09 Interviewing MSE Childhood Psych Flashcards
Good interviewing causes
Improved psych symptoms
improved med compliance
Improved trust- increased information
Decreased risk of being sued
Physician communication problems
Failing to mention name of new medication
Failing to mention med purpose
Failing to review negative side effects
Failure too relate duration of treatment
BPS model
Biological facet
Psychological facet
Social Facet
(spiritual facet?)
Paternalistic relationship
“Doctor knows best”
Informative
Doctor informs patient- patient chooses
Interprative
Doctor interprets the patient’s situation and values then shares some responsibility in decision making process with patient
Deliberative
Doctor advocates for certain action
Transferrence
Patient transfers past relationships onto doctor:
Can affect responses- sometimes positively, negatively, or both
Countertransferrence
Doctor transfers previous relationship to patient
Facilitation
Verbal and nonverbal cues to encourage patient to continue with story-
nodding, leaning forward and increasing eye contact, “yes and then”
Reflection
Restating- confirms you are listening
Clarification
Questioning to clarify and encapsulate
Redirection
“I appreciate all that you have been telling me but we have a lot of ground to cover”
Iterpretation
interpreting a different meaning from what someone had said
Advice
Not always a good thing to do- remember that listening is doing something. You dont need to be compelled to do something.
8 Point MSE - A snake moves toward prey silently in jungles
Appearance/ Attitude, behabior Speech Mood (subjective) and affect (objective) - Euthymic and congruent Thought form/process context Perception Sensorium/cognition Insight Judgement
Thoughtform process
Loose associations- derailment
Clang associations- Rhythms and sounds cause associations “eye-pie”
Neologisms- inventions
Preservation- stuck on one idea
Flight of ideas- rapid jumping from thought to thought
Normal: Logical- linear- goal oriented
Thought content
Delusions- false beliefs
Ideas of reference- The TV is talking about me
Ideas of influence- The TV is controlling me
Perception
Hallucinations- generated perceptions believed to be real by patient
Illusions- misinterpretations of external perceptions
Sensorium/cognition
Sensorium- awareness Alertness orientation Concentration Memory Calculation fund of knowledge
Folstein MMSE
More sensorium than anything else- delrious patient will score low but a psychotic may score high
30 points- 10 minutes
Cutoff is 26/27
Signs and symptoms of stress in a child
Change in: Eating Sleep Activity level Regression
Infant stress
stranger anxiety (afraid of sudden stimuli)
Toddler Stress Sx
Temper tantrums
Soiling/wetting
Stuttering
(fears animals)
2.5-5yr stress Sx
Intrusiveness and masturbation
fear- monsters, mutilation, specific phobias
5-prepubescence Stress symptoms
Truancy, lying, stealing, learning problems
fears burglars has obsessions
Adolescent Stress Sx
Identity crisis, exually acting out, substance abuse, delinquency
(fears war and death)
Oppositional defiant disorder
- Does not violate others’ basic rights
*Children through adolescents - negative, hostile, defiant behavior lasting >6 months
- loses temper, argues with adults, refuses to comply, deliberately annoys, blames, spiteful/resentful/vindictive.
*M>F
*overbearing parents
Tx: PArent training, psychotherapy, CBT, social skill training
Conduct disorder
- Violates others basic rights- precurser to antisocial per. dis.
*Lying, stealing, truancy, running away, bullying/fighting, property destruction, fire setting, mean to animals or people, breaking and entering
*M>f, older kids and teens
*associated with depression, alcohol abuse, and family problems
*Multifactorial cause
Tx:
-Depression meds, Lithium for aggression/impulsiveness
-family, group, or behavioral therapy
-probation/residental programs
Separation anxiety disorder
- afraid to leave parents because of wories that something bad will happen to them
- 7-10 years
Tx:
Imipramine, Alprazolam, Buspirone, Paroxetine, sertraline
Psychotherapy- behavioral, CBT, family
Elimination Disorders
*Enuresis (>age 5) or encoparesis(> age 4) (pooping and peeing inappropriately)
*M>F
*Doesnt count if laxatives or other neuro/med cause
Tx:
Laxatives and retraining, Behavior therapy
Meds: Impreamine, DDAVP
