Clinical Psychiatry & Psych Assessment Flashcards Preview

5. HDS Neuro Psych > Clinical Psychiatry & Psych Assessment > Flashcards

Flashcards in Clinical Psychiatry & Psych Assessment Deck (22)
Loading flashcards...
1
Q

Definition of Mental Disorder

(DSM‐5)

A
  • A mental disorder is a syndrome characterized by significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in psychological, biological, or developmental processes underlying mental functioning.
  • Mental Disorders are associated with significant distress or disability in social, occupational, or other important activities.
  • Goal: Psychiatric Diagnosis
2
Q

Diagnostic and Statistical Manual of Mental Disorders (DSM)

Features

A
  • Descriptive Approach: Atheoretical
  • Diagnostic Criteria: Operationalized
  • Systematic Description: Associated Features
3
Q

General Approach of the DSM

A
  • Medical Illness can have a psychiatric presentation
    • Hypothyroidism presenting as Depression
    • Frontal lobe tumor presenting as Mania
    • Infections presenting as Psychosis
  • Substance Abuse disorders also have psychiatric presentations
    • Amphetamines presenting with Psychosis
    • ETOH with Depression
  • Always need to exclude that the presentation of a patient is not due to a medical illness or substance use
4
Q

Psychiatric Diagnosis

Conclusions

A
  • Psychiatric diagnosis is not just based on symptom checklist
  • Diagnostic criteria are offered as guidelines
  • Clinical judgement has to be exercised in assessing the presence and severity of each symptom
  • Recognize the combination of predisposing, precipitating, perpetuating and protective factors that have resulted in a particular condition
  • Use diagnostic and contextual information to develop an evidence-based treatment plan
5
Q

Psychiatric History Taking

A
  • Identifying information
  • Presenting complaints
  • History of present illness
  • Past medical / surgical history
  • Past psychiatric history
  • Alcohol and substance use
  • Family psychiatric history
  • Personal and Social History
6
Q

Psychiatric Interview

A
  • Begin with open ended questions
  • Let the patient tell his/her story
  • Clarify
  • Anxiety and depression mean different things to different people
  • Patient’s primary concerns may not be the physician’s main concerns
  • Suicide, homicide, domestic violence, and abuse should not be omitted from a review of the current situation
  • Avoid checklist questions
  • The key ingredient: Doctor Patient Relationship
7
Q

Substance Abuse History

A
  • What
  • How much (Quantity /$$$)
  • For how long
  • How
  • What if not used (Withdrawal symptoms)
  • Treatment History
  • Complications from use
8
Q

Trauma History

A

Essential component of the HPI and should always be assessed

  • Childhood Trauma
  • Intimate Partner Violence
  • Combat Trauma
  • Elder Abuse
9
Q

Personal and Social History

A
  • Where the person grew up; what family life was like
  • How far the person advanced in school; what subjects the person preferred
  • Hobbies and interests
  • Marital and relationship history
  • Work /Occupation
  • Spiritual orientation and practice
  • Legal History
10
Q

Collateral History

A
  • Family (need consent from pt)
  • In case of children there are more sources: Teachers, Wrap around workers, Foster parents…
  • Other caregivers
  • Primary Care Physician
  • Others (Insurance / Probation Officers….)
11
Q

The Physical Exam

A
  • Weight and Height
  • Trauma
  • Track marks
  • Neuro exam
  • Movement disorders
12
Q

Mental Status Exam (MSE)

Components

A
  • General appearance and behavior
    • Appearance
    • Behavior
    • Psychomotor activity
    • Attitude
  • Mood and Affectivity
    • Mood
    • Affect
    • Appropriateness
    • Range
    • Mobility
    • Reactivity
  • Speech characteristics
  • Thought
    • Thought process: Formal Thought Disorder
    • Thought content: Delusions
    • Depressive cognitions, Anxiety, Phobias, Obsessions, SI
  • Perception
    • Hallucinations
    • Illusions
  • Sensorium and Cognition
    • Level of consciousness
    • Attention and concentration
    • Orientation and memory
    • Language, reading, writing
    • Visuospatial ability
    • Abstraction
    • General fund of information
  • Judgment and insight
    • Test judgment / Social Judgment / Clinical judgment
    • Grades of insight
13
Q

Mood and Affect

A
  • Affect: An immediately expressed and observed emotion
  • Mood: emotional experience over a more prolonged period of time
  • Observed Disturbance of Affect:
    • Blunted: reduction of expression
    • Flat: absent expression
    • Inappropriate: discordance between expression and content of speech
    • Labile: abnormal variability with rapid shifts
14
Q

Formal Thought Disorders

A

An impaired capacity to sustain coherent discourse, and occurs in the patient’s written or spoken language.

Indicates a disturbance of the organization and expression of thought.

  • Incoherence
    • Only the word structure is preserved but there are no discernible connections between words
    • “Word salad”
  • Tangentiality
    • Moves from thought to thought but never seems to get to the main point
  • Derailment or Loose Associations
    • Severely disordered thinking
    • Thoughts lose almost all connections with one another and become disconnected and disjointed
  • Circumstantiality
    • Person talks in circles, providing excessive and unnecessary detail before getting to the point
  • Flight of ideas
    • Continuous, rapid speech that changes focus from moment to moment based on association, distractions, or plays on words
15
Q

Delusions

A

A firm and fixed false belief that is held with firm conviction in spite of evidence of the contrary and not in keeping with the persons religious and / or cultural beliefs.

Types of Delusions:

  • (Bizarre)
  • Delusional jealousy
  • Erotomanic
  • Grandiose
  • Persecutory
  • Somatic
  • Thought insertion
  • Thought broadcast
16
Q

Illusion

A

Distortion of a sensory stimulus

17
Q

Hallucinations

A

Perception in the absence of stimulus

Perception like experience with the clarity and impact of a true perception but without the external stimulation of the relevant sensory organ.

Types of Hallucinations:

  • Auditory
  • Visual
  • Tactile
  • Olfactory
  • Gustatory
18
Q

Anxiety

A

Apprehensive anticipation of future danger or misfortune accompanied by a feeling of worry, distress and/or somatic symptoms of tension.

19
Q

Panic

A

Discrete periods of sudden onset of fear or terror, often associated with feelings of impending doom.

20
Q

Obsessions & Compulsions

A
  • Obsessions: Recurrent, persistent, thoughts, urges or images that are experienced as intrusive and unwanted, and it causes anxiety.
    • The individual attempts to ignore or suppress these thoughts, urges and images with some other thought or action (i.e., Compulsions)
  • Compulsions: are repetitive behaviors or mental acts that the individual feels driven to perform in response to an obsession, or according to rules that must be rigidly applied.
    • Compulsions reduce the anxiety produced by an obsession
21
Q

Depersonalization and Derealization

A
  • “As if” phenomenon
  • Feeling detached
  • Feeling like an outside observer
22
Q

Phobia

A

A persistent fear of a specific object, activity or situation (i.e. Phobic stimulus) that is out of proportion to the actual danger posed by the specific object, activity or situation and a compelling desire to avoid it.