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5. Psychiatry > 1- Psych Interview and MSE > Flashcards

1- Psych Interview and MSE Flashcards

1
Q

During the MSE what types of questions are asked?

A

Open ended questions

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2
Q

In psychiatry what in the more important factor in formulating a diagnosis and tx plan?

A

The pts history

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3
Q

What are the 4 P’s to the pts psychosocial and environmental conditions?

A
  • Predisposing to
  • Precipitating
  • Perpetuating
  • Protecting against current episode
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4
Q

Quality of sleep, appetite, energy, psychomotor retardation/activation, concentration are what type of sx?

A

Neurovegetative sx

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5
Q

Auditory and visual hallucinations are what type of sx?

A

Psychotic sx

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6
Q

What is the goal of a psych HPI?

A

Establish a baseline of mental health for a pt:

  • Pt’s level of functioning when “well”
  • Goals (outpatient setting)
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7
Q

Why does a psych HPI ask if work and relationships have been affected?

A

B/c for many diagnoses in DSM-5, there is a criterion that sx must cause distress and impair various areas of functioning

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8
Q

What are spontaneous, involuntary movements that occur during an altered state of consciousness and can range from purposeful to disorganized?

A

Automatisms

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9
Q

When asking about substance abuse history, what 2 drugs are often overlooked?

A

Caffeine and nicotine

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10
Q

What is a pt/s developmental hx?

A

Hx of developmental milestones - did they achieve them on time, have friends in school, academic performance

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11
Q

In psych, what is analogous to performing a PE in other areas of medicine?

A

The MSE

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12
Q

What is the goal of the MSE?

A

To describe the pt in as much detail as possible

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13
Q

Does a MSE tell you about the pt on a long term basis or only at the moment of the exam?

A

Only at the moment of the exam (can change every hr, day, etc)

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14
Q

What can pupil size indicate on MSE?

A

Drug intoxication/withdrawal

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15
Q

What can needle marks/tracks indicate on MSE?

A

Drug use

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16
Q

What can eroding of tooth enamel indicate on MSE?

A

Eating disorder (from vomiting)

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17
Q

What can superficial cuts on the arm indicate on MSE?

A

Self harm

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18
Q

What is mood?

A

An emotion the pt feels

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19
Q

What is affect?

A

An assessment of how a pt’s mood appears to the examiner, including the amount and range of emotional expression

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20
Q

What are the types of “affect”?

A

Euthymic (normal), euphoric, neutral, dysphoric

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21
Q

The quality/range of a person’s affect describes the depth and range of feelings shown. How is it described? (5)

A

Flat (none), blunted (shallow), constricted (limited), full (average), intense (more than normal)

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22
Q

What does motility describe w/ respect to affect? How it is described? (3)

A

How quickly a person appears to shift emotional states. Sluggish, supple, labile

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23
Q

A pt that is laughing one second and crying the next is an example of what affect?

A

Labile affect

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24
Q

A pt that giggles while telling you he set his house on fire is an example of what affect?

A

Inappropriate

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25
What describes whether the affect of a pt is congruent w/ the subject of a conversation or stated mood?
Appropriateness
26
T or F: When evaluating a person's thought process you are not commenting on WHAT the pt is thinking, but HOW the pt expresses his or her thoughts?
TRUE
27
What is circumstantiality?
When the point of the conversation is eventually reached by w/ oveerinclusion of trivial or irrelevant details
28
A pt that remain expressionless and monotone even when discussing happy or sad moments has what affect?
Flat affect
29
What is a thought disorder in which the point of the conversation is never reach?
Tangentiality
30
What is the thought disorder in which there is no logical connection from one thought to the next?
Loosening of associations
31
What is the thought disorder in which thoughts change abruptly from one idea to another and is usually accompanied by rapid/pressured speech?
Flight of idea
32
What is the thought disorder in which the pt uses made up words?
Neologisms
33
What is the thought disorder in which a pt speaks in an incoherent collection of words?
Word salas
34
What is the thought disorder in which word connections are due to phonetics rather than actual mean? EX: "My car is red. I've been in bed. It hurts my head"
Clang association
35
What is the thought disorder in which there is abrupt cessation of communication before the idea is finished?
Thought blocking
36
What does thought content describe?
Types of ideas expressed by the pt
37
Poverty of thought vs overabundance, delusions, SI/HI, phobias, obsession, and compulsions are examples of what?
Thought content disorders
38
Hallucinations are perceptual disturbances. How should you document it?
* Sensory modality (auditory = most common) * Character (ringing, humming, voices/ command) * Time of day experiences (only before bed, upon waking)
39
When is a hypnagogic hallucination experienced?
Only before falling asleeping
40
What is a Hypnopompic hallucination experienced?
Only upon awakening
41
What are inaccurate perceptions of existing sensory stimuli?
Illusions
42
What is the experience of feeling detached from one's surrounds/mental processes?
Derealization/depersonalization
43
What is a grandeur delusions?
Belief that one has special powers or is important (God, president)
44
What is a paranoid delusions?
Belief that one is being persecuted
45
What is a reference delusion?
Belief that some event is uniquely related to the pt (TV character is sending pt messages)
46
What is a thought processing delusion?
Belief that one's thoughts can be hear by others
47
What is a religious delusion?
Conventional religious beliefs are exaggerated (Jesus talks to me)
48
What is a somatic delusion?
False belief concerning body image (I have cancer)
49
What is insight?
Pt's levels of awareness and understanding of his/her problem
50
How is a pt's judgment described?
Excellent, good, fair, poor
51
What does a MMSE assess?
Gross cognitive function
52
What is Tarasoff's rule?
Legal obligation of doctor to protect and notify others if pt is expresses imminent harm against others
53
As a psych provider should you directly challenge a pt's delusion?
No, just acknowledge that you understand that the pt believes the delusion is true
54
Should you admit a pt that is actively planning or contemplating suicide?
Yes
55
The mental status exam is used to describe what?
A patient's current state of mind
56
What are the MSE domains? (12)
Appearance, altertness/ orientation, speech, motor behavior, mood/ affect, attention, memory, perception, insight, judgement, thought content, thought processes
57
What must be completed with each psych visit?
Mental status exam (basis to formulate any psychiatric dx)
58
Observation of grooming/clothing, skin lesions, body modifications, habitus/physique fall under what MSE domain?
Appearance
59
Should psych patients be orientented or disoriented?
Oriented
60
What domain of the MSE includes level of consciousness and awareness to person/ time/ place?
Altertness and orientation
61
Speech domain evaluates what?
Speach production (rate, volume, type: sluredm aphasia, word salad) NOT speech content
62
What domain of the MSE evalutes for hyper/ hypoactive, rigidity, restlessness/ akathisia, combativeness, tics, eye contact/ gait?
Motor behavior
63
A pt's ability to focus or concentrate over time on 1 task or acitivity falls under what domain of MSE?
Attention
64
What is remote memory?
Distant past (childhood memories
65
What is recent remote memory?
Weeks to months (current events w/in the last few weeks)
66
What is recent memory?
Hours to days
67
6 digit test and word list recall is used to evaluate what type of memory?
Immediate retention and recall
68
What are hallucinations?
False sensory perception NOT assocaited w/ REAL external stimuli (auditory, visual, olfactory, tactile, gustatory)
69
What domain of the MSE is defined as sensory awareness of objects in the environment and their interrelationships? (internal stimuli)
Perception
70
What is depersonalization (related to perceptiond domain)?
A person's subjective sense of being unreal, strange, or unfamiliar
71
What is derealization?
Subjective sense that environment is strange or unreal
72
What is formication?
Feeling of bugs crawling on or under the skin
73
What domain of the MSE is defined as a patient's awareness that sxs or disturbed behaviors are normal or abnormal?
Insight
74
Insight is a continuum over several encounters are defined by what?
Recognition they may have mental illness, compliance w/ tx plan, re-lable false mental events
75
Which category of disorders is most commonly associated with poor insight?
Personality disorders
76
What domain of the MSE is defined as a process of comparing and evaluating alternative when deciding a course of action?
Judgment
77
What domain of the MSE is defined as WHAT the patient thinks about/ the focus of their concerns and the extent to which they believe their thoughts/ conviction?
Thought content
78
What domain of MSE evaluates if a pt can make sound, reasonable, and/or responsible decisions?
Judgment
79
Paranoid, grandeur, nihistic, ideas of reference, idease of influence, persecution are all examples of what?
Delusion
80
Recurrent, uncontrollable thoughts, images, or impulses are what type of thought content?
Obsessions (not false thoughts but they are prominent)
81
Repetitive behaviors or mental acts that a person feels driven to perform are what type of thought content?
Compulsions
82
Persistent, irrational, exaggerated fear of a specific stimulus or situation accompanied by a compelling desire to avoid the stimulus are what type of thought content?
Phobias
83
Does a pt know a phobia is irrational?
Yes
84
What domain of the MSE is defined as the quanity tempo and coherence of thought?
Thought processes
85
Rapid thinking, slow/ hesitant thinking, goal-directed thinking, relevent responses, loose associations/ flight of ideas, tangential/ circumstantial, perseveration, and blocking are all examples of what?
Thought processes
86
Logic, coherence, and relevance of a pt's thought as it leads to a selected goal will revel what about a pt?
HOW a pt thinks
87
What is a MMSE?
Brief neuropsychological test to screen for dementia

5. Psychiatry (19 decks)

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