NR 509 Final Exam Study Guide. Sign up for an individual topic or chapter, whichever

you prefer. Please have section completed by October 5th :)

Chapter 5 Ashley (1-6)/ Catlin (7-9)

Behavior/Mental Health Assessment and Modification for Age

-Unexplained conditions lasting >6weeks should prompt screening for depression,

anxiety, or both

-PRIME-MD (Primary Care Evaluation of Mental Disorders). 26 questions and take 10

minutes to complete. Used for the 5 most common=anxiety, depression, alcohol,

somatoform, and eating disorders.

-Patient indications for Mental Health Screening:

1.Medically unexplained physical symptoms-more than half have depression and

anxiety disorders

2. Multiple physical or somatic symptoms or high symptom count

3.High severity of the presenting somatic symptoms, chronic pain

4.Symptoms for more than 6 weeks

5. Physician rating as a “difficult encounter”

6. Recent stress

7.Low-self rating of overall health

8.Frequent use of health care services

9.Substance abuse.

-CAGE=substance-related and addictive disorders

Modification for Age

Elderly:

-Complain of memory problems but usually is due to benign forgetfulness

-Retrieve and process data more slowly and take longer to learn new information

-Slower motor responses and their ability to perform complex task may diminish

-Important to distinguish age-related changes from manifestations of mental disorders

-More susceptible to delirium which can be the first sign of infection, problems

with medications, or impending dementia

Infant: Assess mental status of a newborn=observing newborn activities

 1.Look at human faces and turn to parents voice

 2.Ability to shout out repetitive stimuli

 3. Bond with caregiver

 4.Self-soothe

Normal VS. Abnormal Findings and Interpretation

-Mood disorders: compulsions, obsessions, phobias, and anxieties

-Lethargic: drowsy, but open their eyes and look at you, respond to questions, and then

fall asleep.

-Obtunded: open their eyes and look at you, but respond slowly and are somewhat

confused.

-Agitated depression: crying, pacing, and hand-wringing

-Depression: the hopeless slumped posture and slowed movements.

-Grooming and personal hygiene may deteriorate: Depression, schizophrenia, and

dementia

-Manic Episode: the agitated and expansive movement of a manic episode

-Obsessive-Compulsive Disorder: Excessive fastidiousness

-Lesion parietal cortex: one side neglect in the opposite parietal cortex, usually in the

nondominant side

-Parkinsonism: facial immobility

-Paranoia: anger, hostility, suspiciousness, or evasiveness

-Mania: Elation and euphoria

-Schizophrenia: flat affect and remoteness

-Apathy (dull affect with detachment and indifference): dementia, anxiety, and depression

-Hallucination: schizophrenia, alcohol withdrawal, and systemic toxicity

-Amnestic Disorders: impaired memory or new learning ability and reduce social or

occupational functioning, but lack the global features of delirium and or dementia.

Anxiety and depression, and intellectual disability may also cause recent memory

impairment.

-Calculating ability: poor performance = dementia or aphasia

-Variations and abnormalities in thought processes:

1.Circumstantiality: The mildest thought disorder, consisting of speech with unnecessary

detail, indirections, and delay in reaching the point. Some topics may have a meaningful

connection

-Occurs in people with obsessions

2. Derailment: Tangential, speech with shifting from topics that are loosely connected or

unrelated. The patient is unaware of the lack of association

-Schizophrenia, manic episodes, and other psychotic disorders

3.Flight of ideas, an almost continuous flow of accelerated speech with abrupt changes

from one topic to the next. Changes are based on understandable associations, play on

words, or distracting stimuli, but ideas are not well connected.

 -Manic episodes

4.Neologisms: invented or distorted words, or words with new and highly idiosyncratic

meanings

 -Schizophrenia, psychotic disorders, and aphasia

5.Incoherence: Speech that is incomprehensible and illogical, with lack of meaningful

connections, abrupt changes in topic, or disordered grammar or word use. Flight of

ideas, when severe, may produce incoherence

 -Schizophrenia

6.Blocking: Sudden interruption of speech in mid sentence or before the idea is

completed “losing the thought”

 -Schizophrenia

7.Confabulation: Fabrication of facts or events, to fill in the gaps from impaired memory

-Korsakoff syndrome from alcoholism

8.Perseveration: persistent repetition of words or ideas

 -Schizophrenia or other psychotic disorders

9. Echolalia: Repetition of the words and phrases of others

 -Manic episodes or Schizo

10.Clanging: Speech with choice of words based on sound, rather than meaning, as in

rhyming and punning. Example: “look at my eyes and nose, wise eyes and rosy nose. To

to one, the ayes have it!”

 -Schizo and manic episodes

Abnormalities of Perception

1. Illusions: misinterpretations of real external stimuli, such as mistaking rustling leaves

for the sounds of voices

 -Grief, delirium, PTSD, Schizo