Mental Status Exam Continued
The final piece of the mental status exam is AFFECT. What is affect and why is it important? When used as a noun affect describes someone’s emotional response to a given situation. This is extremely important when evaluating the mental status of your patient.
You have identified whether or not your patient is alert, oriented, cognitive and coherent. The patient meets all these criteria, but the final piece to consider is their behavior, demeanor or in short AFFECT. Are they calm and cooperative and acting the way a reasonable person would act under the given circumstances? Or, is the patient combative, uncooperative, belligerent? There are many different words used to describe the affect of your patients. Are they flat, with no real emotional response or verbal response to you? Combative? Erratic, are they demonstrating erratic unpredictable behavior and thought process. Maybe on a drug overdose? They can tell you the presidents name and city you’re in but they are emotionally and psychologically detached, this is why you can tell immediately when you come on scene that the erratic unpredictable meth patient gets a ride to the hospital, it’s actually very black and white, not gray.
There are two populations however that AFFECT is extremely important. Do you think you can name them? The first is the most important. Pediatrics!!!!!!!! The pediatric patient for EMS is all about affect. How is your kiddo acting? They can’t answer all the normal questions we ask their adult counterparts. So is the child acting normal? If not then consider it altered mental status, because they are. Then treat them according to your guidelines. This is very important and will serve you well. The second is the geriatric population, but more specifically the patients that suffer from debilitating diseases like dementia, Alzheimer’s or Parkinson’s. Are they “acting” normal for them? This is what we are trying to determine when we ask their care provider. This is AFFECT, is their affect normal for them given the situation.
We hope this helps give you some tools to determine mental status with your patient and then be able to act decisively. As always own the day and go out the door with intent.