Mental Health

Alterations in mental health can be more difficult to diagnose because there is no
definitive laboratory test or radiological study with which to isolate the disorder.
Patients may initially seek treatment from primary care practitioners for a variety
of complaints: anxiety, insomnia, generalized aches, or other somatic complaints.
A thorough patient history should include past medical conditions, any prior
mental health conditions and their treatment course, current medications, social
history (including habits, work, exercise, and substance use), cultural background,
environmental factors, family history, and changes in libido, appetite, or sleep.
Physical examination focuses on the chief complaint from the patient’s point
of view and traces the progression of symptoms in a chronological order from
the time of onset. Mental status examination is completed focusing on the patient’s
appearance, activity and behavior, affect, mood, speech, content of thought, thought
process, cognition, judgment, and insight.
The majority of patients are cared for on an outpatient basis. Hospitalization
should be considered for those who:
• Are too sick to care for themselves.
• Present a serious threat to themselves or to others.
• Neglect to care for themselves.
• Are violent or have bizarre behavior.
• Have suicidal ideation.
• Have paranoid ideation.
• Have delusions.
• Have a marked impairment in judgment.
Patients with a coexisting mental health disorder are also admitted to a medical
surgical floor only if the medical condition warrants medical management. Caring
for the patient admitted with a medical or surgical condition does not preclude the
need to care for the patient’s depression or schizophrenia as well. Patients may also
develop medical conditions as a result of their mental health issues. Patients with
inadequate nutritional intake due to an eating disorder may have significant elec-
trolyte imbalances or cardiac dysfunction.