History, MSE, Dx (Ch 2)

Question 1

The 4 Ps

Answer 1

Pt’s psychosocial and environmental conditions Predisposing to, Precipitating, Perpetuating, and Protecting against the current episode

Question 2

Neurovegetative symptoms

Answer 2

quality of sleep, appetite, energy, psychomotor retardation/activation, concentration

Question 3

Importance of asking about caffeine/nicotine use

Answer 3

nicotine withdrawal may cause anxiety and agitation

Question 4

NSAID effect on lithium

Answer 4

NSAID decreases Lithium excretion which increases lithium concentrations.

Exceptions may be sulindac and aspirin

Question 5

Psychomotor retardation

Answer 5

slowness of voluntary and involuntary movements
aka hypokinesia or bradykinesia

Akinesia: absence of movement

Question 6

Automatisms

Answer 6

spontaneous, involuntary movements during an altered state of consciousness

range from purposeful to disorganized

Question 7

Pressured speech

Answer 7

usually uninterruptible

patient compelled to continue speaking

Question 8

Assess patient’s intellectual functioning

Answer 8

Proverb interpretation: assess if patient has difficulty with abstraction

Vocabulary strategies: define a particular vocabulary word correctly and appropriately use in sentence reflects intellectual capacity

Question 9

example of labile affect

Answer 9

laughing one second, crying the next

Question 10

Affect

Answer 10

assessment of how the patient’s mood appears to the examiner - amount and range of emotional expression

Question 11

Circumstantiality

Answer 11

point of the conversation is eventually reached but with over inclusion of trivial or irrelevant details

Question 12

Tangentiality

Answer 12

point of conversation never reached, responses usually in ballpark

Question 13

Loosening of associations

Answer 13

no logical connection from one thought to another

Question 14

Flight of ideas

Answer 14

thoughts change abruptly from one idea to another, usually accompanied by rapid/pressured speech

Question 15

Neologisms

Answer 15

made up words

Question 16

Word salad

Answer 16

incoherent collection of words

Question 17

Clang associations

Answer 17

word connections due to phonetics rather than actual meaning

“my car is red. I’ve been in bed. It hurts my head.”

Question 18

Though blocking

Answer 18

Abrupt cessation of communication before the idea of finished

Question 19

Grandeur delusions

Answer 19

belief that one has special powers or is someone important (Jesus, President)

Question 20

Paranoid delusions

Answer 20

belief that one is being persecuted

Question 21

Reference delusions

Answer 21

belief that some event is uniquely related to patient (e.g. TV show character is sending patient messages)

Question 22

Thought broadcasting delusions

Answer 22

belief that one’s thoughts can be heard by others

Question 23

Religious delusions

Answer 23

conventional beliefs exaggerated (e.g. Jesus talks to me)

Question 24

Somatic delusions

Answer 24

false belief concerning body image (e.g. I have cancer)

Question 25

Poverty of thought vs overabundance

Answer 25

Too few versions too many ideas expressed

Question 26

Delusions

Answer 26

fixed, false beliefs that are not shared by the person's culture and cannot be changed by reasoning. Classified as bizarre (impossible to be true) or non bizarre (at least possible)

Question 27

Phobias

Answer 27

persistent, irrational fears

Question 28

Obsessions

Answer 28

repetitive, intrusive thoughts

Question 29

Compulsions

Answer 29

Repetitive behaviors (usually linked with obsessive thoughts)

Question 30

Hallucinations

Answer 30

Sensory perceptions in absence of actual stimulus Auditory (most common), visual, taste, olfactory, or tactile

Question 31

Types of auditory hallucinations

Answer 31

ringing, humming, whispers, or voices speaking clear words

Question 32

Command auditory hallucinations

Answer 32

voices instruct the patient to do something

Question 33

Hypnagogic hallucination

Answer 33

hallucinations only before falling asleep

Question 34

Hypnopompic hallucination

Answer 34

hallucinations only upon awakening

Question 35

Illusions

Answer 35

Inaccurate perception of existing sensory stimuli (wall appears to be moving)

Question 36

Derealization/Depersonalization

Answer 36

feeling detached to one's surroundings/mental processes

Question 37

Alcoholic hallucination

Answer 37

auditory (usually), visual and tactile hallucinations occurring during or after period of heavy alcohol consumption Patient aware they are hallucinations, not real DTs - no clouding of sensorium and VS are normal

Question 38

Consciousness

Answer 38

Pt's level of awareness Alert, drowsy, lethargic, stuporous, coma

Question 39

Orientation

Answer 39

to person, place, and time

Question 40

Calculation

Answer 40

ability to add/subtract

Question 41

Immediate memory (registration)

Answer 41

dependent on attention/concentration and can be tested by asking a patient to repeat several digits or words

Question 42

Recent (short term) memory

Answer 42

Events w/in past few minutes, hours or days

Question 43

Remote memory

Answer 43

long term

Question 44

Fund of knowledge

Answer 44

Level of knowledge in context of the patient's culture and education Who is president? Who was Picasso?

Question 45

Attention/Concentration

Answer 45

Ability to subtract serial 7s from 100 or to spell "world" backwards

Question 46

Reading/writing

Answer 46

simple sentences (must make sure patient is literate first)

Question 47

Abstract concepts

Answer 47

Ability to explain similarities between objects and understand the meaning of simple proverbs

Question 48

Insight

Answer 48

level of awareness and understanding of problem full, partial/limited or none

Question 49

Problems with insight example related to illness

Answer 49

complete denial of illness or blaming it on something else

Question 50

Judgment

Answer 50

ability to understand outcome of actions and use awareness in decision making excellent, good, fair, or poor

Question 51

Tarasoff rule

Answer 51

If a patient expresses imminent threats against friends, family, or others, the doctor should notify potential victims and/or protection agencies when appropriate