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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
Q

What describes whether the affect of a pt is congruent w/ the subject of a conversation or stated mood?

A

Appropriateness

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26
Q

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?

A

TRUE

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27
Q

What is circumstantiality?

A

When the point of the conversation is eventually reached by w/ oveerinclusion of trivial or irrelevant details

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28
Q

A pt that remain expressionless and monotone even when discussing happy or sad moments has what affect?

A

Flat affect

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29
Q

What is a thought disorder in which the point of the conversation is never reach?

A

Tangentiality

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30
Q

What is the thought disorder in which there is no logical connection from one thought to the next?

A

Loosening of associations

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31
Q

What is the thought disorder in which thoughts change abruptly from one idea to another and is usually accompanied by rapid/pressured speech?

A

Flight of idea

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32
Q

What is the thought disorder in which the pt uses made up words?

A

Neologisms

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33
Q

What is the thought disorder in which a pt speaks in an incoherent collection of words?

A

Word salas

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34
Q

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”

A

Clang association

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35
Q

What is the thought disorder in which there is abrupt cessation of communication before the idea is finished?

A

Thought blocking

36
Q

What does thought content describe?

A

Types of ideas expressed by the pt

37
Q

Poverty of thought vs overabundance, delusions, SI/HI, phobias, obsession, and compulsions are examples of what?

A

Thought content disorders

38
Q

Hallucinations are perceptual disturbances. How should you document it?

A
  • Sensory modality (auditory = most common)
  • Character (ringing, humming, voices/ command)
  • Time of day experiences (only before bed, upon waking)
39
Q

When is a hypnagogic hallucination experienced?

A

Only before falling asleeping

40
Q

What is a Hypnopompic hallucination experienced?

A

Only upon awakening

41
Q

What are inaccurate perceptions of existing sensory stimuli?

A

Illusions

42
Q

What is the experience of feeling detached from one’s surrounds/mental processes?

A

Derealization/depersonalization

43
Q

What is a grandeur delusions?

A

Belief that one has special powers or is important (God, president)

44
Q

What is a paranoid delusions?

A

Belief that one is being persecuted

45
Q

What is a reference delusion?

A

Belief that some event is uniquely related to the pt (TV character is sending pt messages)

46
Q

What is a thought processing delusion?

A

Belief that one’s thoughts can be hear by others

47
Q

What is a religious delusion?

A

Conventional religious beliefs are exaggerated (Jesus talks to me)

48
Q

What is a somatic delusion?

A

False belief concerning body image (I have cancer)

49
Q

What is insight?

A

Pt’s levels of awareness and understanding of his/her problem

50
Q

How is a pt’s judgment described?

A

Excellent, good, fair, poor

51
Q

What does a MMSE assess?

A

Gross cognitive function

52
Q

What is Tarasoff’s rule?

A

Legal obligation of doctor to protect and notify others if pt is expresses imminent harm against others

53
Q

As a psych provider should you directly challenge a pt’s delusion?

A

No, just acknowledge that you understand that the pt believes the delusion is true

54
Q

Should you admit a pt that is actively planning or contemplating suicide?

A

Yes

55
Q

The mental status exam is used to describe what?

A

A patient’s current state of mind

56
Q

What are the MSE domains? (12)

A

Appearance, altertness/ orientation, speech, motor behavior, mood/ affect, attention, memory, perception, insight, judgement, thought content, thought processes

57
Q

What must be completed with each psych visit?

A

Mental status exam (basis to formulate any psychiatric dx)

58
Q

Observation of grooming/clothing, skin lesions, body modifications, habitus/physique fall under what MSE domain?

A

Appearance

59
Q

Should psych patients be orientented or disoriented?

A

Oriented

60
Q

What domain of the MSE includes level of consciousness and awareness to person/ time/ place?

A

Altertness and orientation

61
Q

Speech domain evaluates what?

A

Speach production (rate, volume, type: sluredm aphasia, word salad) NOT speech content

62
Q

What domain of the MSE evalutes for hyper/ hypoactive, rigidity, restlessness/ akathisia, combativeness, tics, eye contact/ gait?

A

Motor behavior

63
Q

A pt’s ability to focus or concentrate over time on 1 task or acitivity falls under what domain of MSE?

A

Attention

64
Q

What is remote memory?

A

Distant past (childhood memories

65
Q

What is recent remote memory?

A

Weeks to months (current events w/in the last few weeks)

66
Q

What is recent memory?

A

Hours to days

67
Q

6 digit test and word list recall is used to evaluate what type of memory?

A

Immediate retention and recall

68
Q

What are hallucinations?

A

False sensory perception NOT assocaited w/ REAL external stimuli (auditory, visual, olfactory, tactile, gustatory)

69
Q

What domain of the MSE is defined as sensory awareness of objects in the environment and their interrelationships? (internal stimuli)

A

Perception

70
Q

What is depersonalization (related to perceptiond domain)?

A

A person’s subjective sense of being unreal, strange, or unfamiliar

71
Q

What is derealization?

A

Subjective sense that environment is strange or unreal

72
Q

What is formication?

A

Feeling of bugs crawling on or under the skin

73
Q

What domain of the MSE is defined as a patient’s awareness that sxs or disturbed behaviors are normal or abnormal?

A

Insight

74
Q

Insight is a continuum over several encounters are defined by what?

A

Recognition they may have mental illness, compliance w/ tx plan, re-lable false mental events

75
Q

Which category of disorders is most commonly associated with poor insight?

A

Personality disorders

76
Q

What domain of the MSE is defined as a process of comparing and evaluating alternative when deciding a course of action?

A

Judgment

77
Q

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?

A

Thought content

78
Q

What domain of MSE evaluates if a pt can make sound, reasonable, and/or responsible decisions?

A

Judgment

79
Q

Paranoid, grandeur, nihistic, ideas of reference, idease of influence, persecution are all examples of what?

A

Delusion

80
Q

Recurrent, uncontrollable thoughts, images, or impulses are what type of thought content?

A

Obsessions (not false thoughts but they are prominent)

81
Q

Repetitive behaviors or mental acts that a person feels driven to perform are what type of thought content?

A

Compulsions

82
Q

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?

A

Phobias

83
Q

Does a pt know a phobia is irrational?

A

Yes

84
Q

What domain of the MSE is defined as the quanity tempo and coherence of thought?

A

Thought processes

85
Q

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?

A

Thought processes

86
Q

Logic, coherence, and relevance of a pt’s thought as it leads to a selected goal will revel what about a pt?

A

HOW a pt thinks

87
Q

What is a MMSE?

A

Brief neuropsychological test to screen for dementia

5. Psychiatry (19 decks)

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