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Mental Health Nursing - Assessing Mental HealthA physical exam is often part of mental health assessments to rule out physical ailments. This may include blood tests or urine tests, as well as brain scans.Psychologists utilize a variety instruments to evaluate mental health. These tools can be anything from pencil and paper test forms, to in-depth interviews or self-completed questionnaires for postal mail.Affect and moodMood and affect are the most significant elements of the mental state exam (MSE) and are the first things to be observed by a medical professional. They describe a patient's general emotional state. This can be anything from sadness to happiness or irritability and anger. Affect can be measured by looking at facial expressions and demeanour as well as the reactivity to internal or external stimuli (e.g. smiling at a joke or crying at the loss of a loved one).Affect is a feeling that lasts only a few minutes but mood is a more sustained emotional state. It is usually described as euthymic, or dysphoric, or normal (meaning depression). However, psychiatric professionals must be careful not to confuse the terms because they have different definitions and are affected by a variety of factors.While the MSE is a useful clinical tool, it isn't always easy to interpret based on subjective patient report. Inquiring about the feelings of patients over the past few weeks can be more beneficial than relying solely on physician observations. A recent study showed that a significant proportion of symptoms, even those grouped together under the same disorder category, vary between assessment tools. This could be due the different emphasis placed on emotional, cognitive or physical symptoms, as along with differences in time periods and frequency of reporting symptom reports.It is also possible that the MSE relies on self-report, which may be prone to bias. For instance, a patient who complains of anxiety and a headache will likely report an lower score than a patient who reports only an occasional headache. Additionally there is a tendency for patients to downplay negative emotions and underestimate the severity of positive feelings.The mood and the affect of a person can have an impact on thought content. This can affect the way people make decisions, their interpersonal behavior and physical functioning. They are influenced by fatigue, stress and social interactions, as well as global events, hormones and the weather. Positive moods can increase creativity and mental strength. A negative mood can lead to confusion and lower concentration. A thorough and thoughtful mental health assessment should be able to consider the patient's mood as well as affect, as well as fundamental factors.Thought contentOne of the most important aspects of a mental state examination is assessing how the patient thinks. Particularly, evaluating thought processes and thought content. The thought process is the logic, coherence and organization of the patient's thoughts. The normal process of thinking is focused and logic-based. In several mental health conditions however, the thought process is distorted. Examples include hallucinations, delusions, and loose associations.A mental status examination also examines judgment and insight. Insight is the ability to see that there is an issue, and judgement is the ability to make an informed decision when presented with information. Both are affected by many mental health conditions such as schizophrenia and depression. If a patient suffers from impaired judgment and/or insight, they are at a higher chance of harming themselves or others. For instance when they are in danger of destroying their home the sensible judgment would tell that they should leave the premises immediately. A patient with impaired judgement might suggest they stay in the house to try to get rid of the flame.Thought content refers to the topics, subjects and beliefs that a patient has. Examiners generally comment on the clarity, connection and quality of a patient's thoughts. They will note tangential thoughts or those that are merely circumstantial, and in the event that the patient's thoughts diverge (digressions off from the main topic of the conversation). They will also comment on the speed of someone's thoughts, for instance, whether they seem fast or slow.It is also crucial to determine whether the patient's mood is in line with the environment in which they live. For instance, a person who is depressed might hear voices that are angry and threatening, while someone suffering from schizophrenia could experience a hallucination of the sound of a calm and soothing voice. A patient should be questioned about any homicidal or suicidal ideation. Although these are rare, they can be life-threatening and should be taken into consideration in every mental health evaluation.ObservationA nurse's observation skills are crucial in a mental health assessment. They involve a thorough evaluation of appearance, behavior, any peculiar beliefs or perceptions (such delusions or hallucinations) and mood cognition (including attention, memory, orientation). A mental health assessment for nursing also includes observing mobility, which includes any physical movement, such as eating or drinking, brushing your teeth, using the toilet and taking off shoes.The Observation portion of the mental state exam is crucial in determining if the patient is a danger to themselves or anyone else. This is determined by assessing whether the patient is moving in a way which suggests they may be threatening to harm themself or someone else.A detailed evaluation of the thought-based content is also done by monitoring the patient during the interview and determining their preoccupations. It is particularly important to determine if a patient has any suicidal or homicidal ideas and to determine if they are experiencing thoughts of delusion.Global assessment of functioning (GAF) is an assessment of functioning in numerical form, ranging between 0 and 100, combines the ability of an individual to perform in everyday life along with their capacity for coping with stressors. The GAF is an essential part of the mental state exam and assists in making treatment decisions.It is crucial to realize that observing the behaviour of a patient may cause anxiety. Therefore, it is essential that the procedure is conducted in a manner that doesn't cause or make the patient feel uncomfortable. iampsychiatry.uk is also crucial that the patient is informed about the purpose of the observation as well as the length of time it will take.Nursing observation is a crucial ability and should be an integral part of the nursing process. However, it should be noted that patients might not agree with the degree of observation and if they are unable to come to an agreement with staff then they should be able to access an advocate service which can represent their needs and help patients in any discussions about their treatment. This should be a component of the local policy and practice, with the participation and the support of user groups.QuestioningMany people are reluctant to discuss their mental health issues, but family members can often tell when something is amiss. They can also encourage the person to seek an assessment. These tests can cover a wide range of subjects, including mood, appearance and the thought process. In addition to these tests, the mental health professional will also ask the individual questions about their life, such as what's happened recently and what their feelings have been like.The assessment also includes a cognitive evaluation that focuses on the ability of the individual to think clearly and recall information. The test taker may be asked to complete basic tasks, such as focusing their attention on an alphabet of words or objects, memorizing simple lists or solving math problems. The test can also be used to assess the individual's judgment and ability to make good choices. The test also assesses the patient's insight, which reflects their level of understanding about their illness and its impact on them.Another important component of a mental health assessment is the person's attitude toward other people, himself and the illness. The patient's tone of voice, facial expression and body language can indicate hostility, anger or depression, or a feeling of insecurity. It is also important to note whether the patient appears to be seeking help or just living with their illness.In more serious instances the evaluation of mental health might include a thorough examination of the patient's thoughts which could include illusions or hallucinations. These conditions can be dangerous and even fatal.In general the mental health assessment should be holistic and look at the person's interactions with their social world. A health professional might use photographs, music, art or a range of assessment tools using electronic technology to help understand the person and their unique view of the world around them. They should also talk about the challenges that led the person to seek help, and reassure them there is nothing wrong in seeing a mental healthcare professional.