Wednesday, August 19, 2015

Content of Mental Status Exam

Content of Mental Status Exam

1. General Presentation.

A. Appearance-apparent age, grooming, state of health, hygiene/cleanliness, physical characteristic {build/weight, physical abnormalities, deformities, etc.), state of health, distress, pain, appropriateness of attire. pride, dignity, Note unilateral neglect of dress, description of appearance should be enough detail for identification. take into consideration the individual’s age, race, sex, educational background, cultural background, socioeconomic status, etc.

B. Motor Activity-posture {slouched, erect), gait {staggering, shuffling, rigid), coordination, speed-activity level, gestures, tremors, tics/grimacing, relaxed, restless, pacing, threatening, hyperactive or under active, disorganized, purposeful, stereotyped movements, repetitive.

C. Interpersonal-rapport with the interviewer. Engaged, interested, cooperative, opposition/resistant, submissive, defensive, fearful, note how they greet examiner.

D. Facial Expression-relaxed, tense, happy, sad, alert, day-dreamy, angry, smiling, distrustful/suspicious, tearful.

E. Behavior-distant, indifferent, evasive, negative, irritable, labile, depressive, anxious, sullen, angry, assaultive, exhibitionistic, seductive, frightened, alert, agitated, lethargic, somnolent.

2. State of Consciousness-alert, hyperalert, lethargic -reasons for lethargy often organic.

3. Speech.

A. Form-conversational, distractible, rambling, circumstantial, tangential.

B. Quantity-mute, overtalkative, can’t be interupted.

C. Rate-rapid, accelerated, pressured, slow, blocked.

D. Quality-dramatic, histrionic, sarcastic, humorous.

F. Expressive Language-normal, circumstantial, anomia, paraphasia, clanging, echolalia, incoherent, blocking, neologisms, perseveration, flight of ideas, mutism.

G. Receptive Language-normal, comprehends, abnormal.

H. Dysprodia-Flat monotone speech-no emotional expression.

4. Mood and Affect.

A. Mood-a symptom as reported by the individual describing how they feel emotionally, such as: normal, euphoric, elevated, depressed, irritable, anxious, angry.

B. Affect-observed reaction or expressions. Range of affect includes: broad, restricted, blunted, flat, inappropriate, labile, mood congruent, mood incongruent.

5. Orientation and Intellectual Ability.

A. Orientation-time, person, place, and self. The individual should be asked questions such as the day of the week, month, the date, where he lives, where he is now, if he knows who he is.

B. Intellectual Ability-above average, average, below average.

        a. General information-the last four presidents, governor, the capitol, what direction does the sun rise, etc.

        b. Calculation-serially subtracting 7 from 100 (at least six times). Simple multiplication word problems such as, “if a pencil costs 5 cents, how many pencils can you buy with 45 cents?”.

        c. Abstract Reasoning-proverbs. This is the ability to make valid generalizations. Responses may be literal, concrete, personalized, or bizarre. Example, “Still waters run deep”, “ A rolling stone gather no moss”.

        d. Opposites-slow/fast, big/small, hard/soft.

6. Attention & Concentration-.

A Concentration-Days of the week backward-serial sevens-serial threes, serial fives.

B. Attention-Non-numeric test-read series of random letters-have patient tap finger or say yes every time hear chosen letter. Numeric-string of digits forward and backward-starting with three digits. Stop when patient misses two of each. Average is 7 digits.

7. Memory-immediate (10 to 30 sec) short term (up to 1hour) recent (2 hours to 4 days) recent past (past few months) remote past (6 months to lifetime).

8. Thought Processes/Content-deals with organization and composition of thought. Examples include: normal, blocking, loose associations, confabulation, flight of ideas, ideas of reference, illogical thinking, grandiosity, magical thinking, obsessions, perseveration, delusions, depersonalization, suicidal ideation, homicidal ideation.

9. Hallucination-none, auditory, visual,olfactory, gustatory.

10. Insight-good, fair, poor. Understanding, thought,feeling, behavior.

11. Impulse Control-good, fair, poor. The ability/tendency to resist or act on impulses.

*This is not exhaustive-mental status questions could go on interminably.

Wednesday, July 22, 2015

Culturally Diverse Intervention: Acculturated and Bi-cultural

Culturally Diverse Intervention: Acculturated and Bi-cultural

Diversity in intervention adds difficulty to the already complicated planning in an intervention. Introducing diversity means to be especially sensitive to populations that vary in values, life styles, or situations. The first two components of the interpersonal styles that are in our society are acculturation and bi-cultural individuals.

Acculturated individuals mostly identify with the white society class. Examples of acculturated individuals are African Americans and Latinos, who typically fit in with the white middle class in America. These African Americans and Latinos would live in white neighborhoods, be friends with white adults, and have mainly white colleagues. However, the spouse of the acculturated individual may not identify or describe his or her spouse as having acculturated into white society to the extent that is correct. Also, involving the extended family into the treatment plan is not as important with an acculturated individual.

Bi-cultural is the next component of intervention with diverse individuals. The bi-cultural individual is slightly more immersed in his or her own culture than the acculturated individual. However, he or she will still be easy interacting with white society. The life of the bi-cultural individual will be integrated in all areas including work, living environment, and entertainment. Their friends will integrate with them as well, mixing between white to Latino to African-American to Native Americans. When treating these individuals, involving the extended family in the process becomes more significant. In fact, it is beneficial for the entire treatment to be integrated in many areas to ensure the individual’s maximum comfort.

Wednesday, June 3, 2015

Action Responses

Action Responses

Another type of therapeutic response is action responses, where the client’s structured reference has more data and perceptions from the counselor. Timing is important in these responses, and they should be used once the client and the counselor have a firm and trusting relationship. Action responses ask questions only with a specific purpose in mind, using open-ended questions (beginning with either what, how, where, or who) to gain more information from the client, focusing with probes on the problems of the client, waiting a moment after questioning the client to give him time to think and answer, limiting questions to one at a time, not using belligerent or blame-oriented questions, not using too many probes at one time (so that the client will feel at ease), using open-ended probes only at the start of the treatment, making sure that questions presented to the client are legitimate and therapeutic, and effectively using these questions to achieve your intended effect.

Sometimes the counselor must confront the client if his messages are unclear or mixed. The purposes of confrontation are to help the client to understand the way that they see themselves, to reveal discrepancies, and to show the client an important point. Before using confrontation, however, there must be strong and trusting relationship between the counselor and the client. Even after the rapport is achieved, the counselor must present the confrontation in a timely manner that is an expressive and tangible thought, behavior, or feeling.

Wednesday, May 27, 2015

Additional Factors Crucial in Counseling

Additional Factors Crucial in Counseling

For a successful counseling procedure, the counselor must possess certain qualities, including interpersonal skills that work effectively, little or no confrontation, fervent concern for curing the client’s problems, adaptability, no discomfort in discussing most topics, self-awareness, comprehension, sound mental health, sensitivity, a non-judgmental attitude, objectivity, reliability, competence, honesty, and empathy towards clients. The counselor and client’s personal relationship is extremely important in the counseling process. Both the client and the counselor should be actively involved in the relationship; however, the client should be the focus of it and not the counselor. Yet, some boundaries should be decided on in the relationship as well. Important factors in the client-counselor relationship are a strong bond, collaboration, pre-determined goals and objectives, competence on the part of the counselor in determining the client’s ideas and meanings, multi-cultural empathy on the part of the counselor in understanding the client’s world-view, noticing what the client values, and empathy. The counselor needs to also be genuine, not phony, or acting in a way different from internal feelings. Within the professional relationship, the counselor needs to be able to continually share what is occurring, stay focused, and remain accountable to goals. Other qualities for the counselor are warmth (acting humanely, accepting the client, and keeping the treatment friendly), congruence (acting the way that he speaks), positive regard and respect (respectful attitude, acting respectful, acting in a committed manner towards the client, demonstrating empathy, behaving warmly), and overall making sure that the client views the counselor as warm and friendly.

Wednesday, May 6, 2015

Adolescent Recovery

Adolescent Recovery

Recovery for adolescents in the developmental model is a gradual process that is made up of various emotional, psychological, and socially associated recovery tasks that become increasingly complex. The term recovery refers to the abstinence from mood-altering chemicals while advancing the area of functioning in the individual.

The pretreatment phase (which typically takes place when the individual begins treatment) of the developmental model is where the adolescent will see view his or her unpleasant experiences as consequences of the inability to hold control over their life because of use. They will also change their perspectives regarding how their abuse is related to their problems. Additionally, they will feel emotional pain that stimulates them, and they will consciously decide to become involved in the treatment procedure.

The next phase is the initial stabilization that will take place in the first two weeks of treatment. In it, patterns of use are disrupted, withdrawal recovery occurs during the period of abstinence, and there is a detoxification from impulsive behaviors.

The next phase is the early recovery phase I, where struggles with acceptance and understanding of addiction occurs, along with the adolescent’s ability to recognize triggers and to learn of skills that encourage personal development. He or she will also take personal responsibility for choices, decisions, and actions as well as identifying and voicing feelings.

The next phase is the early recovery phase II, where the adolescent will manage triggers, manage drug craving, and accept recovery. The last phases are the middle, the advanced, and the maintenance phase (which continues throughout the adolescent’s life).