Mental Health

Question 1

The ability to focus or concentrate over time on one task or activity—an inattentive or distractible person with impaired consciousness has difficulty giving a history or responding to questions

Answer 1

Attention

Question 2

The process of registering or recording information, tested by asking for immediate repetition of material, followed by storage or retention of information

Answer 2

Memory

Question 3

Awareness of personal identity, place, and time, requires both memory and attention

Answer 3

Orientation

Question 4

Sensory awareness of objects in the environment and their interrelationships (external stimuli), also refers to internal stimuli such as dreams or hallucinations

Answer 4

Perception

Question 5

The logic, coherence, and relevance of the patient’s thought as it leads to selected goals, or how people think

Answer 5

Thought process

Question 6

What the patient thinks about, including level of insight and judgment

Answer 6

Thought content

Question 7

Awareness that symptoms or disturbed behaviors are normal or abnormal

Answer 7

Insight

Question 8

Process of comparing and evaluating alternatives when deciding on a course of action; reflects values that may or may not be based on reality and social conventions or norms

Answer 8

Judgment

Question 9

An observable, usually episodic, feeling or tone expressed through voice, facial expression, and demeanor

Answer 9

Affect

Question 10

A more sustained emotion that may color a person’s view of the world

Answer 10

Mood

Question 11

A complex symbolic system for expressing, receiving, and comprehending words, as with consciousness, attention ad memory, language is essential for assessing other mental functions

Answer 11

Language

Question 12

Assessed by vocabulary, amount of information, abstract thinking, calculations, and construction of objects that have two or three dimensions

Answer 12

Higher cognitive functions

Question 13

when obtain HPI it is important to obtain pre-morbid personality

Answer 13

• Social relationships
• Mood
• Attitudes toward work or responsibilities
• Typical response to criticism or praise
• Leisure activities and hobbies

Question 14

Mental status examination consists of six components:

Answer 14

• appearance and behavior
• speech and language
• mood
• thoughts and perceptions
• insight and judgment
• cognitive function

Question 15

speech & language deficit evaluation technique

Question 16

patients who struggle with naming emotions

Answer 16

alexithymia ( helpful to list some emotions for them to choose from)

Question 17

lack of goal directedness, incorporating tedious and unnecessary details, with
difficulty in arriving at an end point.

Answer 17

Thought process-
Circumstantiality

Question 18

digresses from the subject, introducing thoughts that seem unrelated, oblique, and
irrelevant.

Answer 18

Thought process-
Tangentiality

Question 19

sudden cessation in the middle of a sentence at which point a patient cannot
recover what has been said

Answer 19

Thought process-
Thought blocking

Question 20

jumping from one topic to another with no apparent connection between the
topics

Answer 20

Thought process-
Loose associations

Question 21

Speech with unnecessary detail, indirection, and delay in reaching the point. Some topics may have a meaningful connection

Answer 21

Thought process-
Circumstantiality

Question 22

Sudden interruption of speech in midsentence or before the idea is completed, attributed to “losing the thought”; can occur in normal people

Answer 22

Thought process-
Blocking

Question 23

An almost continuous flow of accelerated speech with abrupt changes from one topic to the next.

Answer 23

Thought process-
Flight of ideas

Question 24

Fabrication of facts or events in response to questions, to fill in the gaps from impaired memory

Answer 24

Thought process-
Confabulation

Question 25

Speech that is incomprehensible and illogic, with lack of meaningful connections, abrupt changes in topic, or disordered grammar or word use.

Answer 25

Thought process- Incoherence

Question 26

Tangential” speech with shifting topics that are loosely connected or unrelated. Patient is unaware of lack of association

Answer 26

Thought process- Derailment

Question 27

Invented or distorted words, or words with new and highly idiosyncratic meanings

Answer 27

Thought process- Neologisms

Question 28

Persistent repetition of words or ideas

Answer 28

Thought process- Perseveration

Question 29

Repetition of the words and phrases of others

Answer 29

Thought process- Echolalia

Question 30

Speech with choice of words based on sound rather than meaning, as in rhyming and punning

Answer 30

Thought process- Clanging

Question 31

Perceptual disturbances

Answer 31

Question 32

repetitive, unwelcome, irrational thoughts that impose themselves on the patient's consciousness over which he or she has no apparent control. Accompanied by feelings of anxious dread and are ego alien, unacceptable, and undesirable. Often resisted by the patient.

Answer 32

Thought& perception- Obsessions

Question 33

repetitive stereotyped behaviors that the patient feels impelled to perform ritualistically, even though he or she recognizes the irrationality and absurdity of the behaviors. Although no pleasure is derived from performing the act, there is a temporary sense of relief of tension when it is completed. Usually associated with obsession.

Answer 33

Thought& perception- Compulsions

Question 34

patient's absorption with his or her own thoughts to such a degree that the patient loses contact with external reality. Can range from mere absentmindedness to suicidal or homicidal ideation and the autistic thinking of the

Answer 34

Thought& perception- Preoccupations

Question 35

morbid fears that are reflected by morbid anxiety. Often not spontaneously conveyed in the interview

Answer 35

Thought& perception- Phobias

Question 36

Cognitive function

Answer 36

Question 37

Birthdays, anniversaries, SSN, names of schools attended, jobs held, past historical events

Answer 37

Remote memory

Question 38

Events of the day, weather, today’s appointment time, laboratory tests taken during the day

Answer 38

Recent memory

Question 39

New learning ability

Answer 39

Question 40

Higher cognitive function

Answer 40

Question 41

Depression

Answer 41

Question 42

Suicide risk

Answer 42

Question 43

Substance use disorder

Answer 43

Question 44

Memory loss- alarm symptoms

Answer 44

Alarm symptoms can be classified into 2 types: • Symptoms reflecting the seriousness of the underlying cause of memory loss • Abrupt onset, gait abnormalities, altered mental status, psychosis, disruptive behavior, new seizures • Memory loss in patients with chronic diseases signaling a serious complication of their disease: • HIV/AIDS, Autoimmune diseases, Cancer, Anemia, Thyroid disease

Question 45

Memory loss- narrowing differential diagnosis

Answer 45

For all others, neurocognitive screening tests can be done to evaluate the severity of the memory and functional impairments. • Patients that screen positive for more serious impairment will require referral to a neurologist to further evaluate for the type of underlying disorder may be causing the memory loss.

Question 46

Vascular dementia

Answer 46

Dementia temporally related to a stroke or due to chronic cerebral ischemia. Classically, the dementia progresses in a stepwise manner, but it may be steadily progressive. It may be difficult to distinguish from Alzheimer's disease. In the early stages, subcortical signs (eg, depression, subtle gait disturbances) and language difficulties often outweigh memory impairment, in contrast to early Alzheimer's disease, in which memory loss typically predominates.

Question 47

Alzheimer's disease

Answer 47

Dementia that has an insidious onset and progresses steadily in the absence of focal neurologic signs or other identifiable causes. Autopsy reveals characteristic cortical degeneration with amyloid plaques and neurofibrillary tangles.

Question 48

Mild Cognitive Impairment

Answer 48

Depending on the definition used, between 5% and 16% per year will progress to dementia.

Question 49

Diffuse Lewy body disease (DLBD)

Answer 49

The early coexistence of dementia and Parkinson's disease. Unlike Parkinson's disease, the dementia of DLBD either precedes or occurs within 12 months of the onset of extrapyramidal symptoms. The cognitive impairment often fluctuates, and psychiatric symptoms (commonly visual hallucinations) occur early in the course of the illness.

Question 50

Frontotemporal dementia

Answer 50

A progressive dementia in which personality changes (eg, apathy, self-neglect, perseveration, hyperorality) and speech impairment typically exceed memory loss during the early stages.6

Question 51

Anxiety- alarm symptoms

Answer 51

• Look for physical manifestations of serious illness to differentiate anxiety driven symptoms from symptom driven anxiety. • Hypoxia, hypoglycemia, heart rhythm • Assess for substance use, intoxication and suicidal ideation.

Question 52

Anxiety - Narrowing differential (Sudden onset with no obvious trigger)

Answer 52

Panic disorder

Question 53

Anxiety - Narrowing differential (Social anxiety or phobia )

Answer 53

Social anxiety

Question 54

Anxiety - Narrowing differential (Confined spaces)

Answer 54

Agrophobia

Question 55

Anxiety - Narrowing differential (Trigger recalls a past trauma)

Answer 55

PTSD

Question 56

Anxiety - Narrowing differential ( Intrusive thoughts with repetitive need to perform specific acts )

Answer 56

OCD

Question 57

Anxiety - Narrowing differential (Multiple triggers that are persistent)

Answer 57

generalized anxiety disorder

Question 58

Depressed mood - alarm symptoms

Answer 58

The major alarm symptom here is suicidality. • Because patients rarely volunteer thoughts of suicide, it is important to ask directly about suicidality. • The topic may be introduced by asking, "Have you been feeling that life is not worth living or that you would be better off dead?" • Another approach is to ask, "Sometimes when a person feels down or depressed, they might think about dying. Have you been having any thoughts like that?" If a patient reports suicidal ideation, it is important to further assess if the patient has immediate plans and the overall risk level. Screening tools to assess immediate risk should be utilized. • High risk patients need immediate intervention and hospitalization.

Question 59

Depressed Mood - differential diagnosis (experiencing five or more symptoms during the same 2-week period and at least one of the symptoms should be either depressed mood or loss of interest or pleasure.)

Answer 59

Major depression

Question 60

Depressed Mood - differential diagnosis (Seasonally occurring depressed mood)

Answer 60

Seasonally effective disorder

Question 61

Depressed Mood - differential diagnosis (Occurs prior to menstruation)

Answer 61

Premenstrual dysphoric disorder

Question 62

Depressed Mood - differential diagnosis (Episodes of major depression alternating with episodes of mania)

Answer 62

Bipolar disorder

Question 63

Depressed Mood - differential diagnosis (Depressed mood with hallucinations or delusions)

Answer 63

Psychosis

Question 64

Depressed Mood - differential diagnosis (Persistent depressive disorder for 2 years is a continuous, long-term form of depression. You may feel sad and empty, lose interest in daily activities)

Answer 64

Dysthymic disorder