Cognitive Assessment in Psychiatry

Dr. Chee Kok-Yoon Neuropsychiatrist

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Table of Content
Purpose Elements Conclusion

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 Why do you carry out cognitive assessment

in psychiatric patients?

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Purpose

Diagnosis

e.g. Alzheimers disease e.g. Schizophrenia e.g. Encephalopathy e.g. Psychotropics

Complication / Part of illness

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Prognosis / Monitoring

Elements
Consciousness is a state of awareness of the self and the
environment.

3 dimensions of consciousness Vigilance (wakefulness) - drowsiness

(sleep)

Lucidity - clouding Consciousness of self

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Qualitative change of consciousness

Delirium Fluctuation of consciousness Confusion: description of the patients selfexperience 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 readily disturbed by rapt concentration, strong emotion or organic brain factors. Orientation in space is disturbed later in the disease 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 fails
to remember his own name. nurse?

How about asking if he could recognize a 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: objective observation of another

person, object or event some duration of time

Attention & Concentration

Concentration: attention sustained for Lack of attention denotes an inability to

focus on an object in a purposeful way and disturbance 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: Serial

subtraction of 7s; Months of year backwards; 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 or
multiplication questions may be used. helpful with limited educational background.

problems of money and change are often 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 in
schizophrenia and organic states may result in a literalness of expression and understanding. supercially without tact, nesse of any awareness of nuance.

Abstractions and symbols are interpreted

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Bedside Testing

Abstract Reasoning

described the ability to mentally shift back and forth between general concepts and specic examples. of all the frequent used ways to test abstract reasoning, asking proverb interpretation is probably the least useful. alternative is to ask for the similarity between 2 or more objects, which really mean asking to what 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 nding
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Bedside Testing
Posing hypothetical situation: the presumed
correct response to such senarios is often obvious and the answer may be very different from the patients actual behavior. complexity of variables shaping behavior and are simplistic in assuming a single correct response.

Moreover such questions often miss the

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Disturbance of Judgement
A judgement is a thought which express a
view of reality

To assess whether it is disturbed or not, Is not made solely on the basis of that
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one needs to measure it against objective fact. particular belief or argument, but on taking the whole of the persons behavior and opinions into account.

Judgement
A mans claims to be a gure of royalty
persecuted by the Marxists could, in fact, be true. But the opinion of his judgement was disturbed would be conrmed 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 from
the delusion can be preserved.

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Judgement
judgement may be more usefully assessed

by observing the patients behaviour during the interview and by asking elaboration on true incidents in the recent history.

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Thank you

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