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• W33436980 abstract "Deaf since birth, Mrs. H, age 47, is withdrawn and says she is 18 months pregnant. She signs to herself; an interpreter says she uses unintelligible signs and poor syntax. How would you care for her? CASE Self-signing Mrs. H, a 47-year-old, deaf, American woman, is brought into the emergency room because she is becoming increasingly withdrawn and is signing to herself. She was hospitalized more than 10 years ago after developing psychotic symptoms and received a diagnosis of psychotic disorder, not otherwise specified. She was treated with olanzapine, 10 mg/d, and valproic acid, 1,000 mg/d, but she has not seen a psychiatrist or taken any psychotropics in 8 years. Upon admission to the inpatient psychiatric unit, Mrs. H reports, through an American Sign Language (ASL) interpreter, that she has had problems with her parents and with being fair and that she is 18 months pregnant. Urine pregnancy test is negative. Mrs. H also reports that her mother is pregnant. She indicates that it is difficult for her to describe what she is trying to say and that it is difficult to be deaf. She endorsesvery strong racing thoughts, which she first states have been present for 15 years, then reports it has been 20 months. She endorses high-energy levels, feeling like there iswork to do,and poor sleep. However, when asked, she indicates that she sleeps for 15 hours a day. Which is critical when conducting a psychiatric assessment for a deaf patient? a) rely only on the ASL interpreter b) inquire about the patient's communication preferences c) use written language to communicate instead of speech d) use a family member as interpreter The authors' observations Mental health assessment of a deafa patient involves a unique set of challenges and requires a specialized skill set for mental health practitioners--a skill set that is not routinely covered in psychiatric training programs. Deafness history It is important to assess the cause of deafness, (12) if known, and its age of onset (Table 1). A person is considered to be prelingually deaf if hearing loss was diagnosed before age 3. (2) Clinicians should establish the patient's communication preferences (use of assistive devices or interpreters or preference for lip reading), home communication dynamic, (2) and language fluency level. (1-3) Ask the patient if she attended a specialized school for the deaf and, if so, if there was an emphasis on oral communication or signing. (2) HISTORY Conflicting reports Mrs. H reports that she has been deaf since age 9, and that she learned sign language in India, where she became the star king. Mrs. H states that she then moved to the United States where she went to a school for the deaf. When asked if her family is able to communicate with her in sign language, she nods and indicates that they speak to her in African and Indian. Mrs. H's husband, who is hearing, says that Mrs. H is congenitally deaf, and was raised in the Midwestern United States where she attended a specialized school for the deaf. Mr. H and his 2 adult sons are hearing but communicate with Mrs. H in basic ASL. He states that Mrs. H sometimes uses signs that he and his sons cannot interpret. In addition to increased self-preoccupation and self-signing, Mrs. H has become more impulsive. What are limitations of the mental status examination when evaluating a deaf patient? a) facial expressions have a specific linguistic function in ASL b) there is no differentiation in the mental status exam of deaf patients from that of hearing patients c) the Mini-Mental State Examination (MMSE) is a validated tool to assess cognition in deaf patients d) the clinician should not rely on the interpreter to assist with the mental status examination The authors' observations Performing a mental status examination of a deaf patient without recognizing some of the challenges inherent to this task can lead to misleading findings. …" @default.
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• W33436980 date "2014-04-01" @default.
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• W33436980 title "Deaf and self-signing" @default.
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