09 Interviewing MSE Childhood Psych

Question 0

Good interviewing causes

Answer 0

Improved psych symptoms
improved med compliance
Improved trust- increased information
Decreased risk of being sued

Question 1

Physician communication problems

Answer 1

Failing to mention name of new medication
Failing to mention med purpose
Failing to review negative side effects
Failure too relate duration of treatment

Question 2

BPS model

Answer 2

Biological facet
Psychological facet
Social Facet
(spiritual facet?)

Question 3

Paternalistic relationship

Answer 3

“Doctor knows best”

Question 4

Informative

Answer 4

Doctor informs patient- patient chooses

Question 5

Interprative

Answer 5

Doctor interprets the patient’s situation and values then shares some responsibility in decision making process with patient

Question 6

Deliberative

Answer 6

Doctor advocates for certain action

Question 7

Transferrence

Answer 7

Patient transfers past relationships onto doctor:

Can affect responses- sometimes positively, negatively, or both

Question 8

Countertransferrence

Answer 8

Doctor transfers previous relationship to patient

Question 9

Facilitation

Answer 9

Verbal and nonverbal cues to encourage patient to continue with story-
nodding, leaning forward and increasing eye contact, “yes and then”

Question 10

Reflection

Answer 10

Restating- confirms you are listening

Question 11

Clarification

Answer 11

Questioning to clarify and encapsulate

Question 12

Redirection

Answer 12

“I appreciate all that you have been telling me but we have a lot of ground to cover”

Question 13

Iterpretation

Answer 13

interpreting a different meaning from what someone had said

Question 14

Advice

Answer 14

Not always a good thing to do- remember that listening is doing something. You dont need to be compelled to do something.

Question 15

8 Point MSE - A snake moves toward prey silently in jungles

Answer 15

Appearance/ Attitude, behabior
Speech
Mood (subjective) and affect (objective) - Euthymic and congruent
Thought form/process context
Perception
Sensorium/cognition
Insight
Judgement

Question 16

Thoughtform process

Answer 16

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

Question 17

Thought content

Answer 17

Delusions- false beliefs
Ideas of reference- The TV is talking about me
Ideas of influence- The TV is controlling me

Question 18

Perception

Answer 18

Hallucinations- generated perceptions believed to be real by patient
Illusions- misinterpretations of external perceptions

Question 19

Sensorium/cognition

Answer 19

Sensorium- awareness
Alertness
orientation
Concentration
Memory
Calculation
fund of knowledge

Question 20

Folstein MMSE

Answer 20

More sensorium than anything else- delrious patient will score low but a psychotic may score high

30 points- 10 minutes

Cutoff is 26/27

Question 21

Signs and symptoms of stress in a child

Answer 21

Change in:
Eating
Sleep
Activity level
Regression

Question 22

Infant stress

Answer 22

stranger anxiety
(afraid of sudden stimuli)

Question 23

Toddler Stress Sx

Answer 23

Temper tantrums
Soiling/wetting
Stuttering
(fears animals)

Question 24

2.5-5yr stress Sx

Answer 24

Intrusiveness and masturbation

fear- monsters, mutilation, specific phobias

Question 25

5-prepubescence Stress symptoms

Answer 25

Truancy, lying, stealing, learning problems

fears burglars has obsessions

Question 26

Adolescent Stress Sx

Answer 26

Identity crisis, exually acting out, substance abuse, delinquency
(fears war and death)

Question 27

Oppositional defiant disorder

Answer 27

• 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

Question 28

Conduct disorder

Answer 28

• 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

Question 29

Separation anxiety disorder

Answer 29

• 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

Question 30

Elimination Disorders

Answer 30

*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