. These are uncommon, but could be life-threatening and should be taken into consideration in every mental health assessment. Observation The observation skills of nurses play an important role in a mental health assessment. They include a careful review of the appearance, behavior and any strange beliefs or perceptions (such as hallucinations or delusions) mood, as well as aspects of cognition (including attention to the environment, orientation memory). A mental state examination for nurses also involves observing the ability to move, which includes physical movement, such as eating drinking, eating, brushing teeth or using the toilet, as well as putting on shoes. The observation component of the mental health examination is vital in determining if the patient poses a risk to them or anyone else. This is accomplished by determining whether the patient appears to be acting in a way that suggests they are trying to harm themselves or another person. In addition, a detailed assessment of thought content is done by keeping track of the patient throughout the interview and determining their thoughts and concerns. It is essential to determine if the patient has any suicidal or homicidal ideas and to determine if they are experiencing thoughts of delusion. A global assessment of functioning (GAF) is an assessment of a numerical score on a scale from 0 to 100 that combines a person's ability to function in daily life and their ability to cope with the stresses in their lives. The GAF is a vital part of the mental status examination and helps to guide the treatment decisions. It is important to understand that observing the behavior of a patient could cause distress. It is therefore important that the procedure is conducted in a way that doesn't cause or feel intrusive. It is also crucial that the patient is aware of the reason for the observation and the amount of time it will last. Nursing observation is an essential skill and it must be an integral element of the nursing process. It is crucial to keep in mind that patients might disagree on the degree of observation. If they are unable to come to an agreement with staff, they must be able access an advocate service that can represent their interests and aid them in any discussions about their treatment. This should be an integral element of the local observation policy and practice, with the participation of user groups to ensure that patients are involved in the development of written documents and staff training for this aspect of clinical governance. Questioning Many people are reluctant to discuss their mental health issues, however family members can usually tell when something is amiss. They can also encourage the person to take a look at an assessment. These assessments can be a variety of topics such as mood, appearance and the thought process. In addition to these tests, mental health professionals will also ask the individual questions about their life, including what has been going on lately and what their feelings have been like. The assessment also includes a cognitive assessment that focuses on the person's ability to think clearly and recall information. The person may be required to complete simple tasks such as focussing on a list or objects, recollecting lists or completing math problems. The test can also check the person's ability to make sound decisions and use their judgment. The test determines a person's perception, which is their knowledge of their illness and how it affects them. The person's attitude towards others, himself and the illness is also an important aspect of a mental evaluation. The tone of voice, facial expression, and the body language of a patient can signal depression, anger or a sense of powerlessness. It is also important to know whether the patient is seeking help or resigned to living with their condition. In more serious instances an assessment of mental health may include an examination of the patient's mental state that could include hallucinations (false perceptions of sensory stimuli that are not real stimuli) or illusions (misperceptions of real stimuli). These conditions can be extremely dangerous and even deadly. In general the mental health assessment should take a holistic approach and examine the person's relationship to their social environment. Health professionals can employ photographs, music, art, or any other assessment tool to better understand the individual. They should also speak to the person about the difficulties that have caused them to seek assistance and reassure them that there is nothing wrong with visiting a mental health professional.