Chapter 5

Question 1

What is a clue to a medical cause of psychiatric symptoms?

Answer 1

Later age of onset, known underlying medical condition , atypical presentation of psychiatric condition, absence of personal or family history of psych condition, poor response to usual treatment , substance or medication use, waxing and waning mental status, abnormal vital signs

Indicates that psychiatric symptoms may be secondary to an underlying medical condition.

Question 2

What are some indicators that a psychiatric condition may have a medical cause?

Answer 2

• Known underlying medical condition
• Atypical presentation of psychiatric condition
• Absence of personal or family history of psychiatric condition
• Poor response to usual treatment
• Substance use or medication use
• Waxing and waning mental status
• Abnormal vital signs

These indicators help differentiate between primary psychiatric disorders and those secondary to medical issues.

Question 3

What is delirium?

Answer 3

A rapid onset of confusion often associated with an underlying medical condition

Delirium can manifest as altered mental status and may require urgent medical evaluation.

Question 4

Name a category of medical disorders that can cause psychiatric symptoms.

Answer 4

• Neurologic
• Endocrine
• Substances
• Infectious
• Cardiopulmonary

These categories encompass a variety of conditions that may affect mental health.

Question 5

Provide an example of a neurologic disorder that can cause psychiatric symptoms.

Answer 5

Stroke

Other examples include tumor, MS, dementia, meningitis/encephalitis, head injury, seizure disorder, Parkinson’s disease.

Question 6

What is an example of an endocrine disorder that can cause psychiatric symptoms?

Answer 6

Hypo/hyperthyroidism

Other examples include adrenal disorder, liver disorder, vitamin deficiency.

Question 7

Fill in the blank: _______ can cause psychiatric symptoms due to use and withdrawal.

Answer 7

Substances

Examples include corticosteroids, antidepressants, drugs of abuse.

Question 8

Name an infectious condition that can lead to psychiatric symptoms.

Answer 8

Pneumonia

Other examples include urinary tract infection, syphilis, HIV.

Question 9

What cardiopulmonary issue can cause psychiatric symptoms?

Answer 9

Myocardial infarction

Hypercarbia and hypoxia are also examples.

Question 10

What is assessed in the Appearance and behavior element of the Mental Status Exam?

Answer 10

Patient’s stated age, style of dress, notable physical features, grooming, and hygiene

Includes motor activity such as slowed or agitated movements, gait, postures, pacing, and hand wringing.

Question 11

What types of attitudes may a patient exhibit during the interview?

Answer 11

Cooperative, agitated, disinhibited, disinterested

These attitudes can affect the flow of the interview.

Question 12

What aspects of Speech are evaluated in the Mental Status Exam?

Answer 12

Fluency, normality of amount, rate, tone, and volume

Includes stuttering and word-finding difficulties.

Question 13

What are some patient-descriptive words for Mood?

Answer 13

Sad, angry

Patients may describe their mood using their own words.

Question 14

What does Affect refer to in the Mental Status Exam?

Answer 14

The expression of mood as it appears to the clinician

Includes quality, quantity, range, and appropriateness to the situation.

Question 15

What are some examples of Thought content in psychiatric assessment?

Answer 15

Ruminative, obsessional, delusions

These reflect the spontaneous expressions of the patient.

Question 16

What characterizes a normal Thought process?

Answer 16

Linear, organized, and goal-directed

This indicates effective cognitive functioning.

Question 17

Define ‘Flight of ideas’ in the context of Thought process.

Answer 17

Rapidly moving from one thought to another, logically connected

Often observed in manic episodes.

Question 18

What does Circumstantial thinking involve?

Answer 18

Including details not directly relevant but eventually returning to the subject

This can indicate a lack of focus but not disorganization.

Question 19

What is Tangential thinking?

Answer 19

Beginning OK but never returning to the original question

Thoughts may seem irrelevant or only loosely related.

Question 20

What does ‘Loose thoughts or associations’ refer to?

Answer 20

Difficult or impossible to see connections between content

Often indicates severe thought disorder.

Question 21

What is Perseveration in thought processes?

Answer 21

Unable to move to other topics despite attempts to change the subject

This can indicate rigidity in thought patterns.

Question 22

What is Thought-blocking?

Answer 22

Patient appears unable to complete a thought, stopping mid-sentence

This can be associated with various psychiatric conditions.

Question 23

Define Neologisms.

Answer 23

New word or combination of several words

Often seen in psychotic disorders.

Question 24

What is meant by ‘Word salad’?

Answer 24

Confused language with no apparent meaning

This indicates severe disorganization in thought processes.

Question 25

What are perceptual disturbances?

Answer 25

Hallucinations, illusions, depersonalization, derealization ## Footnote Perceptual disturbances refer to alterations in perception, such as sensing things that are not present (hallucinations) or misinterpreting real stimuli (illusions).

Question 26

Define depersonalization.

Answer 26

A feeling that one is not oneself ## Footnote Depersonalization is a dissociative symptom where an individual feels detached from their own body or thoughts.

Question 27

What is derealization?

Answer 27

A feeling that one's environment has changed in a strange way that is difficult to describe ## Footnote Derealization involves a sense of unreality or detachment from the surrounding world.

Question 28

List the components of cognition evaluated in a mental status exam.

Answer 28

* Alertness, orientation * Concentration * Memory * Calculations * Fund of knowledge * Abstract reasoning ## Footnote These components help assess a patient's cognitive functioning and mental clarity.

Question 29

What does recent memory assessment involve?

Answer 29

3-word recall ## Footnote Recent memory is often tested by asking the patient to remember and later recall a set of words.

Question 30

Provide an example of a calculation question used in cognitive assessment.

Answer 30

What is 2 times 24? ## Footnote Calculation questions assess numerical reasoning and basic arithmetic skills.

Question 31

What does 'fund of knowledge' refer to in a mental status exam?

Answer 31

General knowledge about the world ## Footnote This may include questions about historical figures or geographical facts.

Question 32

Explain abstract reasoning in the context of a mental status exam.

Answer 32

The ability to understand concepts and meanings beyond the literal ## Footnote An example question might be, 'What does 'People in glass houses should not throw stones' mean?'

Question 33

What is the significance of insight in psychiatric assessment?

Answer 33

Understanding of feelings, presentation, functioning, and potential causes of distress ## Footnote Insight can be categorized as no insight, partial insight, or full insight.

Question 34

Define judgment in the context of psychiatric assessment.

Answer 34

A person's capacity to make good decisions and act on them ## Footnote This includes assessing whether patients engage in dangerous behaviors or can participate in their own care.

Question 35

True or False: Insight can only be categorized as full insight.

Answer 35

False ## Footnote Insight can be categorized as no insight, partial insight, or full insight.

Question 36

Chan 19, is a college sophomore who is being seen by the PMHNP in follow up after discharge from a hospitalization 1 week ago for a psychotic episode. Chan's parents live in Taiwan, and he lives in an apartment with his brother. Chan is polite, well groomed and quiet. He answers questions about his sleep and medication in one word responses and can't give good history info. Pmhnp's next best course of action is:

Answer 36

Obtain a release of information from Chan to have you speak with his brother.

Question 37

The PMHMP is called by the group home about Edna, a 70-year-old woman with stable, bipolar illness. He was found by the direct service professional in her nightgown talking to no one in particular. The DSP reports that he worked in the home, four days for a week and has known enough for months and has never seen any unusual behavior in the past. He worked two days ago when Edna was her regular self. Inappropriate response for the PMHMP would be:

Answer 37

 please take her to the emergency department today and let me know the outcome

Question 38

When evaluating a patient with schizophrenia, which of the following statements provides an indication of the patient's judgment?

Answer 38

I should just quit my job and live in my car for a while

Question 39

Match the statement to an element of the mental status exam, the patient has passive suicidal ideation with no plan or intent.

Answer 39

Thought Content

Question 40

Match the statement to an element of the mental status exam, no spontaneous questions provide provides one word answers to questions.

Answer 40

 Thought process (poverty of thought)

Question 41

Match the statement to an element of the mental status exam, I check in with my case manager on Monday Mondays and we write the appointments for the week on my calendar.

Answer 41

Judgment

Question 43

Match the statement to an element of the mental status exam, response to simple questions after 3 to 5 second pause.

Answer 43

Speech (latency of response)

Question 44

Match the statement to an element of the mental status exam, I don't know why I'm here. People just need to stop forcing me to see doctors.

Answer 44

Insight (poor)

Question 45

Match the statement to an element of the mental status exam, the patient dozed off and on during the interview and had to have his name called out loudly to answer questions.

Answer 45

Cognition (level of alertness)