Chapter 16:
Checklist of Client Behavior Evidencing Mental Impairments
(Based upon Logan, Learning to Observe Signs of Mental Impairment

REALITY CONFUSION

__ Reports hallucinations

__ Hearing Voices

__ "Seeing things" (people, objects, unformed images such as flashes of light)

__ Smelling things not there

__ Tactile (feelings of being touched by someone/something not there)

__ Gustatory (false perception of taste)

__ Misperceives harmless image as being threatening

__ Irrational fears, i.e., leaving his cell, heights, spiders, snakes

__ Seems confused about people or surroundings

__ Consistent false beliefs. i.e.

__ Lawyers out to get him

__ Guard/another person in love with him

__ Food being poisoned

__ Being controlled by outside forces

__ Others are talking about him

SPEECH AND LANGUAGE

Nonsensical Speech

__ Speech which is incoherent at times

__ Use of new word formations (not slang)

__ Use of "non-words"

__ Use of non-sequiturs

__ Conclusions based on faulty promises

Half Answers

__ Brief, unelaborated answers to questions

__ Monosyllabic answers to questions

__ Language tends to be vague, repetitive, stereotyped

__ Answers are lengthy but actual information is little

__ Speech seems like "empty philosophizing"

Off Track

__ Changes subject in the middle of a sentence in response to another stimulus

__ Answers questions in an oblique or irrelevant way

__ Pattern of speech seems "disjointed"

__ Ideas slip gradually off-track from one oblique thought to another

__ Speech pattern which is circuitous, indirect or delayed in reaching its goal

Includes many tedious details

__ Seems "long-winded"

__ Requires that you interrupt in order to finish business

__ Starts on one subject, then wanders away and never returns

__ Persistent, inappropriate repetition of words, ideas or subjects once the discussion begins

Rapid Speech

__ Talks rapidly and is hard to interrupt

__ Sentences left unfinished because of eagerness to move on

__ Continues talking even when interrupted

__ Often speaks loudly and emphatically

__ Talks too much and interrupts others

Delayed or Interrupted Speech

__ Speech is very slow

__ Excessive wait before answering or responding

__ Difficulty finding right word to use

__ Stops in the middle of a thought and after some silence cannot remember what he was talking about

__ Says his "mind went blank"

Sound-Related Problems

__ Recognizable mispronunciations

__ Substitution of inappropriate word

__ Slurred speech

__ Speaks in a monotone even when discussing emotional material

__ Talks in excessively formal or stilted way

__ Language may appear "quaint or outdated"

Other Language Problems

__ Writing is very small

__ Writing is prolific

__ Has trouble reading

__ Spells poorly

MEMORY AND ATTENTION

__ Has trouble remembering childhood data

__ Has trouble recalling things that happened in past few months

__ Has trouble remembering things in last few days

__ Has trouble recalling events surrounding crime or trial

__ Has trouble remembering people's names

__ Reports "memories" which do not correspond to documentation

__ Seems to "fill in" details of faulty memory

__ Sometimes appears to be "lying" about events in his life or events surrounding crime

__ Has extraordinary ability to recall

__ Problems concentrating

__ Attention drawn to irrelevant or unimportant stimuli

__ Loses train of thought

__ Problems with attention and concentration on emotionally-charged issues

MEDICAL COMPLAINTS

__ Exaggerated concern over health

__ Self-wounds or wounds suspicious in origin

__ "Accidents"

__ Difficulty falling asleep

__ Difficulty staying asleep

__ Excessive sleeping

__ Change in eating habits

__ Loss or decrease in appetite

__ Blurred vision

__ Need to squint or move closer when reading

__ Hearing problems

__ Ringing in ears

__ Headaches

__ Dizziness

__ Nausea

__ Excessive tiredness

EMOTIONAL TONE

__ Worry, fear, over-concern for present or future

__ Mistrust, belief others harbor malicious or discriminatory intent

__ Sorrow, sadness, despondency. pessimism

__ Irritability, belligerence, disdain for others, defiance

__ Impotence

__ Extreme, heightened emotions

__ Flatness in emotional tone. near absence of emotional expression

__ Sudden changes in mood which are disproportionate to situation

__ Inappropriate laughter

PERSONAL INSIGHT AND PROBLEMS SOLVING

__ Low self-esteem

__ Exaggerated self-opinion

__ Overrates level of ability

__ Unrealistic goals; failure to take disabilities into account

__ Denial of mental problems

__ Difficulty planning ahead

__ Poorly organized

__ Difficulty thinking as quickly as needed

__ Difficulty changing a plan or activity when necessary

__ Difficulty in accurately predicting consequences

__ Easily frustrated

__ Impaired ability to learn from mistakes

PHYSICAL ACTIVITY

__ Restlessness

__ Fidgety

__ Kicks leg often/moves arms around a lot

__ Overly talkative

__ Unusually quick reactions

__ Hyper-alert to what is happening in visiting room; constantly looking around, checking behind himself

__ Slow movement, slow speech

__ Slow reaction in movements or while answering questions

__ Balance problems

__ Clumsiness, poor coordination

__ Tense posture and/or facial expression

INTERACTIONS WITH OTHERS

__ Unresponsive family

__ No regular visitors or letters from others

__ No participation in yard activities

__ Discontinuation of yard activities

__ Lack of social greetings to fellow inmates in visiting room

__ Awkward or inappropriate interactions with others in visiting room

__ Willingness to "go along with" or cooperate in almost any way

__ Deficiency in relating to others; lack of spontaneous interactions

__ Socially inappropriate comments and/or actions (including sexual or aggressive)

__ Trouble understanding that some of his behavior is inappropriate

OTHER OBSERVATIONS

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©2001
Kentucky Dept. of Public Advocacy
http://www.dpa.state.ky.us