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Mental Health Nursing – Assessing Mental Health Mental health assessments often include a physical exam to rule out physical ailments. This may include blood tests and urine tests as well as brain scans. Psychologists also employ a array of tools to measure mental health. These range from tests that are written on paper and pen to in-depth interviews or self-complete postal questionnaires. Mood and affect Mood and affect are the most significant components of the mental status exam (MSE) and are the first to be viewed by the doctor. They are the general emotional state that can range from joy to sadness, or anger to anger. The affect can be assessed by facial expressions, overall demeanor and the reaction to internal or external stimuli. You can express your emotions by smirking at the joke or crying when you lose a loved one. Affect is a feeling that is temporary, while mood is a state of sustained emotion. It is typically described as euthymic, or normal, or dysphoric (meaning depressed). However, psychiatric specialists must be careful not to misunderstand the terms because they have different definitions and are affected by a variety of factors. While the MSE is a helpful clinical tool, it can be difficult to interpret based on a subjective patient report. It is therefore beneficial to ask patients how they've felt over the past few weeks, as opposed to using only the observation of a physician. Recent research revealed that assessment tools were different in their ability to detect a substantial part of symptoms. This included those that were grouped under the same disorder. This could be due to the different emphasis placed on emotional or cognitive symptoms, and also the differences between time periods and frequency in the reporting of symptoms. It is possible that the MSE is based on self-reporting which could be susceptible to bias. For instance, a person who describes experiencing a headache and anxiety will likely have a lower score than a patient who reports only the sensation of a headache. In addition there is an inclination for patients to minimize negative feelings and overestimate the severity of positive emotions. Mood and affect have a direct impact on the content of thoughts, which can influence the way people make decisions, their interpersonal behavior and physical performance. They can be affected by stress, fatigue social interactions, world events, hormones and even the weather. In fact positive moods have been proven to boost thinking and creativity. A negative mood can cause confusion and reduce concentration. A thorough and careful mental health evaluation must take into account the patient's mood and affect, as well as underlying factors. Thought content Assessing how the patient thinks is one the most crucial aspects of a mental health examination. Assessment of thought process and content. The thought process is the logic, coherence and organization of a patient’s thoughts. Normal thought processes are logical and focused on a goal. In many mental health disorders 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 identify that there is a problem, while judgement is the ability to make a rational decision when presented with information. Both are impaired in several mental health conditions, such as depression and schizophrenia. If a patient suffers from impaired insight and/or judgement in any way, they are at a higher chance of harming themselves or others. If they are in danger, their rational judgment would advise them to leave the home immediately. However, a person with impaired judgment might suggest staying in the building and attempting to put the fire out. Thought content includes the topics, subjects and beliefs that a patient holds. Typically, examiners discuss the clarity, connection and the content of a patient's thinking. They will also note tangential thoughts or those that are merely circumstantial, and when a patient is digressing (digressions away from the topic of the conversation). They will also provide feedback on a person's pace of thinking, such as whether they seem fast or slower. Other important areas to consider are whether the patient's thoughts are mood congruent or incongruent with their environment. For example, a patient who is depressed might hear voices that sound aggressive and threatening, whereas someone suffering from schizophrenia could experience a hallucination of an ethereal and calm voice. A patient should also be asked about any suicidal or homicidal ideation. These are uncommon, but could be life-threatening and should be taken into account during every mental health assessment. Observation The observation skills of nurses are crucial in the mental health assessment. They are a thorough examination of appearance, behavior, any unusual beliefs or perceptions (such delusions or hallucinations), mood, and cognition (including attention, memory and orientation). The nursing mental state exam also involves the observation of the movement. This includes any physical movement like eating, drinking and brushing teeth. The observation component of the mental status exam is an essential element of determining whether a patient may pose the risk to themselves or others. This is done by assessing whether the patient appears to be moving in a deliberate way that suggests they are trying to harm themselves or another person. A detailed evaluation of the content of thoughts is also done by monitoring the patient during the interview and determining their thoughts and concerns. It is important to check whether the patient is suffering from suicidal, homicidal, or delusional thoughts. Global assessment of functioning (GAF), an assessment of functioning in numerical form, ranging from 0 to 100, combines the ability of a person to perform in everyday life and their capability of managing stressors. The GAF is a crucial component of the mental state exam and helps guide the treatment decisions. It is crucial to be aware that watching an individual's behavior can cause anxiety and it is important that the process is conducted in a manner that does not cause anxiety for the patient and does not make them feel uncomfortable. It is also essential that the patient is fully informed about the purpose of the observation and the length of time it will last. Nursing observation is a crucial ability and should be a central part of the nursing process. However, it must be noted that patients might not agree with the degree of observation and if they cannot reach an agreement with staff, then they should have access to an advocate service which can represent their interests and support them in any discussions regarding their care. This should be a component of local policy and practice, with the involvement and participation of groups of patients. Questioning Many people are hesitant to discuss their mental health issues, but family members can often tell when something is amiss. They can also encourage the person to get an assessment. These assessments be conducted on a variety of subjects such as mood, appearance and thought process. In addition to these tests, the mental health professional will also ask the person questions regarding their personal life, such as what's been happening lately and what their feelings have been like. The test also includes a cognitive evaluation that focuses on the ability of the individual to think clearly and remember information. The test subject may ask to complete simple tasks, such as keeping their attention on the list of objects or words and recollecting lists of basic information or solving math problems. The test can also be used to check the person's judgment and ability to make informed choices. The test also assesses the patient's insight that reflects their level of understanding about their illness and its impact on them. The person's attitude towards others, himself and the illness is an important element of a mental evaluation. The tone of voice, the facial expression, and the body language of a patient may indicate depression, anger, or a feeling of helplessness. It is important to observe whether the patient seems to seek help or accepting their condition. In Continue Reading , an assessment of mental health may include an examination the patient's thoughts that may include hallucinations or even illusions. It is important to note the presence of these conditions because they can be extremely risky and even life-threatening. In general the mental health assessment must be holistic and examine the person's relationship to their social world. A health professional could use images, music, art or a variety of electronic assessment tools to better understand the person and their unique perspective on the world around them. They should also talk about the challenges that led the person to seek help, and assure them there is nothing wrong with seeing a mental health professional.