 Acute onset (within hours or minutes)  First episode  Geriatric age  Current medical illness  Significant substance abuse  Nonauditory disturbances of perception  Neurological symptoms such as loss of consciousness, seizures, or head injury  Mental status changes such as disorientation or diminished alertness  Constructional apraxia (difficulties drawing a clock, cube, or intersecting pentagon) Features that point to a medical cause of a mental disorder include the following: The most important question for an emergency psychiatric nurse practitioner to address is whether the presenting problem is medical, psychiatric, or both. If their symptoms developed acutely, over minutes or hours, the cause is likely to be medical. If the patient develops psychiatric symptoms that have slowly worsened over time, the cause is more likely to be related to a mental disorder than a medical condition.

Thought objectivity is neither a subcategory nor a primary category. Gross impairment is a subcategory of judgment. Mental status exam findings are based on primary categories, which include general appearance, speech, affect, mood, thought process, thought content, orientation, memory, concentration, abstraction, and judgment.ĭistractibility is a subcategory of concentration. The Saint Louis University mental status examination is a tool to measure for mild cognitive impairment and dementia. The global deterioration scale is used to measure cognitive function. The Zung self-report inventory is used to measure depression. The scale for assessment of negative symptoms is an assessment tool for patients with schizophrenia. The S-MAST is a tool used to assess and screen for alcoholism in the geriatric population. The AUDIT assessment is also an alcohol use assessment tool, less commonly used than CIWA. The CIWA assessment is used to assess the withdrawal severity of alcohol and/or benzodiazepines. The COWS (Clinical Opiate Withdrawal Scale) assessment is used to assess the withdrawal severity of opiates.

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