1 - Psychiatric Sx and Mental Status Exam

Question 1

Cognitive therapy vs Medical

Answer 1

As effective, and effects can last longer

Question 2

Prevalence of major diagnosable mental illiness

Answer 2

One out of four people

Question 3

The costliest mental disorder

Answer 3

Schizophrenia (100B)

Question 4

Three of the top ten illness affecting humans are psychiatric. What are they?

Answer 4

Major Depression

Bipolar Disorder

Schizophrenia

Question 5

5 steps of the psychiatric eval

Answer 5

1. Observe
2. Establish rapport
3. Secure permission from the patient
4. Open ended questions
5. Transition to specific or closed ended questions later

Question 6

10 areas of medical history

Answer 6

1. Chief Concern
2. HPI
3. PMH + PSH
4. Hospitalizations
5. Medications
6. Allergies
7. Social Hx
8. Family Hx
9. ROS

Question 7

Observed (only) parts of the mental status exam (6)

Answer 7

Appearance

Behavior

Attitude

Level of Consciousness

Speech and Language

Affect

Question 8

Inquired parts of the Mental Status Exam

Answer 8

Orientation

Mood

Question 9

Observed/Inquired part of the mental status exam

Answer 9

Thought process/form

Thought content

Insight/judgement

atention span

Memory

Intellectual functioning

Question 10

Appearance, attitude, and behavior include…

Answer 10

General appearance

Posture

Psychomotor activity

Physical activity (fidgeting)

Interpersonal behavior

Rapport, attitude

Question 11

Mood includes

Answer 11

Elated, Euthymic, Depressed, suicidal

Question 12

Affect includes

Answer 12

appropriate/inappropriate

Flat

Full range (normal)

Constricted

Labile (in borderline, etc)

Question 13

Mood vs affect

Answer 13

Mood = pervasive feeling state or emotion that someone is feeling.

Affect = objectively observable expression of mood

Question 14

Speech components (4+3Q)

Answer 14

Rate, amount, tone, dynamics,

Impaired? Aphasic? Appropriate for IQ?

Question 15

Thought process

Answer 15

1. Stream of thought
2. Rate
3. Logical
4. Sequential (vs. tangential, circumstantial)
5. Relevant
6. Goal directed

Question 16

Disturbances in thought process are often demonstrated through ___________

Answer 16

Speech abnormalities

Question 17

Types of hallucinations (7)

Answer 17

Auditory, visual, gust/olfactory, kinetic

*Hypnagogic (sleep) + hypnopompic (wake)

Question 18

MMSE

Answer 18

Mini-Mental State Exam

Orientation, Registration, Attention/Calculation, Recall, Language

Question 19

What is insight

Answer 19

The patients awareness that one does or does not have a problem

Question 20

Judgement

Answer 20

The ability to appreciate the effects of their behaviour on their ownt future or the well being of others

Question 21

Two things to test Impulsivity

Answer 21

Estimate degree of impulse control

Inquire about doing things without thinking or planning

“Ferrari engine with a bicycle brake”

Question 22

Reliability

Answer 22

Attempt to estimate (Does the patient have a history of missing appointments or arriving late?)

Question 23

Interview summary, two components

Answer 23

Summary of positive findings

Estimation of the reliability of the interview

Question 24

Interview summary (DSM5 vs 4)

Answer 24

DSM5 allows for descriptive objective method for Dx

DSM4 used 5 axis system

Question 25

5 axis system of DSM4

Answer 25

1. Major psychiatric disorder 2. mental state (intelligence) 3. medical conditions 4. stress level triggers 5. GAF score (1-100)