cognitive assessment 2

8/12/2019 Cognitive Assessment 2

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Table of Content

Purpose Elements

Conclusion

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Why do you carry out cognitive assessmentin psychiatric patients?



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Purpose

Diagnosis

e.g. Alzheimers disease

Complication / Part of illness

e.g. Schizophrenia

e.g. Encephalopathy

e.g. Psychotropics

Prognosis / Monitoring



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Qualitative change of

consciousness

Delirium Fluctuation of consciousness Confusion: description of the patients self-

experience or the doctors observation



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Orientation

Time

Place

Person



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Orientation

Capacity of a person to gauge accurately time,space and person in his current setting.

Orientation in time is labile and quite readilydisturbed by rapt concentration, strong emotion

or organic brain factors.

Orientation in space is disturbed later in thedisease process than time. Disorientation in time

and place are evidence of an organic mental state.



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Orientation

In disorientation of person, the patient failsto remember his own name.

How about asking if he could recognize anurse?

It occurs at a very late stage of organic

deterioration.

Delusion of mis-orientation



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Attention

Concentration



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Attention &

Concentration Attention: objective observation of anotherperson, object or event

Concentration: attention sustained forsome duration of time

Lack of attention denotes an inability tofocus on an object in a purposeful way anddisturbance of concentration is an inability

to retain this attention.



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Bedside Testing

Orientation and attention

Alertness: level of wakefulness and

reactivity

Orientation: Time/Place/Person

Attention/Concentration: Serialsubtraction of 7s; Months of yearbackwards; Days of week backwards; digit

span forwards and backwards.



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Memory



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Bedside Testing

Memory Immediate Recall

Recent Memory

Remote memory



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Bedside Testing

Calculation

ability to manipulate numbers mentally

simple addition, subtraction ormultiplication questions may be used.

problems of money and change are oftenhelpful with limited educationalbackground.

Not the same as serial 7.



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Bedside Testing

Fund of knowledge must be tailored to the unique

circumstances and educational level of

the individual



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Concrete Thinking

Abnormal process of thinking inschizophrenia and organic states may result

in a literalness of expression and

understanding.

Abstractions and symbols are interpreted

superficially without tact, finesse of anyawareness of nuance.



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Bedside Testing

Abstract Reasoning

described the ability to mentally shift back andforth between general concepts and specificexamples.

of all the frequent used ways to test abstractreasoning, asking proverb interpretation is

probably the least useful.

alternative is to ask for the similarity between 2or more objects, which really mean asking towhat conceptual abstraction do both belong.



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Bedside Testing

Insight describes patients capacity to recognize

and understand their own symptoms and

illness.



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Bedside Testing

Judgement

can the person recognize prevailing social

norms of behavior and comply? and will this person be able to cooperate

with medical evaluation and treatment?

least descriptive and most inferential must often draw from information in the

history to supplement mental status

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Bedside Testing

Posing hypothetical situation: the presumedcorrect response to such senarios is often

obvious and the answer may be very

different from the patients actual behavior.

Moreover such questions often miss thecomplexity of variables shaping behaviorand are simplistic in assuming a single

correct response.



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Disturbance of

ud ement A judgement is a thought which express a

view of reality

To assess whether it is disturbed or not,one needs to measure it against objective

fact.

Is not made solely on the basis of thatparticular belief or argument, but on taking

the whole of the persons behavior and

opinions into account.Sunday, April 21, 13


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Judgement

A mans claims to be a figure of royaltypersecuted by the Marxists could, in fact, be

true. But the opinion of his judgement wasdisturbed would be confirmed if he had

suddenly become convinced about his

royalty when a psychiatric nurse had

commented to him about the tattoos on

his arm.



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Judgement

Delusions are a disturbance of judgement.

Judgement in other areas of life apart fromthe delusion can be preserved.



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Thank you

cognitive assessment 2

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