Examination and Diagnosis Flashcards
(46 cards)
1
Q
What are the components of a psychiatric history?
A
- Identifying data
- Chief complaint (patient’s own words)
- History of present illness
- Past psychiatric history
- Past medical history
- Medications
- Allergies
- Family history
- Social history (occupation, education, living situation, substance abuse, etc.)
- Mental status exam
2
Q
What should the history of present illness include?
A
-
Information about the current episode
- Why the patient came to the doctor
- Description of current episode
- Events leading up to current moment (precipitating events)
- How work & relationships have been affected
- The patient’s support system (who the patient lives with, distance & level of contact with friends & relatives)
- Relationship btwn physical & psychological symptoms
- Vegetative symptoms (insomnia, loss of appetite, problems with concentration)
-
Information about past episodes
- Chronological account of past psychiatric problems/episodes
-
Establishing a baseline of mental health
- Patient’s functioning when “well”
- Developmental history: physical & intellectual ability at various stages of life (outpatient setting only)
- Life values, goals (outpatient setting)
- Evidence of secondary gain
3
Q
What are the 8 things that the mental status examination assesses?
A
- Appearance/Behavior
- Mood/Affect
- Speech
- Perception
- Thought process/Thought content
- Sensorium/Cognition
- Insight/Judgment
- Suicidal/Homicidal ideation
4
Q
True or False:
The mental status exam tells about a patient’s mental status all the time.
A
False
The mental status exam tells only about the mental status at that moment.
5
Q
How is appearance assessed?
A
- Physical appearance - clothing, hygiene, posture, grooming
- Behavior - mannerisms, tics, eye contact
- Attitude - cooperative, hostile, guarded, seductive, apathetic
6
Q
How is speech assessed?
A
-
Rate - slow, average, rapid, pressured
- Pressured speech is continuous, fast & uninterruptible
- Volume - soft, average or loud
- Articulation - well articulated versus lisp, stutter, mumbling
- Tone - angry versus pleading, etc.
7
Q
How is mood assessed?
A
- The emotion that the patient tells you he feels or is conveyed nonverbally
- “How are you feeling today”
- Have patients rate their stated mood from 1-10
8
Q
How is affect assessed?
A
- An assessment of how the patient’s mood appears to the examiner (amt & range of emotional expression)
-
Quality - depth & range of feelings shown
- Flat: none
- Blunted: shallow
- Constricted: limited
- Full: average
- Intense: more than normal
-
Motility - how quickly a person appears to shift emotional states
- Sluggish vs supple vs labile
-
Appropriateness to content - whether the affect is congruent with the subject of conversation
- Appropriate vs not appropriate
9
Q
How is thought process assessed?
A
- The patient’s form of thinking
- How he or she uses language and puts ideas together
- Describes whether the patient’s thoughts are logical, meaningful and goal-directed
- It doesn’t comment on what the patient thinks, only how the patient expresses his or her thoughts
10
Q
What are 8 examples of thought process disorders?
A
- Loosening of associations
- Flight of ideas
- Neologisms
- Word salad
- Clang associations
- Thought blocking
- Tangentiality
- Circumstantiality
11
Q
Loosening of associations
A
No logical connection from one thought to another
12
Q
Flight of ideas
A
a fast stream of very tangential thoughts
13
Q
Neologisms
A
made-up words
14
Q
Word salad
A
incoherent collection of words
15
Q
Clang associations
A
- Word connections due to phonetics rather than actual meaning
- “My car is red. I’ve been in bed. It hurts my head”
16
Q
Thought blocking
A
abrupt cessation of communication before the idea is finished
17
Q
Tangentiality
A
point of conversation never reached due to lack of goal-directed associations between ideas
18
Q
Circumstantiality
A
point of conversation is reached after circuitous path
19
Q
How is thought content assessed?
A
the types of ideas expressed by the patient
20
Q
What are 6 examples of thought content disorders?
A
- Poverty of thought vs overabundance
- Delusions
- Suicidal and homicidal thoughts
- Phobias
- Obsessions
- Compulsions
21
Q
Poverty of thought vs overabundance
A
too few versus too many ideas expressed
22
Q
Delusions
A
fixed, false beliefs that are not shared by the person’s culture and cannot be changed by reasoning
23
Q
Suicidal and homicidal thoughts
A
- Ask if the patient feels like harming him/herself or others
- Identify if the plan is well formulated
- Ask of the patient has intent (if released right now, would he go and kill himself or harm others?)
24
Q
Phobias
A
persistent, irrational fears
25
Obsessions
repetitive, intrusive thoughts
26
Compulsions
repetitive behaviors (usually linked with obsessive thoughts)
27
How is **perception** assessed?
* **Hallucinations** - sensory expereinces not based in reality (visual, auditory, tactile, gustatory, olfactory)
* **Illusions** - inaccurate perception of existing sensory stimuli (ex: wall appears as if it's moving)
28
What are 5 examples of delusions?
* **Grandeur** - belief that one has special powers or is someone important (Jesus, president)
* **Paranoid** - belief that one is being persecuted
* **Reference** - belief that some event is uniquely related to patient (TV show character sending patient messages)
* **Thought broadcasting** - belief that one's thoughts can be heard by others
* **Religious** - conventional beliefs exaggerated (Jesus talks to me)
29
How are **sensorium & cognition** assessed?
* **Consciousness** - patient's level of awareness; possible range includes: alert, drowsy, lethargic, stuporous, coma
* **Orientation** - to person, place, time
* **Calculation** - ability to add/subtract
* **Memory**
* Immediate - can repeat several digits are recall 3 words 5 min later
* Recent - events within past few days
* Recent past - events w/i past few mo
* Remote - events from childhood
* **Fund of knowledge** - level of knowledge in the context of the patient's culture and education (who is the present? who was Picasso?)
* **Attention/Concentration** - ability to subtract serial 7s from 100 or to spell "world" backwards
* **Reading/Writing** - simple sentences (must make sure the patient is literate first!)
* **Abstract concepts** - ability to explain similarities btwn objects and understand the meaning of simple proverbs
30
How is **insight** assessed?
* Patient's level of awareness and understanding of his or her problem
* Problems with insight include complete denial of illness or blaming it on something else
31
How is **judgment** assessed?
* Patient's ability to understand the outcome of his or her actions and use this awareness in decision making
* "What would you do if you smelled smoke in a crowded theater?"
32
What are some ways to test ability to abstract?
* **Similarities**
* How are an apple and orange alike?
* Normal answer: "they are fruits"
* Concrete answer: "they are round"
* **Proverb testing**
* What is meant by "You can't judge a book by it's cover"?
* Normal answer: "You can't judge people by how they look"
* Concrete answer: "Books have different covers"
33
How do you approach a **violent** patient?
* Avoid being alone with a violent patient
* Ask "Do you feel like you want to hurt someone or that you might hurt someone?"
* If the patient expresses imminent threats, the doctor should notify potential victims and/or protection agencies when appropriate
34
How do you approach a **delusional** patient?
* The psychiatrist should not directly challenge a delusion or insist that it is untrue, but he should not imply he believes it either
* Simply acknowledge that you understand that the _patient_ believes the delusion to be true
35
How do you approach a **depressed** patient?
* Important to offer reassurance that he or she can improve with appropriate therapy
* Inquiring about suicidal thoughts is _crucial_
* Feeling of hopelessness
* Substance use
* Hx prior suicide attempts (increased risk)
* If patient is planning or contemplating suicide, he or she musst be hospitalized or otherwise protected
36
Axis I of DSM IV
* All diagnoses of mental illness
* Substance abuse
* Developmental disorders
* Not including personality disorders and mental retardation
37
Axis II of DSM IV
* Personality disorders
* Mental retardation
38
Axis III of DSM IV
* General medical conditions
39
Axis IV of DSM IV
* Psychosocial and environmental problems
* ex: homelessness, divorce
40
Axis V of DSM IV
* Global Assessment of Function (GAF)
* Rates overall level of daily functioning (social, occupational, psychological) on a scale of 0-100
* Rate current GAF vs. high GAF during the past year
41
Aspects of intelligence include...
* Memory
* Logical reasoning
* Ability to assimilate factual knowledge
* Understanding of abstract concepts
42
What is the intelligence quotient?
* Test of intelligence
* Mean: 100
* Standard deviation: 100
* Scores adjusted for age and gender
* IQ of 100
* Mental age equals chronological age
* Corresponds to the 50th %ile in intellectual ability for the general population
43
What do intelligence tests assess?
What are two common tests?
* Assess cognitive function by evaluating comprehension, fund of knowledge, math skills, vocabulary, picture assembly, and other verbal and performance skills
* **Wechsler Adult Intelligence Scale (WAIS)**
* Most common test for ages 16-75
* Assesses overall intellectual functioning
* 2 parts: verbal & visual-spatial
* **Stanford-Binet Test**
* Tests intellectual ability in patients ages 2-18
44
IQ Chart
* \>130 - very superior
* 120-129 - superior
* 110-119 - high average
* 90-109 - average
* 80-89 - low average
* 70-79 - borderline
* 50-70 - mild mental retardation
* 35-49 - moderate mental retardation
* 25-34 - severe mental retardation
* \<25 - profound mental retardation
45
What are objective personality assessment tests?
What is an example?
* Questions with standardized-answer format that can be objectively scored
* **Minnesota Multiphasic Personality Inventory (MMPI-2)**
* Tests personality for different pathologies and behavioral patterns
* Most commonly used
46
What are projective (personality) assessment tests?
What are two examples?
* No structured-response format
* Often ask for interpretation of ambiguous stimuli
* **Thematic Apperception Test (TAT)**
* Test-taker creates stories based on pictures of people in various situations
* Used to evaluate motivations behind behaviors
* **Rorschach Test**
* Interpretation of ink blots
* Used to identify thought disorders and defense mechanisms
